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Wellor the last 16 years I have run a small community pharmacy in rural west Dorset. My business is older than I am – the little yellow brick building I own is about to turn 235 years old. Right now I’m really concerned about whether it will hold up for the next 12 months.
In my years as a pharmacist, I have never seen things as bad as they are right now. We are going through a period of acute shortage of medicines in England caused by global shortages, insistence on the NHS paying unsustainably low prices for drugs and Brexit, among other things, and people are on edge. Long gone are the days when customers could place a prescription order safe in the knowledge that their life-saving medication would arrive the next day.
A new report from Community Pharmacy England, published last week, shows that hundreds of different medicines have become difficult or impossible to obtain. These days, my employees are more and more likely to be yelled at by anxious and angry customers. This behavior is still the exception, but it is a stark contrast to just a few years ago when people cheerily applauded pharmacists in the street for our services during the pandemic.
Some days my pharmacy feels like a front line service. In recent months, I’ve seen clients go through psychiatric episodes and panic attacks because they can’t get the medication they need. I’ve spent hours chasing down medication only to find out that it’s long gone and the upset person standing in front of me is now the 21st in line to get it.
This week I had to tell a patient who has Addison’s disease, which requires constant steroids, that I can’t give him the medicine. This is serious – the consequences of not treating Addison’s disease include severe nausea, confusion, fever and even death. I asked the patient to wait until next week, which I told them last week. If it’s not available again, I’ll spend another day calling, begging, borrowing, and doing whatever I can to get it.
I handle 21,000 prescription items per month in my two pharmacies. In a typical month, I have to check one prescription product every 30 seconds. Every minute spent trying to resolve one of these issues only adds to the pressure and stress of running a pharmacy. The mental load is incredible. We have even had difficulty getting some palliative care medications. People’s relatives are understandably distraught when I tell them that they will have to return to a loved one who is facing the end of their life, to say that there will be no relief for them today. Telling someone “I can’t get this medicine” is one of the most heartbreaking things I have to do in a day. It is no joke to be in one of the most developed countries in the world and not be able to get some of the most common medicines.
One factor in this ongoing crisis is that the government insists not paying correctly for medicines. Although the NHS allows us to pay higher prices for medicines, it only does so on a case-by-case basis. As one pharmacist in our network put it on last week“Cunky KitKat costs around 85p in a convenience store… [but] 20 of the 100 most common medicines prescribed by GPs cost the NHS less than 85p. Suppliers would prefer to sell their drugs to other countries willing to pay more, and amid this global shortage, this means that we are one of last in line.
Although it is fair to say that we will still have problems with the supply of medicines due to global drug shortages, Brexit only makes matters worse as the UK market is they are no longer separated of the European trading bloc and due to the effect of Brexit on the UK economy. As a country we are in complete denial. Perhaps there are concerns about where the road to higher prices will eventually lead. But at the end of the day, the real policy here is that patients can’t get insulin—a situation I never thought we’d be in, not 100 years from now.
I love being a pharmacist, but sometimes it’s enough to make me think about giving up. I was recently nominated by my local community to go to a royal garden party at Buckingham Palace because they value the contribution we made: keeping our doors open even when we weren’t given PPE; delivery of 40,000 Covid vaccinations. But it’s bitter. A regular customer recently came in with a check for £5,000 because she was so worried we were going to close. I have no intention of cashing it in. But it’s an absolute shame that people now think we have to rely on charity to provide a public service.
If I could say one thing to the government about drug shortages, I would say that it needs to understand the misery it has caused with a decade of underinvestment and neglect. The whole system feels like it’s falling apart around us. My real concern is that pharmacies like mine will start closing all over the country because of this pressure, and it will happen so slowly that it won’t be noticed until it’s too late.
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