Of 586 GPs who responded to the GPonline poll, 87% had seen a rise in medicines they prescribe becoming unavailable in the past 12 months. Just over 50% said they have 'very often' or 'fairly often' been forced to prescribe second-choice medication over the past year because of drug shortages.
In total 14% of respondents felt that drug shortages had had a negative clinical impact on their patients and a further 48% could not discount the likelihood of a negative impact.
One GP taking part in the survey wrote that medicines becoming unavailable could have a 'devastating effect on patients’ health’. Another said: ‘Shortages do affect patient management tremendously as second line medications are not always ideal and in rare cases not as effective.’
Another GP wrote: ‘I have had patients on HRT who had to change preparation and have found their symptoms are less well controlled.’
Respondents expressed concern over the safety of prescribing a second-choice medicine.
One GP said: ‘It is a particular nuisance for the anti-inflammatories. Patients are having to take stronger or unequal doses which is causing harm.’ Another echoed this concern, commenting '[Shortages] create a stressful situation, especially when picking a higher risk alternative, eg swapping from naproxen to diclofenac'. The shortage of naproxen was highlighted by many respondents as an issue, some remarking that patients were left in pain if there was no appropriate alternative.
The inherent safety issues posed by shortages of crucial medicines such as adrenaline autoinjectors were also highlighted, and several GPs emphasised the increased risk of errors associated with having to issue multiple prescriptions.
Prescribing by brand
Some GPs taking part in the survey noted the difficulty of finding an alternative to medications that should be prescribed by brand name, such as modified-release nifedipine. They expressed fears of branded drug shortages adversely affecting outcomes, such as in patients with epilepsy where changing the brand of anticonvulsant prescribed could compromise seizure control.
Respondents also remarked on the harm being done to patients by the psychological impact of shortages, particularly for those with mental health problems. Many GPs had seen patients anxious or distressed by a lack of availability of their usual medication, which they had in some cases been taking for many years.
In their comments on the survey GPs repeatedly expressed frustration that they were not told about shortages and given no information about their extent or likely duration or the reasons for them. This lack of awareness was identified as a major factor contributing to the increased workload caused by shortages, with a third of GPs (31%) saying they spend more than an hour a week dealing with the problem. A total of 7% reported that medicines shortages added two hours or more to their working week.
The difficulty of finding an alternative to prescribe was a recurring theme, with one respondent noting that 'often the alternative is not an equivalent'. However, several GPs highlighted the benefit of practice pharmacists in monitoring shortages and identifying suitable substitutes.
Several GPs taking part in the survey speculated that the shortages could be worsening as an ‘unintended consequence of Brexit’.
A DHSC spokesperson said: 'There is no hard evidence to date to suggest current medicine supply issues are increasing as a result of EU exit.
'Our number one priority is to ensure the continued supply of medicines and we are working closely with industry and partners in the health system to help prevent disruption, including increasing UK buffer stocks. We are confident that, if everyone does what they need to do, the supply of medicines should be uninterrupted in the event of a no deal.
'We have well-established processes to manage and mitigate the small number of supply problems that may arise at any one time due to manufacturing or distribution issues and this has always been the case – every day over 2m prescription items are successfully dispensed in England.'