Earlier this year Ashtons were consulted by the EU Exit Team, which is part of the Commercial Directorate of the Department of Health & Social Care (DHSC), regarding the preparations that we have made for a ‘No-deal’ Brexit. As Ashtons is a main provider of medicine to the independent (non-NHS) healthcare sector we have raised our concerns about managing the risks of medicine shortages.
The DHSC were made aware of Ashtons’ plans for a No-deal Brexit and were satisfied with our response.
Ashtons has been closely following the guidance and requirements provided by the Department of Health & Social Care regarding the continuity of supply of medicines, medical devices, and clinical consumables in the event of a no-deal Brexit.
Updated guidance has been provided to our customers in the Ashtons Newsletter (1, 2, 3).
The current situation
Around three-quarters of medicines and over half of the clinical consumables used by the UK are delivered via the EU, and currently most of this arrives via the ports of Dover and Folkestone.
Recent DHSC guidance (5) issued on 26th June 2019 has recommended a “continued multi-layered approach” to managing the risk of medicine shortages. These measures include:
- Stockpiling by providers (manufacturers)
- Regulatory flexibility to allow the UK to function without EU legislation
- National Supply Disruption Response system
A statement from the Association of the British Pharmaceutical Industry (ABPI), which represents drug manufacturers (providers), said: “Companies are doing everything they can to protect the supply of medicines whatever the Brexit outcome, and have been doing so for the last two years.
“Increasing stocks of medicines has been just one aspect of company contingency planning — plans also include things like changing and adding new supply routes and duplicating manufacturing processes. We continue to work with the government to take the best approach in preparing for all scenarios.”(4)
The DHSC has set up the National Supply Disruption Response (NSDR) system to manage disruptions in supplies caused by a No-deal Brexit.(10)
Note – the DHSC has consistently stated that pharmacies and healthcare organisations including hospitals, care homes and GPs should not stockpile medicines (7, 8, 9, 10). This is because this would increase the risk of medicine shortages throughout the supply chain.
The DHSC recommends (8) that healthcare providers should:
- Plan for longer lead times
- Be prepared to receive stock deliveries outside normal hours.
Ashtons have been implementing these recommendations and our buying team work closely with all our suppliers. Currently we can obtain up to two regular deliveries per day from our main suppliers of medicines. This enables Ashtons to provide a responsive ‘just-in-time’ delivery service to our customers. If there are stock shortages, then the lead time for obtaining some supplies may increase which could result in delays in receiving the affected medicines.
Ashtons monitor out-of-stocks on a daily basis, and actively manage this process by using alternative suppliers when one of our main suppliers is out of stock. Ashtons currently has over 200 active pharmaceutical suppliers, so we use multiple sources of supply to ensure we can reliably and consistently meet our customers’ demands.
Ashtons’ customers normally receive medicines within 24 hours of placing orders.
However, it would be prudent for customers to expect possible delays in receiving medicine orders.
Orders should be placed with Ashtons well in advance of running out of stock, to allow for the possible increased lead times in obtaining supplies.
Ashtons will provide local support to the sites that our pharmacists visit by advising and informing the clinical staff about how to manage their medicine stocks to reduce the risk of shortages, and reinforcing the need to allow longer lead times to receive orders.
In line with the DHSC requirements, we will not be recommending wards or clinics stockpile.
Separate recommendations and arrangements have been made by the DHSC to minimise the risk of shortages for medical devices and clinical consumables (5) and also take into account contingency planning for other relevant activities (10) such as IT service agreements, waste management, facilities management, service maintenance contracts, laundry, and food & catering.
- Ashtons October 2018 article – Mitigating The Risk Of Medicine Shortages In The Period Around Brexit
- Ashtons January 2019 article – Brexit – Mitigation for stock shortages which could arise in the first quarter of 2019
- Ashtons April 2019 guidance
- ABPI Statement on the pharmaceutical industries preparations for a no-deal Brexit
- DHSC Letter to Healthcare sector dated 26th June 2019
- Written statement to Parliament – HCWS1661 on EU Exit preparedness
- NHS Confederation “No-deal operational guidance for the NHS” 25/2/19.
- DHSC Letter to Healthcare sector dated 23 August 2018
- Statement by minister John Gove, reported by Reuters on 19 August 2019
- DHSC Guidance – Actions for adult social care providers to prepare for a no-deal Brexit 12 August 2019