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Many feared that the UK leaving the EU would cause shortages and limitations to the medicine supply throughout England, Scotland, Wales and Northern Ireland. Now ten months on from Brexit are we finally seeing the short fallings? Ninety percent of the UK's medicines are imported from abroad meaning disruptions caused by the outcomes of Brexit and a lack of HGV drivers has caused a significant problem in transporting drugs into the country. Leaked Department of Health and Social Care documents revealed two hundred and nine medicines had supply “issues” in 2019, more than half of these remained in short supply for over three months. Drugs such as hepatitis vaccines and anti-epileptic drugs, faced “extended” problems. A document published by the NHS Nottinghamshire Shared Medicines Management Team compiled a list of shortages and disruptions to supply due to COVID. The following 5 products had long-term manufacturing issues: AstraZeneca’s Zyban (bupropion, anti-smoking drug) Par’s Questran (colestyramine, a bile acid sequestrant) Diamorphine (a painkiller, used for cancer patients) Metoprolol (used for high blood pressure) Co-Careldopa (given to people with Parkinson’s disease) A further thirty medicines had short-term manufacturing issues, including end of life medicines such as morphine and anti-vomiting drug, levomepromazine. NHS Scotland and NHS Wales have published lists of drugs in low supply which are available to view on their NHS websites. NHS England consider this to be ‘sensitive information’ and have not published any shortfalls. An amendment to The Human Medicines Regulations 2019 legislation has added a ‘Serious Shortage Protocol’ (SSP). This allows for pharmacists and contractors to supply patients with a ‘reasonable and appropriate substitute’ if their prescription has an active SSP. Currently, shortages on Fluxoetine, (anti-depressive drug) and Estradot patches, (hormonal replacement therapy) have active SSP’s according to the NHS Business Service Authority. Original source: National Health Executive

The government’s failure to quickly roll out third doses of the Covid vaccine to clinically vulnerable people and those with weakened immune systems is endangering thousands of lives, patient groups and experts have warned. Immunocompromised individuals currently account for one in 20 Covid patients being admitted to intensive care, according to a new analysis by Blood Cancer UK. These people are less able to mount an immune response after two doses, so are therefore being offered a third to keep them protected. This is separate from the ongoing booster programme, applicable to all over-50s and health care workers. However, a recent Blood Cancer UK survey suggested that less than half of people with blood cancer, who make up about 230,000 of the 500,000 immunocompromised people in the UK, had been invited to receive their third dose by the second week of October. Other clinically vulnerable people have reported struggling to book an appointment via their GP practices after being told by NHS England to come forward for a third vaccine dose. With the situation in Britain reaching a “tipping point”, charities and scientists are fearful the number of immunocompromised in intensive care could further worsen in the weeks to come if they remain unable to access booster jabs. Read full story Source: The Independent, 21 October 2021

Mental health patients who were discharged from or admitted to acute mental health services during the first Covid-19 lockdown experienced loneliness and social isolation, according to a new study. Published in the British Journal of Psychiatry Open the 34 patients, carers and clinical staff were interviewed by a team of researchers from The University of Manchester. Mental health service users also reported ‘working harder’ to avoid admission due to fears around environmental safety as a result of COVID-19. “Even before the pandemic, there are lots of safety concerns associated with recent discharge from inpatient mental health services, for example suicide and self-harm,“ said lead author Dr Natasha Tyler, researcher at the GM PSTRC and The University of Manchester. Dr Tyler added: ‘Our patients and carers felt that because of the national need to free-up hospital beds, the quality of discharge and admission planning was compromised at times. “That meant discharging patients from hospitals who were not ready to cope in the community or not admitting patients who needed in-patient care. “The closure of most community support services meant patients had minimal opportunities for accessing care via alternative routes. This worsened their feelings of helplessness and loneliness.” Full article here Source: Greater Manchester Patient Safety Translational Research Centre

