Until we prioritise manufacturing over shortages, even commonplace medications will continue to burden pharmacy teams, says Nick Kaye…

Community pharmacies are widely recognised as the experts in the field of medicines, a view shared not only by other healthcare professionals but also by the patients we serve.

However, the evolving landscape demands that we extend our expertise beyond the realm of pharmaceutical knowledge to navigate the intricate process of supplying medications.

Unfortunately, this transition is hindered by an excessive amount of bureaucratic red tape, consuming countless hours of my team's time. I firmly believe that this bureaucratic burden is a primary source of tension within community pharmacies across the country, diverting our focus from the frontline delivery of essential healthcare services.

While community pharmacies excel in efficiently delivering medicines to patients, the cumbersome bureaucratic procedures create significant challenges.

One example from my practice in Cornwall that illustrates this is the shift by a major wholesaler from a twice-daily delivery to a once-a-day delivery at 5pm. While I comprehend the economic pressures and rationale behind this decision, complications arise when this wholesaler has a solus agreement with a manufacturer and the product reaches its quota.

The resulting time delay becomes a critical issue in our daily operations. The prescription is labelled, the product is ordered and the order is accepted, only to find at 5pm that the product is not in the tote.

We celebrate reaching our quota, only to face the cumbersome process of the 'quota override system.' Barcodes of the prescriptions are added to validate their authenticity and we hope, perhaps in vain, that the medication will arrive the next day at 5pm.

Meanwhile, the patient has been waiting for their crucial medication, causing not only inconvenience but also distress. Conversations ensue, with inevitable comments like 'this happens every time.' Patients ask ‘can you not order it in?’ Regrettably, the response is ‘I'm sorry, but I can't order it without the prescription.’

One can only wonder how often such conversations unfold nationwide, causing distress to both patients and pharmacy teams.

Another significant issue in medication supply involves items that are out of stock, such as the capsule for tablets, a seemingly straightforward substitution.

However, the Medicines Act of 1968 prohibits pharmacists from altering the recipe of a prescription. The rationale behind this rule, rooted in an era when medications were individually formulated by pharmacists, emphasises the importance of standardisation.

Yet, with the contemporary shift towards mass manufacturing and pre-packaging, the relevance of this restriction is questionable. When faced with prescription issues, the current process involves sending the prescription back to the surgery with suggested changes, adding unnecessary complexity to an already intricate system.

To address these challenges effectively, it is imperative to understand the root causes of medication shortages. Acknowledging the global market for medications and the comparatively low payment the UK provides for these vital supplies is crucial.

While the government may laud its success in maintaining low medication prices, it prompts reflection on whether we have lost sight of the technological care and high standards integral to medication manufacturing.

A recent visit to the Accord factory in Barnstaple provided first-hand insight into the vast scale of production, with billions of solid dosage forms manufactured annually. Witnessing the meticulous process of producing amitriptyline 10mg, from the raw ingredient's weight to mixing, tableting, and adding the blue coating, was awe-inspiring.

Yet, the realisation that this intricate process results in a drug tariff price of a mere 65p underscores the need to reassess the value we place on medication manufacturing. Until we prioritise manufacturing over shortages, even commonplace medications will continue to burden community pharmacy teams.

In light of this, implementing systems to facilitate the changing of medications for supply continuity is crucial. While serious shortage protocols are a step in the right direction, additional flexibility is needed. Leveraging our independent prescribing skills, a qualification all pharmacists will possess from 2026, could streamline the process.

This approach not only benefits patients but also allows businesses to grow amid pharmacy closures and mergers, accommodating the potential variations in volumes from month to month.

Empowering pharmacists to use their expertise ensures that supply chains remain uninterrupted, facilitating the most efficient way for patients to receive their medications.

By recognising and utilising our skills as experts, we can contribute to a smoother and more effective medication supply system for the benefit of all stakeholders.

Nick Kaye is the chair of the National Pharmacy Association and pharmacist based in Newquay. These are his personal views.