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Will the UK run out of insulin and other vital medicines in a no-deal Brexit?

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Pharmacists are battling shortages of some drugs even before Brexit

All but the most brazen companies aim to win their customers’ trust. But for businesses supplying life-saving products, failure to deliver means much more than just a lost sale. 

Patients on prescription medicines rely on a complex web of local professionals, wholesalers and multinationals with convoluted supply chains to get them the drugs they need. More than three million prescriptions a day were dispensed in England alone in 2017, according to NHS Digital. 

The leak of the Government’s Operation Yellowhammer documents to the Sunday Times last month laid bare how a no-deal Brexit threatens to blow apart the delicate systems that keep treatments flowing for sufferers of conditions from diabetes to cancer. Even if the worst disruption can be avoided, the nature of the sector means that small-scale shortages can have a major detrimental impact on customers who are affected. 

Those in the industry say they are moving heaven and earth not just to protect their businesses but to ensure patients are kept safe. Yet even before Brexit takes place, pharmacists are battling unprecedented medicine shortages.  

“From what our members tell us, it is as bad it’s ever been at the moment,” says Gareth Jones at the National Pharmacy Association, which represents independent chemists. Brexit is bringing to a head a number of issues that should have been grappled with years ago, it says. 

Multifarious problems

Sources attribute the supply problems to several factors, including lack of availability of active ingredients and disruption from suppliers changing plants. It is difficult to quantify the scale of any scarcity as there is no system of measuring or recording exactly where shortages are occurring, Jones adds. 

Pressure on supplies is rarely unmanageable – for decades, pharmacists have needed to be resourceful from time to time to ensure patients’ needs are met. The complexity of medical supply chains means “pharmacists have always had to deal with a certain level of shortages ... so they’re used to dealing with that as a problem”, Jones says. 

The added strain of a no-deal Brexit is likely to make it more difficult for them to serve patients and could be made still worse if it occurs with winter approaching.

The British Medical Association has warned that the health service is “already routinely overwhelmed by seasonal pressures” and that “the addition of another, complicating factor is certain to dramatically exacerbate that problem”. 

“Medicine supply is a really complicated process even in the best of times,” says Robbie Turner at the Royal Pharmaceutical Society, which supports and promotes the pharmaceutical profession.

Ensuring patients get the drugs they need “is becoming increasingly difficult and no-deal Brexit could make that worse despite all of the planning and work that’s going into mitigating the risks”, he adds. 

Harsh winters amplify the shortages in the supply chain Credit: Matt Cardy/Getty

Doing more with less

For Fin McCaul, the potential consequences of a no-deal Brexit are a major headache. He runs Prestwich Pharmacy, five miles from the centre of Manchester, and has been involved in the business, which dispenses more than 1,000 packets of medication a day, for three decades. Millions of patients in the UK rely on independent pharmacies like his for their medicines. 

He and his staff are “already working harder” to combat existing shortages, spending up to two hours a day speaking to patients to ensure they get the medicines they need or appropriate alternatives and more time drawing up plans to address shortages.

A no-deal Brexit would add to the burden, leading to an estimated three hours a day sourcing medicines plus even more time speaking with customers to understand their needs. 

“I keep being reassured by the Government … that there won’t be any issues,” McCaul says. He acknowledges that ministers have done significant planning by sourcing air freight capacity and working with wholesalers and manufacturers to ensure sufficient stocks are built up to withstand delays at the UK’s borders – but remains concerned. 

“The real challenge of Brexit is we don’t know what we don’t know. We can try and plan for everything under the sun but we just don’t know what will happen,” says McCaul.

While the likes of Well Pharmacy, the UK's third-largest chain, has said it is stockpiling, most are having to put their trust in the Government and companies further up the supply chain getting the planning right. “I’ve got a particular challenge [because] the Government doesn’t want pharmacies to stockpile,” says McCaul. 

Pharmacies have been encouraged not to stockpile Credit: Dan Kitwood/Getty

Individuals are also being urged not to stock up as this could lead to shortages for patients whose need is greater, although Jones concedes it is “understandable that people on lifesaving medicines would want to take their own precautions”. The message to patients is not to panic but to order their medicines as early as possible to give pharmacists enough time to source them. 

It is impossible to predict which medicines are most likely to face shortages but the greatest focus has been on ensuring the supply of drugs that require cold storage, such as insulin and vaccinations, says Turner at the RPS. Delays could render these medicines unusable.

Keep cool

Novo Nordisk, which calls itself the “world’s largest diabetes company”, is one supplier that has increased its storage capacity. The Danish firm supplies insulin for about 500,000 of Britain’s 3.8 million diabetics and has been preparing for a no-deal Brexit for four years, says Adam Burt, who has been involved in its planning. “I think no deal has been a possible scenario for a long time and possibly more likely... in recent weeks,” he says. 

To protect against possible disruption, Novo Nordisk has acquired additional refrigerated storage space and built up 18 to 25 weeks’ supply within the UK of all of its medicines – well in excess of its usual six to seven weeks. 

The company was particularly vulnerable to disruption because all of its products are shipped to the UK via the Dover-Calais crossing. To alleviate the risk it has secured an additional ferry route between Denmark and Hull and will use air freight as a back-up, though only a limited volume of drugs can be carried by plane. 

Burt also welcomes the Government’s decision in August to tender for a £25m 24-hour “express” freight service for a year from October 31 but says that suppliers want more clarity on how to reserve space on the planes. 

If all of this is not sufficient to prevent shortages, the Government could be forced to intervene through the Significant Shortage Protocol regulations introduced in July in anticipation of potential Brexit disruption. The rules allow an alternative product or quantity of drugs to be dispensed by pharmacies to patients who are prescribed a medicine that is unavailable. 

Some in the industry argue that Government should still be doing more. While pharmacists receive a fixed tariff for providing drugs to NHS patients, this can leave them making a loss if the cost of providing those medicines jumps due to shortages.

While the tariff can be adjusted in such cases, this could be done more quickly so that pharmacies do not suffer the financial from disruption outside their control, argues Jones at the NPA. Another suggestion is a loosening of legal restrictions on the sharing of medicines between neighbouring pharmacies. 

Will the combination of planning by Government and industry together with the efforts of local pharmacies be enough to prevent shortages?

A glimmer of hope

“I suspect that if Brexit happens, we’ll have a bit of a logistical nightmare for a period of time but we will get through it,” says McCaul. “Do I see patients suffering at the end of it? Unlikely. We will always find an alternative or an alternative way of getting them what they need over the period of the change.” 

Novo Nordisk’s Burt is still clear that he would prefer that the UK reached an agreement with the EU: “It would probably be remiss not to consider that a deal ... would be the most secure way of ensuring that we could get medicines to the people that need them.” 

And what about the time and money ploughed into no-deal contingency planning? “We’d be delighted if it went to waste.”