Today marks the last day that about four million of the most clinically vulnerable people in England and Wales are advised to shield at home. Letters have been sent out to the group in the last few weeks. They are still being advised to keep social contacts at low levels, work from home where possible and stay at a distance from other people. The change comes amid falling Covid cases and hospital admissions. According to NHS Digital, there are 3.8 million shielded patients in England and 130,000 in Wales. Scotland and Northern Ireland are expected to lift their restrictions later in April. People affected by shielding included Rob Smith, from Hull, who has muscular dystrophy. Shielding for more than a year has been a "nightmare", he told BBC Breakfast. "Where I was able to go out, I didn't feel I wanted to. I didn't feel confident to face people again," he said. "I've always been sociable.... It's had a massive impact." Mr Smith now says he feels anxious about the future and believes for many people who have been shielding, it will "take time to get used to being out there again". He is also wary of the risk of mixing with others again. Read full story Source: BBC News, 31 March 2021

People aged 16 or over who live with immunosuppressed adults should be prioritised for COVID-19 vaccination alongside priority group 6 (people aged 16 to 65 who have a clinical condition that puts them at higher risk), the UK government’s vaccine advisory committee has said. This would include people living in households with an adult who has a weakened immune system, such as those with blood cancer or HIV, or people on immunosuppressive treatment, including chemotherapy, the Joint Committee on Vaccination and Immunisation (JCVI) said. These people are not only more likely to have poorer outcomes after SARS-CoV-2 infection but may not respond as well to the vaccine as others, recent evidence indicates, said the JCVI. The committee said it had made the new recommendation after evidence emerged showing that the covid-19 vaccines may reduce transmission, meaning that vaccinating those around immunosuppressed individuals could help reduce their risk of infection. The JCVI’s chair of COVID-19 immunisations, Wei Shen Lim, said, “The vaccination programme has so far seen high vaccine uptake and very encouraging results on infection rates, hospitalisations, and mortality. Yet we know that the vaccine isn’t as effective in those who are immunosuppressed. Our latest advice will help reduce the risk of infection in those who may not be able to fully benefit from being vaccinated themselves.” Read full story Source: BMJ, 29 March 2021

More than 3.7 million vulnerable people in England will no longer have to shield from the coronavirus from 1 April. It comes as the numbers of COVID-19 cases and hospital admissions have declined for the past couple of weeks. Letters will be sent out to this group in the next two weeks. In them, people will still be advised to keep social contacts at low levels, work from home where possible and stay at a distance from other people. Since 5 January, they have been asked to stay at home as much as possible to reduce their risk of being exposed to the virus. But at a Downing Street press conference, Health Secretary Matt Hancock confirmed shielding guidance, which had been extended to 31 March for all those who are clinically extremely vulnerable, would end on 1 April. England's deputy chief medical officer Dr Jenny Harries recommended the change based on the latest scientific evidence and advice. Read full story Source: BBC News, 17 March 2021

Homeless people will be prioritised for coronavirus vaccinations alongside adults in at-risk groups, the government has said. Matt Hancock, the health secretary, said the decision would “save more lives among those most at risk in society”. It comes after the Joint Committee on Vaccination and Immunisation, which said those experiencing rough-sleeping or homelessness were likely to have underlying health conditions and should be offered vaccinations alongside those in priority group six. "People experiencing homelessness are likely to have health conditions that put them at higher risk of death from COVID-19. He added: "This advice will help us to protect more people who are at greater risk, ensuring that fewer people become seriously ill or die from the virus." Read full story Source: The Independent, 11 March 2021

All adults with a learning disability will be offered the vaccine against coronavirus after new advice from government experts warned they were at greater risk from the virus. The decision is a major win for disability charities and campaigners. The decision will mean as many as 150,000 more people could be offered the vaccine. The government’s Joint Committee on Vaccination and Immunisation (JCVI) has issued new advice saying any adult on GP Learning Disability Register should be prioritised for vaccination along with adults with related conditions such as cerebral palsy. The JCVI had previously said only those were severe learning disabilities and those living in care homes should be prioritised for vaccinations. Disability rights campaigners and charities warned this left vulnerable people at increased risk from the virus. Read full story Source: The Independent, 24 February 2021

