Distribution of medicines - winter crisis in Scotland
Last December saw sustained and heavy snowfall in Scotland. For two weeks much of the country suffered a frozen transport network that resulted in widespread chaos. Across the Central Belt schools closed, offices were reduced to a skeleton staff and many people were stuck at home. For any company a situation like this is a problem, but for those companies responsible for distributing medicines, the responsibility of continuing to operate in difficult circumstances makes having robust backup systems essential. According to members of the Royal Pharmaceutical Society however, it would appear that the severe weather last December created a crisis in the distribution of medicines in Scotland. The Society has been researching the scale of the problem and surveying members to collect and analyse their experiences. Our conclusion is that the current system of medicines distribution is flawed, fragile and anything but robust, with little contingency built into certain parts of the distribution chain. RPS believes that from a clinical and professional point of view this is neither acceptable not sustainable.
Of course, the system of medicines distribution to pharmacy has been an issue for a number of years now. We know from members’ communications to us that more and more of pharmacists’ time is spent on the phone and internet sourcing medicines. The system of quotas and direct to pharmacy schemes is leading to ongoing difficulties in sourcing many medicines. In particular our members in Scotland tell us time and again about the difficulty in obtaining medicines such as Femara and Zyprexa.
What you told us
We carried out research that looked at pharmacists’ experiences of the distribution system before and during the severe winter weather last December. By comparing the results from the two time periods covered by the research, we have been able to see the extent to which pharmacists saw the distribution system fail to provide an adequate and reasonable service during last December.
Our findings are that nearly all pharmacists think there are fundamental flaws that need addressing in the current system of medicines distribution in this country. An overwhelming 97% of pharmacists in Scotland responded that there is a problem with the current system of medicine distribution in Scotland. 86% also believed that the distribution service they received between 2009 and 2010 had deteriorated, with 69% reporting they had late deliveries of medicines either frequently or occasionally during that time period.
Whilst pharmacists are unhappy with the nature of the system as it stands, most also believed that it was adequate despite its flaws. Overall, 73% rated medicines distribution before the winter crisis as either good or average. The main focus of our research however was to gain a more accurate picture of how the medicines distribution systems stood up to the snow storms in Scotland in December 2010. The results in this part of the research were conclusive, and worrying. Last December, parts of the system appear to have come close to collapse.
Whilst a majority of pharmacists rated their distribution systems as good or average before the winter crisis, 69% rated the system as poor or awful during the winter crisis. Nearly all pharmacists saw a deterioration in service, with pharmacists who had previously rated their service as good reporting that it had become awful.
Graph: How pharmacists rated their distribution of medicines service before Winter 2010, and during Winter 2010
Click the image above for a larger version of these graphs
20% of pharmacists saw medicines arriving in pharmacy a week or more after they were due, and 57% typically experienced delays of 3 to 7 days. 62% of pharmacists reported that they were told by their distributor that their order could not be processed because of the bad weather. An astonishing 92% of pharmacists reported that during December they experienced instances where they were prevented from dispensing certain medicines as they had been able to obtain them for their patients.
Indeed, during the worst of the weather we heard of pharmacists going to extraordinary lengths to make sure patients got their medicines. We heard of pharmacists driving and walking through the snow to patients’ homes to deliver essential medicines, of pharmacists sharing medicines to ensure basic supplies and some pharmacists stayed overnight at B&Bs near their pharmacies to make sure they could open in the morning.
What we're doing about it
The Society will be contacting the relevant companies to share the results and ask them how they will work towards ensuring such levels of poor service do not occur again. The Society will also be sharing the results of its research with the Scottish and UK Governments. We believe that distribution networks should revaluate their logistical setups, with contingencies like extreme weather in mind, rather than being entirely focused on making the set-up as cost effective as possible.
Scotland was lucky to avoid a catastrophe last December. Many of the medicines that people ended up waiting over a week for were critical for life-threatening conditions. The Society’s research however only measures the frustration of pharmacists who were unable to carry out their professional duty to provide pharmaceutical care. What is missing in this work is the anguish and fear of patients across Scotland who had to repeatedly make futile trips to pharmacies to see if their medicine was available. But what we know now should be sufficient to get the main stakeholders in this debate round the table and talking to pharmacists about how the medicines distribution system can be made more robust and secure against winter weather.