News

Media And Political Bulletin – 09 March 2020

Media and Political Bulletin

09 March 2020

Media Summary

EU fails to persuade France, Germany to lift coronavirus health gear controls

Reuters, Francesco Guarascio and Philip Blenkinsop, 06 March 2020

Reuters reports that EU officials sought in vain on Friday to persuade France, Germany and other European countries to lift controls on the export of protective medical gear, which officials said could hurt the bloc’s collective effort to fight the coronavirus.

Countries including Germany, France and the Czech Republic have announced bans on exports of protective gear to avoid shortages at home, measures that go against the spirit of free movement of goods within the EU.

Health commissioner Stella Kyriakides called for “solidarity” among EU states to avert shortages in protective gear.

Coronavirus: CMA warns retailers against putting up prices

C+D, Valeria Fiore, 06 March 2020

C+D reports that the Competition and Markets Authority (CMA) has called on retailers to “behave responsibly” and not increase prices during the coronavirus outbreak. The watchdog has kept an eye on reports of prices changing as the virus spreads, and wants to ensure that traders “do not exploit the current situation to take advantage of people.

It will look out for evidence that companies have “broken competition or consumer protection law, for example by charging excessive prices or making misleading claims about the efficacy of protective equipment” during the outbreak, it said.

The CMA will take “enforcement actions” when appropriate and might even consider advising the government to introduce price controls, it added.

97% of UK pharmacists expect ‘great pressure’ in 2020

PharmaTimes, Anna Smith, 06 March 2020

PharmaTimes reports that a new survey has revealed that as many as 97% of UK pharmacists expect to come under greater pressure in 2020, reinforcing the idea that significant changes to pharmacy administration are needed to reduce the growing pressure on them.

The research, conducted by Brother UK, also revealed that 89% say cutting down and optimising back-office processes would release much-needed resource.

The survey, which consisted of 100 pharmacists, also revealed that the key issues they say need to be resolved are complex working processes between pharmacies and GP practices, handling prescriptions, management of patient records and document and label printing.

The true impact of the UK’s hormone replacement therapy shortages

The Pharmaceutical Journal, Emma Wilkinson, 06 March 2020

After more than 18 months of hormone replacement therapy product shortages, the ongoing supply problems have had a drastic impact on the lives of people who rely on it. The Pharmaceutical Journal speaks to pharmacists and their patients.

Much of the frustration among pharmacists, GPs and patients comes down to a lack of information about why they are having to deal with this. There has been no explanation or guidance that accounts for why the UK is having such a significant problem with HRT when other countries do not.

“We really have not got to the bottom of why we have this problem,” says Haitham Hamoda, chair of the British Menopause Society. “‘Manufacturing and supply problems’ is a very vague term, but that is as much as we know.”

 

 

Parliamentary Coverage

There was no parliamentary coverage today.

 

Full Coverage

EU fails to persuade France, Germany to lift coronavirus health gear controls

Reuters, Francesco Guarascio and Philip Blenkinsop, 06 March 2020

EU officials sought in vain on Friday to persuade France, Germany and other European countries to lift controls on the export of protective medical gear, which officials said could hurt the bloc’s collective effort to fight the coronavirus.

Countries including Germany, France and the Czech Republic have announced bans on exports of protective gear to avoid shortages at home, measures that go against the spirit of free movement of goods within the EU.

Such bans “risk undermining our collective approach to handle this crisis” EU crisis management commissioner Janez Lenarcic said at an emergency meeting in Brussels, where officials urged solidarity in the bloc to fight the outbreak.

While the meeting was underway, EU officials working in the building hosting the ministers were sent home and a separate meeting of diplomats was cancelled, after a new case of coronavirus emerged among EU staff. That followed a first case earlier this week.

Many EU countries rely on China, the source of the outbreak, for drug ingredients, and they are now struggling to avoid shortages after the epidemic disrupted supplies and delayed shipments.

Protective gear, such as face masks, is already in short supply in most EU countries, officials said, which puts doctors and nurses at risk.

Europe needs to bring medical production back to Europe, because it relies too much on imports from non-EU countries, officials in France and Germany, the EU’s largest countries, have said.

