SHORTAGES


price of a bottle of water in a local shop. within this price it is difficult to see where there is sufficient margin for the large investments required by each party.


‘historically low prices have led to question marks over the viability of producing medicines for certain manufacturers. It is, without a doubt, difficult for them to maintain a supply – particularly when it comes to small niche generics. It’s simply not viable for them to continue to manufacture them and that’s perfectly understandable. Shortages of API, with price increases often mean supply to the Uk isn’t viable, especially when compared to other more profitable territories for these global companies. when you look at the situation, it’s little wonder that a lot of them have pulled back.


‘The knock-on effect has meant that the whole supply chain has become much more fragile. while some large manufacturers have managed to maintain a portfolio through the recent mergers and takeovers, smaller companies are under increased pressure and the production of many generic lines have become dominated by a small number of manufacturers.


‘It’s simply not viable for many manufacturers to produce for the Uk. with the increasingly complex global supply chains requiring licensing and inspection, pharmaceutical products are not something that can be produced or supplied overnight; there’s always a lag of several months from production to the supply to a patient. when you factor in what happened to Bristol laboratories and Dr Reddy’s, then the rapid escalation of the situation was perhaps inevitable. Bristol laboratories was one of the companies, which had a broad range of lower-priced products, but both Bristol labs and Dr Reddy’s had large market shares for a number of generics, leaving a void which could not be rapidly filled.


‘The huge change in the exchange rate after the Brexit vote also meant that products and raw ingredients bought from outside the EU, which are generally purchased in dollars, have been subject to tremendous upward pressure on pricing for products supplied to the Uk. weak sterling has also killed off many parallel imported (PI) lines and the uncertainty over altering regulations


as a result of Brexit resulted in a reduction in the number of PI licences applied for, with a dramatic reduction in the number of recently approved licences when compared to twelve months ago. when combined, these factors have again tremendously eroded margin for contractors.


‘In my opinion, a set of circumstances colluded to create a situation where, if anything went wrong from the manufacturing point of view, the system was like a deck of cards that was just on the verge of collapse.


‘you have to remember that NI runs with the English NCSO model, not the Scottish model, which, in my opinion, eases pressure on pharmacies more rapidly. In September 2016, there were 17 items on the NCSO list. In September 2017, there were 42, so we’re facing a more challenging environment. The current system relies upon pharmacists continuing to purchase medicines in the hope we will be reimbursed via the NCSO list in the future. given this fact, plus the fact that many NI pharmacists were given a heads-up by reps etc regarding the anticipated difficulties in supply, it’s understandable that there was a great deal of panic buying, which simply exacerbated the situation.


‘when you take everything into consideration, you can clearly see how everything has come together to create a perfect storm, which proves incredibly challenging for pharmacists to manage. Our priority has always been - and will continue to be - our patients, but managing safe and reliable supply has just become much more time consuming and challenging.’


In Enniskillen, meanwhile, joe mcAleer from Belcoo Pharmacy is, very much like many other pharmacists throughout the province, struggling to maintain his medicines supply.


‘The situation really has got out of hand over the last few months,’ he says. ‘I’m probably spending at least a few extra hours a week sourcing medicines alone. There are so many shortliners at the moment now that you could go through eight or ten just for one product and, when you factor in that the prices can vary greatly, it has turned into a bit of a nightmare.


Joe McAleer


‘The situation really has got out of hand over the last few months. I’m probably spending at least a few extra hours a week sourcing medicines alone’


‘I’m finding the concessionary prices particularly frustrating. you simply don’t know what’s coming in and what you’re going to be reimbursed for - and for how much! The Category m cuts were already kicking in and the trading environment was difficult enough at the moment without this extra burden.


‘we certainly had heard on the grapevine about what had happened at Bristol laboratories and so we knew that shortages were coming, but what really confuses me is why there are no shortages down south! I’ve spoken to some of my colleagues across the border and they’re not experiencing any shortages at all. If these current events were all linked to Bristol laboratories and Dr Reddy’s, why aren’t they experiencing the same difficulties as we are in the north? It’s very bizarre but probably, as Turlough says, more down to a combination of factors rather than simply the result of the two manufacturers no longer supplying.’


The situation isn’t much better in the middle of the province either! In the quiet mid-Ulster village of moneymore, Steven mckay, who owns the eponymous pharmacy, is experiencing similar frustration. ‘my pharmacist, Alison, and I are spending an increasing amount of time and effort on chasing suppliers,’ Steven told Pif. ‘Every week there’s something else that’s short or not available at all and, to be honest, there doesn’t seem to be any end to this current situation in sight.


‘The prices have also gone through the roof and there doesn’t seem to be


Steven McKay PhARmACy IN fOCUS - 13


any attempt being made to fix prices. They’re going up and down on a seemingly ad hoc basis and it’s difficult trying to keep a handle on it.


‘we usually operate with all of our stock set up on a ‘one in, one out’ basis through our mclernons system, but we’re now needing to amend our ordering process on practically a daily basis. Even the shortliners are now operating with quotas and that’s affecting us too. we’re not actually using more products and yet we’re having to work with quotas! The whole situation is ludicrous but, as always, pharmacists have to do whatever we have to to ensure that our patients aren’t affected by what’s going on. we’re all going that extra mile at the moment to ensure continuity of supply. It’s frustrating and time consuming, but what else can we do? As I said, the worrying thing is that, as far as I can see, there’s no end in sight to this current situation.’


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