Whatever happens over the course of this year, the supply of medicines to Northern Ireland will change dramatically and could result in less availability, says Terry Maguire...
'Knowing me, knowing you' from ABBA was topping the charts back in 1976, the year I began my pharmacy studies. It seems so prescient now as Brexit, that vague nirvana obsessed over by chauvinistic English Conservatives for nearly 50 years, becomes an absurd and grotesque reality.
No marks for guessing on which side of the Brexit debate I sat. Northern Ireland had a strong electoral majority to stay in Europe. We have a different view of things over here but that’s party politics and my remit here is to give a view on the impact it will have on community pharmacy.
N. Ireland, it seems, is neither out of Europe nor in it. For most of civic, professional and business life we have not reached a nirvana but landed in a confusing no-man’s land. Brexit will potentially impact pharmacy in myriad ways.
The most acute and obvious risk will be with supplies of medicines but in the first days of the new year this is not evident. It could be argued that, in this respect, we have the same problems that pharmacies in Scotland, England and Wales have.
Our good fortune so far may be down to the hard, preparatory work done by our chief pharmacist, Cathy Harrison, and her team in conjunction with the other devolved health departments. Buffer stocks of six to 10 weeks' supply, held in wholesaler depots and elsewhere, will be critical. In addition, supply chain back-up of additional ferry capacity (four ferries were commissioned in October) should help get around any congestion at UK ports.
Should this fail, particularly for high-risk pharmaceuticals such as insulins, express freight services will be used, literally jumping over the congestion and if necessary, the Irish Sea and the world’s newest European border.
A shortage management system, which includes the Serious Shortage Protocol, will be a help. So, in terms of the initial shock of Brexit, all four nations are in it together. Beyond this, N. Ireland will tread a very different path into the future. As part of the N. Ireland protocol (NIP), there is a specific supply issue.
I need two EORI numbers, one for dealing with Great Britain, for example with specials companies, and one for dealing with suppliers in Europe (I get lots of supplies from the Irish Republic). How this will work remains to be seen. We have been given a concession of 12 months to adapt to the new medicine regulatory framework.
N. Ireland, while remaining in the UK, also remains in Europe so medicines here must comply with European standards. The MHRA will still licence the medicines we dispense, but the medicines regulator will need to consider N. Ireland specific aspects in all regulatory decisions. For example, medicine packaging will still require the 2D bar code used to comply with the European Falsified Medicines Directive.
FMD no longer applies in Britain post-Brexit.
In addition, we will need a system for batch-testing of medicines imported from GB into N. Ireland. These currently account for 98 per cent of our stock, which is mainly delivered through the short-line and main-line wholesaler network.
Given that 76 per cent of all medicines used in GB have a touch point in Europe there is the possibility of significant complexity being built into the N. Ireland medicines supply chain. You might begin to wonder if short-line wholesalers would bother.
Over the next 12 months this will require a major redesign of our medicines supply chain. Bonded warehouses are one option being considered. Used extensively in the alcoholic beverages industry, these entities could be set up in mainland Britain for medicines originating in Europe and transiting GB into N. Ireland.
Medicines could be stored for up to 90 days and therefore not require batch testing. Alternatively, a supply chain that involved supplying medicine through the Irish Republic seems equally possible.
Whatever happens over the next 12 months it is likely supplies of medicines to N. Ireland will change dramatically and this could result in less availability of certain lines and – price increases.
And then there is employment. Pharmacists frequently work on both sides of the Irish Border and will continue to do so but I can see a challenge to reciprocal membership between the Pharmaceutical Society of N. Ireland and the Pharmaceutical Society of Ireland.
Our right to practice in the North and South as part of EU is likely to stop but as yet this is not even being discussed. Will we be able to dispense prescriptions from GPs in the Irish Republic? If you have a pharmacy in the border towns of Newry or Strabane this is a big issue.
'No more carefree laughter … tears in my eyes.' Well, I won’t be that melodramatic but Brexit is potentially the biggest disruption in my 45-year association with this proud profession.
Terry Maguire is a leading pharmacist in Northern Ireland.