In December last year, a 19-year-old student we’ll call Tom* left university early to live back at home. His local pharmacy had run out of the anti-anxiety medication he had been taking while struggling with his mental health throughout his second year. He tried another pharmacy nearby, which was also unable to supply the drug, called propranolol.
Tom, who was also on an anti-depressant called sertraline, kept on top of his medication by sending notes to himself on his phone, counting down the tablets: “19 left, 18 left, 17 left”. When this organised and meticulous system for keeping mentally healthy was disrupted, he felt completely “floored”.
He lowered his dose to try and tide himself over during the weekend, but when he returned to the pharmacy on Monday, the drug was still unavailable. He then left university early to stay with his mother, who had very little idea of his illness until that point.
“He and his doctor were working together on finding a dosage that would work, because it’s quite a fine balance when you’re taking a combination of two sets of tablets,” says his mother Lara*, a psychoanalyst who asked to speak under a pseudonym because she wishes to keep her story private from her clients.
“The dosage is important, so when the pharmacist couldn’t get one of the drugs immediately, it threw the process out [of sync],” she says.
“I felt absolutely terrible. I was angry. I thought ‘this is crazy, this is mad, what’s going on?’”
Of course, certain drugs can occasionally fall into short supply, and it isn’t unusual for young people to suffer mental health crises during their university years.
Yet Lara believes Brexit has factored into her son’s plight. He was told by one of the two pharmacists he visited that larger drugstores were “stockpiling” propranolol and therefore unwilling to release it to smaller, community pharmacies. I understand the government is aware of a temporary disruption in some of the supplies of this drug.
“The pharmacist said that people are [also] now stockpiling – going to their doctors a little bit earlier for each prescription, allowing them to hold back some of their medicine, because of Brexit,” says Lara, speaking on behalf of her son. “Tom’s pharmacist said he has been working for 30 years and has never seen anything like this – he used the word ‘apocalyptic’.”
This is just one anecdote, of course, but a story that many may be familiar with by now. There is widespread concern about what a no-deal Brexit means for the supply of medicine and medical products to the UK.
And it’s not just “Project Fear”. This time last month, the Department of Health and Social Care sent a letter to suppliers reiterating its contingency planning if Britain leaves on 31 October without an agreement with the EU.
It warned of “significant disruption” for “six months following a no-deal exit, with the most severe period being the first three months”.
The danger zone for medical supplies is the “predicted reduced traffic flow” at what are known as “short straits crossings” (eg from Calais, Dunkirk and Coquelles to Dover and Folkestone) in the event of no deal. According to the government, about three-quarters of medicines and over half of clinical consumables in the UK come from the EU – with the vast majority relying on such crossings.
Disruption and delay at these crossings would impact the supply of medicines and medical products. In light of this risk, the government issued guidance to suppliers on re-routing and stockpiling. Wholesalers, like pharmaceutical companies, have been told to stockpile an additional six weeks’ supply in the UK, for example.
And as for those products with a short shelf-life, or that cannot be stockpiled (like medical radioisotopes – used for diagnostic tests and cancer treatments)? “We ask for alternative air freight plans to be made.”
Hospital heads have warned, however, that they could run out of vital supplies despite this contingency planning.
I have been unable to contact Tom’s pharmacist. Yet another community pharmacist tells me that stock shortages are indeed getting worse.
“There’s definitely quite a lot of stock shortages now than when I think back to a year ago, or the year before that,” says Thorrun Govind, a community pharmacist in the northwest who began working as a pharmacist in 2016.
“It is really hard at the moment, and a lot of pharmacies are spending a lot of time trying to chase around for drugs when we want to be spending it with patients.”
Govind is quick to point out, however, that there is “no evidence” that this is “down to Brexit”, and she herself does not stockpile beyond business-as-usual levels.
“If you think about the impact on society if everyone starts stockpiling, it’s not good for society,” she says.
“I don’t want patients and pharmacies to be stockpiling, because I want patients to have access to medications as and when they need them. And that would be detrimental if people started stockpiling… We are where we are now, whether you’re for Brexit or against Brexit, I think you’ve still got to think about the overall impact of individuals’ actions on the rest of the country.”
This is at the heart of the government’s no-deal dilemma in medicine. Intensive planning is required, the future is uncertain, but panicking patients would only make the situation worse.
One thing that would help, however, is better funding for pharmacies. They have suffered deep cuts since December 2015, when the government announced it would slash the sector’s funding by 6 per cent. Then months later it finalised its cuts as 12 per cent from December 2016-March 2017, with a 7.4 per cent further drop in next financial year, according to Chemist and Druggist.
Although a new deal was announced last week, “committing” £13bn to the sector with an aim of expanding its role, funding for the sector will remain flat in cash terms, at £2.59bn, over the next five years – a real-terms 9 per cent budget cut, with the expectation to take on more services.
“The government’s cuts to pharmacy mean that some are not holding as much stock because of the cost of it,” says Govind. “So, if you cut the funding for pharmacy, that impacts on staffing levels, and part of that is you can’t hold a load of stock on your shelves as well.”
As well as doing free social care work, like putting medication into blister packs and trays, pharmacies are also being forced to pick up the slack elsewhere.
“They want to push people to come into pharmacies obviously rather than to GPs and A&E, because obviously this shortage of GPs is getting worse – but they don’t want to fund pharmacies,” says Govind.
One pharmacist reports spending 15 hours a week sorting out medicine stock issues. Govind says she is “similar” – though not quite as many hours, she is “spending too much time” trying to source medications.
“I have no evidence to attribute it to Brexit, but I think it’s just another thing to add to the mix isn’t it?” she suggests.
“There is no evidence to date to suggest that the small number of current supply issues we are managing is related to EU exit or are increasing because of it,” a Department of Health and Social Care spokesperson says.
“The department is doing everything appropriate to prepare for a potential no-deal on the 31st October. We are working with all our partners and our plans should ensure the supply of medicines and medical products remains uninterrupted.”
Perhaps, then, reversing pharmacy cuts should be part of the government’s effort to do all it can in preparation for a no-deal Brexit.
*These names have been changed on request of anonymity.