France imports about 40% of drug ingredients from China, a situation that the French Finance Minister Bruno Le Maire called over-reliance on Beijing.

“This is not something that will be solved tomorrow, but we must start this discussion today so that we have a solution after tomorrow,” Austrian Health Minister Rudolf Anschober told reporters at the meeting in Brussels.

No immediate shortages of medicines have so far been experienced in the EU because of the epidemic, officials said, but concerns were mounting after India, the world’s top producer of generic medicines, restrained some exports.

The bloc already faced shortages of several drugs, including for respiratory diseases, before the outbreak.

EXPORT BANS

Health commissioner Stella Kyriakides called for “solidarity” among EU states to avert shortages in protective gear.

French Health Minister Olivier Veran said France had requisitioned protective equipment to have a better understanding of the available stock. He declined answering questions on the export ban.

Germany’s Health Minister Jens Spahn said German restrictions on the export of masks, gloves and suits could be revised if an overall EU ban was introduced on sales to non-EU states.

Belgium’s health minister, Maggie De Block, called the bans “paradoxical” and urged that they be lifted, as did ministers of other countries that have not imposed them.

Italy, the EU country hardest hit by the outbreak so far, has formally requested help from other EU states to meet its needs for protective gear.

Italian health minister Roberto Speranza said more needed to be done at EU level to meet existing needs, and warned that lack of coordination could lead to higher prices for protective gear.

The European Commission, the EU’s executive arm, last week began joint procurement of face masks and other protective gear on behalf of 20 EU states, but the effort probably won’t secure enough supplies before April, officials said.

EU industry commissioner Thierry Breton said he was confident that EU-based manufacturers could meet the growing demand for protective gear in the coming weeks, provided that production was coordinated.

Ministers also discussed measures to prevent the spread of the virus. They agreed not to introduce checks at their mutual frontiers, confirming earlier decisions to maintain free movement of citizens within the EU’s open-border Schengen area.

Coronavirus: CMA warns retailers against putting up prices

C+D, Valeria Fiore, 06 March 2020

The Competition and Markets Authority (CMA) has called on retailers to “behave responsibly” and not increase prices during the coronavirus outbreak.

The watchdog has kept an eye on reports of prices changing as the virus spreads, and wants to ensure that traders “do not exploit the current situation to take advantage of people, it said in a statement yesterday (March 5).

It will look out for evidence that companies have “broken competition or consumer protection law, for example by charging excessive prices or making misleading claims about the efficacy of protective equipment” during the outbreak, it said.

The CMA will take “enforcement actions” when appropriate and might even consider advising the government to introduce price controls, it added.

“We urge retailers to behave responsibly throughout the coronavirus outbreak and not to make misleading claims or charge vastly inflated prices”, CMA CEO Andrea Coscelli said.

These rules may also apply to retailers reselling their good on online marketplaces, he added.

The CMA’s warning comes as Amazon told the news service Reuters last week (February 27) that it had removed “tens of thousands of deals” from its site as some merchants selling health-related products had increased prices.

The outbreak of coronavirus has seen patients flock to buy medical supplies. Several pharmacies have sold out of face masks and hand sanitiser, while others are limiting purchases of hand gel to two per person.

97% of UK pharmacists expect ‘great pressure’ in 2020

PharmaTimes, Anna Smith, 06 March 2020

A new survey has revealed that as many as 97% of UK pharmacists expect to come under greater pressure in 2020, reinforcing the idea that significant changes to pharmacy administration are needed to reduce the growing pressure on them.

The research, conducted by Brother UK, also revealed that 89% say cutting down and optimising back-office processes would release much-needed resource, with more than 60% saying that increasing admin volumes have become a major source of pressure for the sector.

The survey, which consisted of 100 pharmacists, also revealed that the key issues they say need to be resolved are complex working processes between pharmacies and GP practices, handling prescriptions, management of patient records and document and label printing.

“These are challenging times for pharmacists, as they deal with increasing demand for a growing range of services despite the threat of cuts to funding” explained Diane Barnes, senior healthcare business manager at Brother.

