Ensuring a sustainable supply of drugs


We read with interest the editorial [1] in which Drs Ferguson & Woodcock make some accurate observations and useful suggestions about drug shortages, which occupy a significant amount of pharmacists' time. Shortages are estimated to be costing NHS acute care organisations £2 million per year. As the authors acknowledge, the problem is global and existing management strategies are failing. This impacts at a local level and it is painfully evident that current strategies are not working, and are being threatened by NHS changes. The jobs of a number of medicines procurement lead pharmacists are at serious risk. An NHS-owned shortage management database was suspended in August 2012 when funding ceased, and when the National Electronic Library for Medicines is taken over by NICE in 2013, very significant parts of its current functionality will not be transferred.

Understandably, the authors draw particular attention to injectable medicines. We note that they have identified the link between prescribing practice, product choice, commercial viability and the critical relevance of the European market, and we suggest that although parallel exporting has had a major impact on availability of medicines in primary care, it is of much less significance in acute care. We particularly welcome and keenly support their exhortation to colleagues to collaborate to develop consensus about preferred products. In our collective experience, however, one of the biggest challenges of trying to address the safety issues raised by NPSA Alert 20 [2] and product shortage is how we reach meaningful consensus regarding a clearly defined range of products. Many agree in practice but few are willing to compromise to achieve this goal. The nature of the challenge was clearly identified in 2007 [3] but change has been slow. For example, the NHS ‘consensus’ about preferred presentations of potassium chloride infusions, the subject of the first NPSA Safety Alert in 2007, seems to be divided roughly equally into at least three concentrations (20, 40 and 50 mmol.50 ml−1) and two container types (bags or syringes) [4]. The challenge of getting even two of these available as competitively priced, licensed medicines has defeated all our efforts for more than five years.

We strongly believe that rationalisation of product choice is key to achieving a range of benefits for clinicians, patients and the wider NHS, not least in the context of injectable medicines and intensive care. Active collaboration between practising anaesthetists, intensivist nurses and pharmacists is paramount and leadership from specialist groups such as the AAGBI is essential if we are to achieve it. The Intensive Care Society has adopted a range of standard concentrations for a number of intravenous medications, and this should be accepted by all [5].

Having agreed on standard solutions, it is hoped that manufacturers will seek licences for commonly used infusions and work towards mass production of these products. Off-the-shelf, ready-to-use infusions of commonly used medications could become a reality. Information would also be readily available via a website already used by many trusts in the NHS, helping to improve patient safety in an increasingly paperless environment (see www.injguide.nhs.uk).