GPs reported that problems with out of stock medicines were increasing and in addition to driving up practice workload had contributed to rising levels of abuse from patients towards general practice staff.
Of 583 GPs who responded to questions on medicines shortages in a survey by GPonline, 83.5% said shortages had forced them to prescribe second choice drugs within the past year.
More than half of GPs said problems with medicines shortages had worsened over the past year. Four in five said the problem had increased GP workload and more than two thirds said it had inconvenienced patients - at times leading to angry exchanges with practice staff.
A total of 14% said patients had been adversely affected. One respondent said a patient had 'nearly died', while others reported control of long-term conditions being undermined, increased risk of adverse events or patients receiving inferior care. GPs reported that in some cases alternatives were simply not available, delaying or undermining care.
Findings from the poll come after GPonline reported earlier this year on a spike in drug shortages towards the end of 2020. More than 100 products have been listed as out of stock on a drug shortages tracker maintained by our sister website MIMS since early 2020 - with the total peaking at 142 items out of stock in November.
GPs responding to the latest survey said medicines shortages were a 'huge time waster' for practices. Several respondents reported that the problem had been becoming worse over several years - with many blaming Brexit and others saying the pandemic appeared to have contributed.
One GP wrote: 'Leaving aside the panic over-ordering in March 2020 and to a lesser extent at the start of the second wave, which obviously resulted in shortages, I have experienced more requests from pharmacies for substitutions in the last year than ever before.'
Abuse of practice staff
GPs responding to the poll reported that the frequency of medicines shortages had contributed to rising abuse from patients towards staff in primary care.
One GP wrote: 'Patients get cross when we cannot give them the same meds. Pharmacies often no help as they don't tell us what we can get. Patients demand an immediate solution.'
GPs reported patients blaming their GP practice when medicines were not available. One GP wrote: 'This has been going on for the past five years and results in duplication of work for the GP and angry frustrated patients who create more work for us.'
Shortages of HRT drugs were among the most common items mentioned as being unavailable in the survey, along with contraceptives and blood pressure medication.
GPs highlighted concerns that the shortages limited options for them to treat patients. One GP responding to the survey said: 'The medicines shortages are becoming chronic and they are limiting therapeutic options, significantly impacting patients.'
Another wrote: 'Limits prescribing options in some areas - especially HRT. Time consuming and frustrating when you don't know whether the drug you want to prescribe is back in stock or not - often easier to just avoid using these drugs altogether.'
Another GP said they had been forced to alter patients' management plans to work around available medication - while others reported delays to care or harm to patients forced to change medicines.
Government guidance published earlier this year acknowledged that 'medicines supply issues have become an increasingly common problem'.
Legislation that took effect in January 2019 requires suppliers to report on availability of medicines and anticipated shortages. The government guidance said: 'These requirements aimed to address the ongoing concerns about medicine supply issues and to ensure that DHSC have relevant information at the earliest point possible to help manage supply shortages and discontinuations and mitigate any potential impacts on patients.'