“Our research shows a strong demand for change, particularly when it comes to alleviating the growing administrative burden. They want to see universal use of digital records and prescriptions, improvements to IT networks and a shake-up of how surgeries and pharmacies work together, particularly in terms of developing clear responsibilities for prescribing and dispensing.

“Printing and labelling is also a key source of frustration for the sector. More than half (55%) of the pharmacists we spoke to said they have little understanding of how much their business spends on print.”

The results come as pharmacists are expressing concerns at having to provide more services to more patients, which include the new community pharmacist consultation service (CPCS) and a range of clinical functions, such as hepatitis C testing and a stop-smoking referral scheme.

The true impact of the UK’s hormone replacement therapy shortages

The Pharmaceutical Journal, Emma Wilkinson, 06 March 2020

After more than 18 months of hormone replacement therapy product shortages, the ongoing supply problems have had a drastic impact on the lives of people who rely on it.

The line on hormone replacement therapy (HRT) being fed to pharmacists has remained roughly the same since shortages began in late 2018: there are ongoing shortages owing to a range of issues, but alternatives are available and officials are working to keep NHS staff informed and maintain overall supplies.

Speak to pharmacists and their patients, however, and a different picture emerges. There is immense frustration at the rationing and missed medication from women scouring local pharmacies on the hunt for patches, and huge amounts of extra work and inconvenience for all involved.

Kerry Barrett, an author who lives in London, says that around a year ago she took her usual Elleste Duet (estradiol hemihydrate and norethisterone acetate; Mylan) prescription to her pharmacy, only to be told they neither had it nor could they order it in. She eventually got some at the third pharmacy she tried, but, six months later, her GP told her that the product could not be obtained anywhere.

Like many other women, Barrett tried an alternative HRT product, which she took for a couple of months, but almost immediately found her symptoms, including night sweats, insomnia, anxiety and mood swings had returned.

In desperation, she started looking for HRT products at online pharmacies, where she found a three-month supply for almost four times the list price. It was a price she was willing to pay, although she worries about what will happen to those who cannot afford to do the same.

“I think the most frustrating thing is that it doesn’t seem to be taken seriously. I had an early menopause so without my HRT I’m at increased risk of heart disease and osteoporosis. But aside from that, it’s been so debilitating and I struggle to function without the HRT,” she says.

Ongoing problems

Pharmacists say this is far from a one-off. They report dealing with many daily cases of women who cannot get HRT or are struggling to find the right alternative.

Amanda Smith, pharmacy manager at Heath Pharmacy in Halifax, West Yorkshire, says there have been times when the pharmacy was barely managing to fulfil any prescriptions and, on other occasions, they have had to order stock directly from manufacturers with proof of outstanding prescription.

“There have been intermittent deliveries to wholesalers and, if you’re quick, you can place an order, but we have to check constantly throughout the day on the wholesalers websites for the stock to appear and it can all be gone again within an hour, so it’s really down to luck,” she says.

Prescribers are calling up to request alternatives, which can be very time consuming as they often have to check around three or four wholesalers, she explains. At the same time, patients are calling “from far and wide” to see if they have any stock, adding to the workload.

Nuttan Tanna is a pharmacist consultant specialising in women’s health at North West London Hospitals NHS Trust. She works in a specialist clinic for women experiencing menopause who get repeat prescriptions for HRT via their GP and says that many of the women she has treated have had major problems getting their HRT supplied: “The problem is then you get people trying to make their medicine last longer by using half doses, which is no good, or they have given up completely”.

She adds: “These women are frustrated and they really need support. And the thing is the patient should not be struggling with this. But they are all saying how hard their community pharmacist is trying to help them.”

Much of the frustration among pharmacists, GPs and patients comes down to a lack of information about why they are having to deal with this. There has been no explanation or guidance that accounts for why the UK is having such a significant problem with HRT when other countries do not.

Contributing factors

Although the official line is that Brexit and medicines shortages are unrelated, it is often put forward as a contributing factor. In October 2019, HRT was banned from parallel exporting — a process where companies buy medicines meant for UK patients and sell them on at a higher price in another country — by the Department of Health and Social Care. The government insisted the move, announced at the same time as the first serious shortage protocols, had nothing to do with Brexit.

