NHS patients may have to ‘split tablets in half’ to cope with a shortage of 86 drugs, it has emerged.
A 24-page leaked document from the Department of Health and Social Care (DHSC) revealed 17 new shortages of lifesaving treatments, including medications for cancer, epilepsy and heart issues.
It also identified ongoing low stocks of 69 other drugs such as antibiotics for tuberculosis, the painkiller diamorphine, hepatitis vaccines and dementia medication.
The leak comes a month after pharmacists revealed they were suffering shortages in all 36 major medicine categories.
A 24-page leaked document has revealed the NHS is short of 86 drugs – including lifesaving treatments for cancer, epilepsy and heart disease patients
The document, obtained by The Guardian, recommended patients split their pills in half to make their prescription last longer.
But it noted that ‘there are no data’ on the safety of ‘halving or crushing them’ to deliver a lower dose.
The DHSC also stated doctors would need to ration certain drugs and prioritise some patients over others for lifesaving treatments.
The document was circulated on Friday to some doctors from the medicine supply team at the DHSC. It is unclear which doctors got this document.
It said that in some cases patients’ medications could be switched from licensed drugs to generic versions – but it noted there could be delays in import times.
And it also stated some drugs could be switched out for alternatives, but it admitted this is not always safe and may require extra clinical supervision for already-overworked doctors.
For other medications – including one drug for stomach and pancreatic cancer – there is no alternative.
Dr Nick Mann, a GP in Hackney, east London, told The Guardian: ‘This situation is absolutely unprecedented.
Drug shortages revealed in the list
The 24-page document did not name every single one of the 86 drugs it was short of.
But it did list:
Diamorphine – a painkiller used to treat severe cancer pain. Document says there was ‘insufficient stock to cover full forecasted demand in both primary and secondary care’.
Anti-epileptic drugs (AEDs) – which stop sufferers from having seizures. Document says: ‘Patients should normally be maintained on the same brand. However … will be out of stock … until March 2020’.
Relpax – a migraine drug. Document says doctors should split higher dose tablets in two although ‘there are no data on halving or crushing them to deliver a 20mg dose’.
Procyclidine – a Parkinson’s drug out of stock until March 2020. Document says doctors should ‘consider sharing remaining stock locally with the support of your regional procurement lead’.
Tuberculosis medication – two suppliers are out of stock, a third has some stock ‘but is unable to support any uplift in demand’.
Dementia drug – document says doctors should switch to generic or alternative versions of the drug, which could be confusing for patients.
Eye drops – currently out of stock. Document says the Royal College of Opthalmologists ‘has provided clinical guidance to support local prioritisation of remaining supplies’.
‘Previously we would have one or two or three drugs that would go offline for a while, but this is something on a different level.
‘It is going to render the day-to-day treatments that doctors provide very difficult.’
The document recommended in the case of Relpax, a migraine drug, patients should break the higher dose tablets in half to deliver a 20mg dose.
For eye drops that are currently out of stock, the document said the Royal College of Opthalmologists has provided clinical guidance to prioritise which patients should get remaining supplies over others.
Dr Krishna Kasaraneni, British Medical Association (BMA) GP committee executive team member, said: ‘It’s clear that drug shortages are fast-becoming a daily frustration for both GPs and their patients, which is why we urgently need measures put in place to ensure communities across the country continue to get the care they need and deserve.
‘GPs often only know about shortages once a patient returns from the pharmacy needing an alternative prescription, which can not only add to our already crippling workload, but also, and most worryingly, delay patients’ treatment.’
A spokesman at the Association for the British Pharmaceutical Industry said: ‘For new on-patent medicines there is an agreement between the government and pharmaceutical companies to cap NHS spending growth on branded medicines at 2 per cent, with anything over this paid back to the government.
‘Manufacturers know that any medicine shortage is extremely worrying for the people affected by it and they do everything they can to prevent medicine supply problems occurring and to resolve them quickly if they do happen.’
A spokeswoman for the Royal Pharmaceutical Society said: ‘Medicine shortages are an increasing problem.
‘A range of factors are responsible for shortages, such as manufacturing problems, global demand for medicines and fluctuations in the exchange rate.
‘At the moment pharmacists are working incredibly hard to get the medicines patients need. Pharmacists spend hours tracking down stock and working together to help patients.’
MailOnline has approached the Department of Health and Social Care for comment.
In October, drug wholesalers were banned from exporting 27 types of medication abroad in an attempt to tackle worsening shortages.
The Government imposed the blanket ban on various drugs, including all HRT medications, epipens and some blood-thinning pills.
It comes after pharmacists last month revealed they were suffering shortages in all 36 major medicine categories.
A total of 402 community pharmacy professionals reported what medicines they had struggled to get in the last six months.
Hormone replacement therapy drugs (HRT) were most commonly in short supply, with 84 per cent of respondents having difficulty sourcing the products.
Some 67 per cent of pharmacy staff said they have struggled to get contraceptives, and 58 per cent experienced supply issues of antiepileptic drugs.
More than half reported a shortage of creams for inflamed skin or blood circulation problems, such as rubefacients, topical NSAIDs, or capsaicin.
A shortfall was reported across all 36 categories of medicines included in the survey by Chemist and Druggist. No specific drugs or brand names were mentioned.
WHAT OTHER MEDICINES ARE PHARMACISTS SHORT OF?
Last month pharmacists revealed they were suffering shortages in all 36 major medicine categories.
More than 400 of them selected the drugs they have struggled to source in the past six months:
- Diurecits – 64
- Anti-arrhythmic drugs – 64
- Beta-adrenoceptor blocking drugs – 55
- Antihypertensive drugs – 121
- Anticoagulants – 70
- Antipsychotic drugs – 81
- Corticosteroids – 45
- Laxatives – 32
- Calcium-channel blocking drugs – 170
- Nitrates – 54
- Sympathomimetics – 25
- Antiplatelet drugs – 56
- Lipid-regulating drugs – 51
- Bronchodilators – 53
- Antihistamines – 28
- Cough preparations – 6
- Nasal decongestants – 63
- Hypnotics and anxiolytics – 47
- Antidepressant drugs – 99
- Analgesics – 86
- Antiepileptic drugs – 232
- Drugs used in alcohol, nicotine or opidoid dependence – 68
- Antibacterial drugs – 66
- Antifungal drugs – 37
- Antiviral drugs – 20
- Antidiabetic drugs – 88
- Contraceptives – 268
- Non-steroidal anti-inflammatory drugs – 131
- Rubefacients, topical NSAIDs, or capsaicin – 210
- Anti-infective eye preparations – 111
- Emollient and barrier preparations – 89
- Topical corticosteroids – 106
- Immunological products and vaccines – 89
- Dressings – 82
- Appliances – 68
- Hormone replacement therapy drugs – 339
- Other – 32