With the first phase of the UK’s vaccination programme now fully under way, the government’s self-congratulatory tone suggests all clinically vulnerable groups are soon in line for protection. There’s certainly reason to be positive: millions of people are on their way to safety. But look a little closer and many high-risk people are struggling to access the vaccine. When the vaccine was first introduced last year, the Joint Committee on Vaccination and Immunisation (JCVI) put shielders – or the “clinically extremely vulnerable” (CEV) – as low as sixth on the priority list, behind older people with no underlying health conditions. It resulted in the baffling situation where a marathon-running 65-year-old was given priority for the vaccine over a 20-year-old with lung disease who needs oxygen support. The government U-turned after pressure, moving CEV people up to fourth spot behind healthy over-75s. These are complex calculations, but there are still fears some will miss out. Some young disabled people who don’t meet the government’s narrow criteria of CEV and are worried they won’t be prioritised at all. Shielders – many of whom are of working age and live with children – also have extra risk factors compared with older people. As the British Medical Association said this month, we need a more sophisticated vaccine delivery that takes into account circumstantial factors such as race, health inequality and employment. I’ve received many messages from shielders who are terrified of being forced out to work, or of schools reopening before they get their vaccine. There are also those with learning disabilities to consider. Currently, only older people with a learning disability, those who have Down’s syndrome or people who are judged as having a severe learning disability are on the priority list. This means that people with a mild or moderate learning disability aren’t prioritised at all. This is despite the fact all people with learning disabilities have a death rate six times higher than the general population. Young adults with a learning disability are 30 times more likely to die of Covid than young adults in the general population. Read full story Source: The Guardian, 3 February 2021

Dr Rebecca Fisher gives the lowdown on why maintaining general practice as a ‘front door’ to the NHS that is safe for both GPs and patients is not easy. It’s fair to say that Matt Hancock’s pronouncement that henceforth all consultations should be “teleconsultations unless there’s a compelling reason not to”, has not been universally welcomed in general practice. In my surgery, practicing in a pandemic has seen us change our ways of working beyond imagination. In March, like many other practices, we shifted overnight to a “telephone first” approach. And whilst at peak-pandemic we kept face-to-face consultations to a minimum, we’re now seeing more and more patients in person again. Although many consultations can be safely done over the phone, we’re very clear that there are some patients – and some conditions and circumstances – where a patient needs a face-to-face appointment with a GP. NHS England have also been clear that all practices must offer face-to-face consultations if clinically appropriate. But maintaining general practice as a “front door” to the NHS that is safe for both GPs and patients is not easy. Options to quarantine and pre-test patients set out in national guidance and intended to help protect secondary care cannot be deployed in primary care. Other national guidance – for example regarding wearing masks in clinical sites – often seems to be issued with secondary care in mind, with little or delayed clarity for primary care. Measures like maintaining social distancing are also likely to be harder in general practice, where the ability of a surgery to physically distance staff from each other, and patients from each other and staff, is in part dependent on physical factors. Options to quarantine and pre-test patients set out in national guidance and intended to help protect secondary care cannot be deployed in primary care Things like the size and layout of a practice, or the availability of a car park for patients to wait in are hard to change quickly. Stemming from those challenges are ones related to staffing; how to keep practice staff safe from covid-19? NHS England and the British Medical Association have stated that staff should have rigorous, culturally sensitive risk assessment and consider ceasing direct patient contact where risks from covid-19 are high. The risk of catching COVID-19 – or dying from it – is not equally distributed amongst GPs. Age, sex, ethnicity, and underlying health conditions are all important risk factors. New Health Foundation research finds that not only are a significant proportion of GPs at high or very high risk of death from covid-19 (7.9 per cent), but one in three single-handed practices is likely to be run by a GP at high risk. If those GPs step back from face-to-face consultations we estimate that at least 700,000 patients could be left without access to in-person appointments. Even more concerningly, there’s a marked deprivation gradient. If GPs at high risk from COVID-19 step back from direct face-to-face appointments, and gaps in provision aren’t plugged, the patients likely to be most affected are those in deprived areas – the same people who have already been hardest hit by the pandemic GPs at high risk of death from covid are much more likely to be working in areas of greater socioeconomic deprivation. And single-handed practices run by GPs classed as being at very high risk from covid are more than four times as likely to be located in the most deprived clinical commissioning groups than the most affluent. If GPs at high risk from COVID-19 step back from direct face-to-face appointments, and gaps in provision aren’t plugged, the patients likely to be most affected are those in deprived areas – the same people who have already been hardest hit by the pandemic. Where do solutions lie? Ultimate responsibility for providing core general practice services to populations lies with CCGs. In some areas, collaborations between practices (such as GP federations and primary care networks), may be able to organise cross-cover to surgeries where face-to-face provision is not adequate to meet need. But these collaborations have not developed at equal pace across the country, have many demands on their capacity and may not be sufficiently mature to take on this challenge. These local factors – including the availability of locums – will need to be considered by commissioners. It’s vital that CCGs act quickly to understand the extent to which the concerns around GP supply highlighted by our research apply in their localities. In some cases, additional funding will be needed to enable practices to ‘buy in’ locum support for face-to-face consultations. This should be considered a core part of the NHS covid response. Face-to-face GP appointments remain a crucial NHS service, and must be available to the population in proportion with need. Just as in secondary care, protecting staff, and protecting patients in primary care will require additional investment. Failure to adequately assess the extent of the problem, and to provide sufficient resource to engineer solutions is likely to further exacerbate existing health inequalities. Original Source: The HSJ

