3. Essential medicines supply: Patients must have continued access to medicines during the COVID 19 pandemic
Medicines shortages are a common occurrence and unfortunately sourcing medicines for patients has become a necessary routine part of pharmacy practice.
Government must make sure contingency planning is in place to mitigate the effects of any worsening of shortages due to the COVID-19 pandemic.
Critical and end of life care
Specialist medicines are crucial in managing symptoms and easing discomfort and pain for people at the end of life. To meet the unprecedented demands for critical and end of life care that will occur during the coronavirus outbreak, robust plans must be in place.
These plans must take into account flexible plans for returning, re-use and storage of medicines and the possibility that supply of these medicines will become increasingly difficult.
- National guidelines across all four countries are required to give consistency of messaging to the public and clear directions to professionals on repurposing medicines in extremis
- Regulations need to be flexible to support professional decision making and allow scope of practice to expand to ensure the medicines patients require can be made available.
Substance misuse services are essential core services which must be maintained during the COVID-19 pandemic.
Pharmacy provision of Opioid Subsititution Therapy (OST) and needle exchange programmes (NSP) has a vital role in protecting patients and communities.
People who use drugs (PWUD) are a particularly vulnerable risk group who must continue to receive the level of service required to keep them safe and to avoid an increase in drug deaths during the COVID-19 pandemic.
- Interruption to the existing provision of OST and injecting equipment will put people at increased risk of overdose, bloodborne viral infections and drug-related death.
- Service interruption is likely to result in people not obeying the staying at home rules as they source illicit drugs as an alternative and so increasing the risk of COVID19 exposure or transmission in our communities.
Contingency plans should include:
- Flexibility in regulations to allow supply of regular medication even when prescriptions are not readily available
- Risk assessments by prescribers and /or community addiction teams carried out in collaboration with pharmacists to identify those who could cope with any reduction in their supervision or instalment requirements
- Prescriptions should be clearly annotated to indicate risk assessment has been carried out to enable pharmacy teams to make necessary arrangements for the workload required
- Naloxone provision should be extended and available for all people who use drugs
Further information: www.rpharms.com/coronavirus/#additional
Repeat Medicines
In order to ensure that shortages are not made more acute during the COVD 19 crisis we have the following recommendations.
Prescribers
|
Public and Patients
|
Pharmacists
|
Prescribers must NOT change their regular prescribing patterns.
Some prescribers are issuing 56 day prescriptions (or even longer), which has the potential to precipitate unnecessary medicines shortages.
|
Continue to take your medication as prescribed.
Respect the pharmacist’s requirement to maintain stock levels and give you 28 day supply instead of 56 or 84
|
Liaise with local prescribers and GP practice colleagues on how best to manage stocks and shortages including:
- Messaging to patients on changes to repeat prescribing process
- Minimising overprescribing and overordering
|
Post-dated prescriptions should be issued if clinically appropriate, rather than immediate supply.
This will help to reduce footfall through GP practices, without adding pressure to the medicines supply chain.
|
Do not order more than your normal repeat prescription requirements.
Stockpiling medicines at home can lead to shortages of medicine for other patients.
|
If shortages do occur refer to RPS best practice guidance.
|
Electronic or batch repeat dispensing should be used if available and appropriate.
Giving community pharmacies more flexibility on medicine supply, stock control and workload, as well as helping to reduce GP workloads and NHS pressures.
|
Stay at home as much as possible and obey the social distancing guidelines for essential trips.
If self-isolating please ask a neighbour, friend or family members to pick up your medicines from the pharmacy. If this is not possible a volunteer may be able to help.
|
Encourage and promote use of repeat dispensing for your location as much as possible to standardise quantities and help manage workload both at community pharmacy and GP surgery.
- Electronic Repeat Dispensing - England
- Batch Dispensing - Wales
- Care and Review- Scotland
|
Encourage patients to order their next prescription 7 days in advance of when they need it to provide time for it to be written / printed and sent to the pharmacy for dispensing.
|
Order your medication 7 days in advance, or as suggested by your community pharmacy.
|
Clearly communicate with people when they should order their next prescription.
|
Easing the workload of medicines shortages
A legal framework across Great Britain would allow community pharmacists to make professional decisions and take appropriate steps to minimise the impact of medicine shortages on patient care.
Medicines legislation should be amended to allow pharmacists to make minor amendments to prescriptions, such as:
- Different quantities
- Different strengths
- Different formulations
- Generic versions of the same medicine (generic substitution)
For pharmacists in secondary care these substitutions have been standard practice for years. It is time to address this imbalance and improve access to medicines by enabling community pharmacists to make these simple change