For the past 16 years, I have run a small community pharmacy in rural west Dorset. My business is older than me – the little yellow-brick building I own is about to turn 235. Right now, I am really concerned about it getting through the next 12 months.
In my years as a pharmacist, I have never seen things as bad as they are at the moment. We are going through a period of rampant drug shortages in England, caused by global shortages, the NHS’s insistence on paying unsustainably low prices for medicines and Brexit, among other things, and people are on the brink. Long gone are the days when customers could place a prescription order safe in the knowledge their life-saving medication would arrive the next day.
A new report by Community Pharmacy England released last week shows hundreds of different drugs have become hard or impossible to obtain. These days, my staff are increasingly likely to find themselves being screamed at by anxious and angry customers. That behaviour is still the exception, but it is a stark contrast to only a few years ago when people were cheerfully clapping pharmacists in the street for our service during the pandemic.
Some days my pharmacy feels like a frontline service. In recent months, I have seen customers going through psychiatric episodes and panic attacks because they can’t get the drugs they need. I have spent hours chasing after medication, only to find out it long ago went out of stock, and the upset person standing in front of me is now 21st in the queue to receive it.
This week, I had to tell a patient who has Addison’s disease, which requires constant supplementation with steroids, that I cannot get their medicine to them. That’s serious – the repercussions of going without treatment with Addison’s include severe nausea, confusion, fever and even death. I have asked the patient to wait until next week, which is what I told them last week. If it’s not available again, I will spend another day ringing around begging, borrowing and doing whatever I can to get it.
I deal with 21,000 prescription items a month across my two pharmacies. In a typical month, I have to check one prescription item every 30 seconds. Every minute spent trying to resolve one of these problems just adds to the pressure and the stress of running the pharmacy. The mental workload is beyond belief. We have even had difficulties obtaining some palliative care medicines. People’s relatives are understandably distraught when I tell them they will have to go back to a loved one who is looking at the end of their life, to say there will be no relief for them today. Telling someone “I can’t get that medicine” is one of the most heartbreaking things I have to do in a day. It’s beyond a joke to be in one of the most developed countries in the world and unable to get some of the most common medicines.
One factor in this ongoing crisis is that the government insists on not paying properly 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 last week, “A Chunky KitKat costs about 85p in a convenience store … [but] 20 of the 100 most common drugs that are prescribed by GPs cost the NHS less than 85p.” Suppliers would rather sell their medicines to other countries willing to pay more, and amid this global shortage that means we’re one of the last in line.
While it’s fair to say we would still experience issues with medicine supplies due to the global shortage of medicines, Brexit only makes issues worse, because the UK market is no longer part of the European trading bloc, and because of the effect of Brexit on the UK economy. As a country, we are in total denial. Perhaps there is concern about where the road to higher prices will eventually end up. But ultimately, the realpolitik here is that patients can’t get their hands on insulin – a position I never thought we would be in, not in 100 years.
I do love being a pharmacist, but sometimes it’s all enough to make me consider giving up. Recently, I was nominated by my local community to go to a royal garden party at Buckingham Palace, because they value the contribution we have made: keeping our doors open even when we were not given PPE; delivering 40,000 Covid vaccinations. But it’s bittersweet. A regular customer recently came in with a £5,000 cheque because she was so worried we were going to close. I have no intention of cashing it. But it’s absolutely shameful 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 the medicines shortage, I’d say it needs to understand the misery it has caused with a decade of underinvestment and neglect. The whole system feels as though it is crumbling around us. My real concern is that pharmacies like mine will start to close across the country because of these pressures, and it will happen so slowly that it won’t be noticed until it’s too late.
Mike Hewitson owns a pharmacy in west Dorset and is a member of the Community Pharmacy England network. As told to Poppy Noor
