Agenda item

To receive and discuss a report on Medicine Shortages and its impacts on Oxfordshire.

The following people have been invited to attend and present the report: Julie Dandridge (Head of Primary Care Infrastructure, Head of Pharmacy, Optometry and Dentistry, Lead for Primary Care across Oxfordshire BOB Integrated Care Board), Claire Critchley (Medicines Optimisation Lead Pharmacist, BOB Integrated Care Board), David Dean (Chief Executive Officer, Community Pharmacy Thames Valley), and Bhulesh Vadher (Clinical Director of Pharmacy and Medicines Management, Oxford University NHS Hospital Trust)

There are THREE documents attached to this item:

1.     A report from the ICB on medicine shortages.

2.     A report from OUH on medicine shortages

3.     A statement on medicine shortages from Dr Leyla Hannbeck (Chief Executive of the Independent Pharmacies Association).

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Julie Dandridge (Head of Primary Care Infrastructure and Pharmacy), Claire Critchley (Medicines Optimisation Lead Pharmacist), David Dean (Chief Executive Officer for Community Pharmacy Thames Valley), Bhulesh Vadher (Clinical Director of Pharmacy and Medicines Management at Oxford University NHS Hospital Trust), and Rustam Rea (Consultant at Oxford University NHS Hospital Trust) and Leyla Hannbeck (CEO of the Independent Pharmacies Association) attended to speak on the issue of Medicine Shortages.

The Head of Primary Care Infrastructure and Pharmacy highlighted the multifaceted root causes of medicine shortages and the significant impact on patients and healthcare providers. She noted the anxiety patients face when their usual medications are unavailable and the challenges for pharmacists and clinicians in managing these shortages.

The Committee inquired about the main complexities causing medicine shortages. They asked about the international context of manufacturing capacity and whether the impacts of this had now been addressed. The CEO of the Independent Pharmacies Association responded, explaining that global manufacturing capacity issues, dependency on raw materials from countries like China and India, and geopolitical factors contributed to the problem. She also mentioned the impact of Brexit and the UK's pricing strategies, which make it less attractive for manufacturers to supply medicines to the UK. She highlighted the increased demand for certain medications, such as HRT and ADHD treatments, which exacerbated the shortages.

The Committee then asked how NHS contracts and pricing strategies impacted medicine availability. The Chief Executive Officer for Community Pharmacy Thames Valley explained that the national contract for community pharmacies had remained unchanged for several years, creating financial pressures that had led to pharmacies closing. He noted that the contract drove down prices, discouraging manufacturers from supplying the UK market and causing pharmacies to dispense many items at a loss.

The Committee sought clarification on distribution issues contributing to shortages and whether these issues were national or local in scope and what measures could be taken to address them. The Clinical Director of Pharmacy and Medicines Management at Oxford University NHS Hospital Trust explained that the distribution network itself was not the problem; rather, it was the availability of stock from wholesalers and manufacturers. He described the sophisticated systems in place within hospital pharmacies to manage stock and share resources regionally, contrasting this with the less coordinated systems in community pharmacies.

The Committee asked about the impact of medicine shortages on individual patients, particularly those with conditions requiring specific medications. The Clinical Director of Pharmacy and Medicines Management at Oxford University NHS Hospital Trust provided examples of how shortages forced the use of alternative or unlicensed products, which could lead to further shortages. He emphasised the randomness of these shortages and the various factors that could cause them, such as manufacturing issues or supply chain disruptions. The CEO of the Independent Pharmacies Association explained that while national protocols, such as the serious shortages protocol, allowed pharmacists to switch medicines during shortages, high demand still led to product shortages, as seen with antibiotics and Hormone Replacement Therapy (HRT) medicines. Despite pharmacists’ extensive knowledge, they were unable to make simple prescription changes without prescriber approval, which added to the workload of healthcare professionals and caused delays for patients. The CEO advocated for regulatory changes to allow pharmacists to make minor remedial prescriptions, such as substituting different dosages of the same medicine, to improve efficiency.

The Committee raised concerns about the impact on patients with "cliff edge" conditions, where the absence of medication could be life-threatening. The Medicines Optimisation Lead Pharmacist explained the national and local mitigations in place, including systems to manage shortages and ensure alternative medications are available. She noted that while stockpiling was not done locally, there were national reserves for critical medications. Various systems were implemented locally to address shortages, including providing information on alternative medicines, although this could lead to further shortages. Collaboration between primary and secondary care was essential, with efforts to import supplies locally when necessary.

The Committee asked whether the issue of medicine shortages had impacted the workload of the clinical side of the NHS, and if this was being monitored. They also inquired about the global vulnerability to supply chain issues, and whether production could be brought into the UK to improve resilience. The Clinical Director of Pharmacy and Medicines Management noted that the UK's pharmaceutical industry had been offshored over the years, making it challenging to bring manufacturing back. He suggested that while it would be beneficial to increase local production, it was not entirely within the government's control. The Consultant at OUH highlighted the increased clinical and pharmacy burdens due to drug shortages, which necessitated additional resources and adjustments in patient care, particularly in managing diabetes medication.

The Committee questioned the communication and coordination efforts between Community Pharmacies to mitigate the risks associated with medicine shortages. The Chief Executive Officer for Community Pharmacy Thames Valley explained that pharmacies across BOB frequently shared stock via messaging groups to ensure patients received their medications. However, this practice added to pharmacists’ workload, with each spending about a day a week locating stock.

The Medicines Optimisation Lead Pharmacist described the various communication channels used to keep healthcare providers informed, including regular updates on the ICB and OUH websites and newsletters. She acknowledged the challenges of keeping information current due to the rapidly changing situation.

The Committee AGREED to delegate to the Health Scrutiny Officer and the Chair to finalise the wording of the recommendations.