Health

‘It is soul-destroying’: Patients face delays as pharmacists struggle to source drugs

As shortages bite, many beleaguered pharmacists are ringing GPs to request alternative antibiotics

Irish pharmacists have spoken about the knock-on effects of shortages in a wide range of medications. Photograph: iStock

Marese McDonagh
Wed Jan 11 2023 - 05:00

Pharmacist Nial Tully says many GPs are “double-jobbing” at the moment because of the shortage of medications such as antibiotics, meaning that they have to issue prescriptions twice for the same patient.

“I would say that is happening multiple times a day here,” says the Castlerea, Co Roscommon-based pharmacist. One member of his staff is practically “on it full-time” now, ringing GPs, explaining that what they prescribed is not available and asking them to send in an alternative script.

Tully says this was bad enough during the summer when hormone replacement therapy (HRT) became difficult to source, but now “when GPs have their foot to the floor” as Covid, respiratory infections and flu swirl around their communities, the delays in getting alternative prescriptions are creating real hardship for patients.

Aoife O’Connor, who runs the Natural Options pharmacy in Boyle, agrees. She says many products are running out, not just paracetamol and antibiotics, but medication for depression “which people have been on for years and is working for them, and now we can’t get it. It is soul-destroying”.

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When she gets a prescription for an antibiotic for a sick child, she invariably has to contact the GP asking them to prescribe an alternative. “And the patient is standing there waiting, and naturally they are getting annoyed, because they have a sick child in the car. And there is nothing you can do to speed up the process because the doctor is just as busy down in the surgery, so you might not hear back for hours. It is incredibly frustrating,” she says.

When The Irish Times telephoned her, she was sending away a worried grandmother without a prescription. “She has a sick child at home, and the GP may not be able to get back to me until 6pm, and it is not their fault,” she says.

Nial Tully’s sister Sheena Mitchell, a pharmacist based in Milltown in Dublin, wrote a public letter to Taoiseach Leo Varadkar last month urging him to make legislative changes so that pharmacists get more power to treat “common uncomplicated ailments” in patients to help free up GPs to deal with more serious conditions.

Ms Mitchell, the founder of the online family healthcare advice platform, Wonderbaba.ie, has also experienced the frustration of trying to reach overburdened GPs to get them to prescribe for a second time for the same patient.

“In Dublin 6, our GPs are so busy that it could be the next day before you hear back. They do try their best. And if it is an out-of-hours doctor who has prescribed an antibiotic, which is commonplace now as GPs do not have appointments to offer, then you have little to no hope of getting in touch with them at all,” she says.

Pharmacists around the country are dealing with shortages of everything from cough syrups to antibiotics to throat sprays but, according to Ms O’Connor, there is also a problem sourcing some antidepressants that patients may have been on for years.

“We have patients who have medical cards, and while we might source an alternative for them, it could be three times the price, so they may have to pay for this medication,” she explains.

Stockpiling of Calpol and rationing of paracetamol is something Ms O’Connor didn’t expect to witness.

“I had patients coming in this morning buying bottles of Calpol because they heard it is running short, and this has a knock-on effect, because you will have people coming in with prescriptions with a really sick child and they really need Calpol,” she says.

Paracetamol rationing is also a reality. “If someone is prescribed 200, I would say: ‘I will give you 100 today, and will you come back in when you need the remainder of it?’”

Ms O’Connor says that because of the unavailability of antibiotics for children, the HSE has advised pharmacists that they can provide adult antibiotics instead. This requires them to explain to parents how to open the capsules and put the powder into food or drink.

“So you are relying on the knowledge of the person, but how do we know they are opening it correctly and not spilling any?” she says.

Pharmacists have for some time been pressing the Government to introduce a “serious shortage protocol” to allow them to dispense alternative medicines to patients, so that they don’t have to contact GPs if commonly-used prescription drugs are unavailable.

Mr Tully says that if they had done this during the summer, when HRT became difficult to source, the process would have been embedded by now.

“The protocols would mean there would be a list of alternatives drawn up by a senior doctor, saying that if A is not available, then you can give B, or if B is not there, you can give C,” he explains.

Ms O’Connor says it makes sense to permit pharmacists to do more when it comes to treating patients.

“If we were authorised, for example, to give an antibiotic drop for a child, parents would not have to wait in a car park for two hours or four hours, or whatever, to see a GP,” she says.

The pharmacist points out that this has already happened with the morning-after pill.

“Last week, I did six over two days,” she says. “Those were six people who did not need to be waiting in a doctor’s surgery, holding up things when GPs are so busy.”

Like most of her colleagues, Ms O’Connor is coping with shortages of everything from cough syrups to Lyclear cream for scabies, “but you won’t hear much about that because people don’t like to talk about it”.

HRT treatment is in and out of stock all the time. “It is infuriating – you would never see Viagra going in and out of stock,” she says.

Like his colleagues, Shane Currid, a pharmacist based in Ballymote in Co Sligo, says he spends hours every day trawling through suppliers’ websites trying to source medications.

After giving Covid vaccines for 18 months, he had seen what was coming down the tracks, and so ordered more antibiotics than usual last November and December. “But it is the other 195 items that we cannot get our hands on,” he said.

“We spend hours every day checking availability of different products, something we never have done before. You are constantly going from website to website to see if something is in stock,” he says.

Currid believes the antibiotic shortage can probably be attributed to “the three viruses circulating” at the moment: Covid, the respiratory virus and flu.

He believes other factors are responsible for global shortages of many medications. “I don’t know what those issues are whether it is wholesaler related or Brexit-related, or Ukraine war-related,” he says.

One trend he has observed is a change in prescribing habits when it comes to antibiotics, which he believes may have been related to the reports of children dying from Strep A in the UK.

“The HSE seemed to go on a bit of a war footing,” he says. “The line that you don’t prescribe antibiotics unless they are necessary was scrapped.”

He believes GPs started prescribing antibiotics for everybody, just in case it was Strep A. “Because if you present with a sore throat it can be viral, or it can be bacterial. it is hard to tell initially.”

In her December 16th letter to the Taoiseach, Ms Mitchell asked for action on two fronts.

She called for a minor ailments scheme that would allow pharmacists to prescribe approved items for medical card holders, which private patients can already buy over the counter.

She also called for Patient Group Directives (PGDs), which would enable pharmacists to supply medicines to treat certain conditions such as shingles, cystitis and bacterial skin infections.

“We are not trying to encroach on GPs’ roles. We are trying to facilitate them to use their clinical skills even more,” she said. “Some patients do not need to go to their GP. We need to prioritise.”

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