I’m a GP — this is why your blood pressure meds might be out of stock

It is an experience that has become all too familiar for some patients — you turn up to your local pharmacy, prescription in hand and ready to collect your regular medication, only to be told that the drug you need is out of stock. Recently it has been shortages of ramipril, a widely used treatment for high blood pressure, that have hit the headlines. These supply issues are not just an inconvenience. They can create anxiety, disrupt treatment and can affect people’s health and quality of life.

In recent years, we have seen shortages of medicines such as antibiotics, hormone replacement therapy (HRT), and drugs for treating ADHD. The shortage of ramipril became serious enough for the government to introduce a “serious shortage protocol”, an emergency measure designed to help pharmacists manage limited supplies of a drug.

Although shortages can often be managed safely, they are deeply concerning because they affect medicines that many people rely on every day. For patients, discovering that their regular medication is unavailable will be alarming.

Many people with long-term conditions such as high blood pressure, diabetes or asthma depend on consistent treatment to stay well. Even a short interruption can increase anxiety and leave patients worried about whether their condition will worsen.

Pharmacists and GPs also face additional pressures as they try to find suitable alternatives and reassure concerned patients.

Why are shortages happening?

The causes of medicine shortages are complex. Many medicines used in the NHS are manufactured overseas, with ingredients sourced from different countries. This means that disruptions from factory closures or lack of key ingredients can affect supplies in the UK.

Major global crises such as the Covid-19 pandemic, international conflicts and rising energy costs are also causes of disruption. During the pandemic, for example, factories shut down, shipping routes were disrupted and countries sometimes prioritised supplies for their own populations.

Another important cause is the economics of “generic medicines” — drugs that are no longer patented. Generic medicines are usually much cheaper than branded medicines and help save the NHS money. However, the low drug prices paid by the NHS can make the UK a less attractive market for some global suppliers. If drug manufacturers can earn higher profits elsewhere, supplies may be directed to those other countries first.

Medicine production has also become increasingly concentrated, with relatively few manufacturers making certain drugs. If one factory encounters a problem — for example, contamination issues or manufacturing faults — supplies around the world can quickly be affected.

How does the NHS respond?

When shortages occur, the NHS has several ways of responding. One of the most important tools is the serious shortage protocol. This allows pharmacists to supply an alternative version of a medicine without the patient needing to return immediately to their GP for a new prescription.

For example, a pharmacist may be able to provide a different strength, formulation (such as a capsule rather than a tablet) or quantity of the drug.

Pharmacists may also issue only one month’s supply of a medicine at a time rather than the usual two or three months that many people with long-term conditions such as high blood pressure or thyroid disease may usually receive.

This helps ensure that available stock is shared fairly among patients. However, this can be worrying for patients who fear that the medicine may not be available when they next request it.

Problems have become routine

As a GP, I have seen medicine shortages become much more common over the past decade. When I first began to work as a GP, shortages were unusual events. Now they are a routine part of clinical practice.

GPs often only become aware of a shortage after patients report that their pharmacy cannot supply a medicine. This can create extra work for both surgeries and pharmacies as alternative prescriptions are arranged.

Patients often ask whether it is safe to switch to a different medicine. In many cases, alternatives are available. For example, there are several medicines related to ramipril (ACE inhibitors). However, switching is not always straightforward.

Patients can respond differently to medications, even when they are within the same drug class. A replacement medicine may not work quite as well for a particular individual or could cause side effects. For this reason, doctors generally prefer patients to stay on the same medication whenever possible.

Fortunately, most shortages can eventually be managed safely. Pharmacists and GPs work closely together to identify alternatives and minimise risks to patients. Nevertheless, the process can be stressful and time-consuming for everyone involved.

What can patients do?

There are steps patients can take to help reduce problems during shortages. Ordering repeat prescriptions in good time is one of the most useful actions. This gives pharmacists more opportunity to locate stock or contact the GP if changes are needed. Patients should also avoid stockpiling medicines as this can worsen shortages for others.

It is also important to recognise that pharmacists and GPs are not responsible for causing shortages. Pharmacy teams in particular work hard to track down supplies, contact wholesalers and help patients find alternative treatments.

What can the government do?

The government must take a greater role in protecting supplies of essential medicines. This could include improving stock monitoring and strengthening supply chains. Expanding domestic production capacity in the UK would help reduce dependence on overseas suppliers and improve security of drug supplies during global crises.

Medicine shortages will not disappear completely but recent problems should serve as a warning. Reliable access to medicines is an essential part of modern healthcare. Patients need confidence that the treatments they rely on will be available when they need them.

Ensuring that happens must be a priority for the government, the NHS and the pharmaceutical industry. In an era when we talk constantly about defence and energy security, we must apply the same thinking to the medicines we rely on to stay healthy.

• Dr Azeem has been a GP for over 30 years and is also a professor of primary care and public health at Imperial College London’s School of Public Health