The British Menopause Society (BMS) has been working closely with the Royal Society of Obstetricians and Gynaecologists (RCOG) to provide any advice and information it can about managing the shortages, and is not shy about sharing its frustration.

“We really have not got to the bottom of why we have this problem,” says Haitham Hamoda, chair of the BMS. “‘Manufacturing and supply problems’ is a very vague term, but that is as much as we know. When you use vague terminology, that is when people start speculating.”

He stresses that alternatives are available and it is frustrating to hear of women going abroad for HRT as that shouldn’t need to happen. He is “cautiously optimistic” that, should stocks start to come back in from Spring 2020, as is being advised, there will be improvement over the course of the year.

The BMS and the RCOG wrote to Matt Hancock, the health and social care secretary , in early February 2020, requesting that they form part of a working group with government, industry and regulatory agencies to establish the cause of HRT shortages and ensure that they are not repeated.

The government gave a non-committal response. And in a written parliamentary answer, published five days after the government received the letter, the health minister Jo Churchill said: “We have been working closely with all suppliers of HRT preparations to maintain overall supply to patients, and we anticipate the supply situation will improve from the end of this month”.

The government says that although it shares information it holds on HRT shortages with the NHS, it will not make this information public.

Robin Conibere, a GP pharmacist based at the Beacon Medical Group in Devon, has little faith that stocks will return to normal levels in March 2020 given what has happened to date. He says every day he takes two or three calls about HRT — a topic which he has had to train himself up on very quickly.

“Because there is so much individual variation, people are happy with what they’re on and if you start having to experiment it’s not going to be easy. Most patients are really frustrated and fed up, some are going without meds, and it has affected their day to day quality of life,” he says.

He has been trying to keep on top of what is available by checking BMS guidance, taking extra steps to check wholesaler supplies and being in contact with a local group that uses the Telegram app (where pharmacies list what stock they might hold). But stocks change all the time, he says. “We’re going round in circles — we have got good relationships with our community pharmacies, but it’s really difficult.”

Conibere adds that prescribers are essentially left generating paper prescriptions and telling patients that they will have to shop around. Yet patients still come back empty-handed asking “what now?”.

Tom Gregory, a GP practice pharmacist and independent prescriber in North Somerset, said he did, at one point, spend some time trying to track shortages and get ahead of what was happening, but this proved to be too much work.

“I can’t work out what the reason is, and there do seem to have been ripple effects when one [product] is out of stock, but you can’t pin down where it’s happening. They seem to come back in then go out of stock again. I wish I knew what was going on — if we knew what the problem is at least we could explain that to patients.”

Tanna has taken the approach of providing more education around switching HRT products after hearing how much prescribers were struggling. “I already run a service for GPs who call or email us to ask what to do. I’m now starting to talk to GP colleagues and do some training because they should be able to switch without having to contact us.”

Ending the shortages

However, things could improve for women using HRT products.

Theramex has said its Evorel Mono 50 (estradiol) and Evorel Conti (estradiol hemihydrate and norethisterone acetate) patches would be available by the end of February 2020. It claims that it has increased output, brought in an extra manufacturer and worked with UK health authorities to shorten timelines, and it promises that the rest of the Evorel range will be available by the end of March 2020.

And the BMS’s most recent update on HRT supply shortages, published on 27 January 2020, lists several products due back in stock in March 2020; however, it also notes that some — the FemSeven (Tevi) range in particular — will be unavailable until the end of 2020, or even into 2021 depending on the product. The list is compiled by the BMS which contacts pharmacists to record the stock they can access.

A spokeswoman for the BMS told The Pharmaceutical Journal on 2 March 2020 that it was still receiving reports of shortages, including Theramex Evorel products, even though the manufacturer said they should be available by the end of February 2020.

So for the moment, it looks like pharmacists will have to continue to spend their limited time chasing HRT prescriptions for women who are desperate for a product that works for them.

Robin Conibere says: “I don’t really have any faith that it will get better anytime soon. HRT that was supposedly out of stock until December 2019 still hasn’t come back, and there is so much variation around the country.”

Media And Political Bulletin – 09 March 2020

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