Doctors and surgeons’ leaders have issued a warning that the NHS must not shut down normal care again if a second wave of Covid-19 hits as that would risk patients dying from lack of treatment. Here, one patient tells her story. Marie Temple (not her real name) was distraught when her MRI was cancelled in March, shortly after the UK went into lockdown and Boris Johnson ordered the NHS to cancel all non-urgent treatment. Temple, who lives in the north of England, was diagnosed with a benign brain tumour last year after suffering seizures and shortly afterwards had surgery to remove it. She had been promised a follow-up MRI scan in late March to see if the surgery had been a success, but she received a letter saying her hospital was dealing only with emergency cases and she didn’t qualify. Read the full article here.

New analysis by the Health Foundation reveals the devastating impact the pandemic has had on social care in England. The independent charity says the findings provide further evidence that the government acted too slowly and did not do enough to support social care users and staff, and that protecting social care has been given far lower priority than the NHS. The Health Foundation finds that policy action on social care has focused primarily on care homes and that this has risked leaving out other vulnerable groups of users and services, including those receiving care in their own homes (domiciliary care). It also notes that the shortcomings of the government’s response have been made worse by longstanding political neglect and chronic underfunding of the social care system. Since March there have been more than 30,500 excess deaths* among care home residents in England and 4,500 excess deaths among people receiving domiciliary care. While high numbers of excess deaths of people living in care homes have been well reported, the analysis shows there has been a greater proportional increase in deaths among domiciliary care users than in care homes (225% compared to 208%). And while deaths in care homes have now returned to average levels for this time of year, the latest data (up until 19 June) shows that there have continued to be excess deaths reported among domiciliary care users. The Health Foundation says that decades of inaction by successive governments have meant that the social care system entered the pandemic underfunded, understaffed, and at risk of collapse. Read full article here.

More than a quarter of black, Asian and minority ethnic NHS staff had not yet had a risk assessment in relation to their exposure to coronavirus, according to the latest data collection by national NHS leaders. Full article here on the HSJ website (paywalled)

The government removed a key section from Public Health England’s review (published Tuesday) of the relative risk of COVID-19 to specific groups, HSJ has discovered. The review reveals the virus poses a greater risk to those who are older, male and overweight. The risk is also described as “disproportionate” for those with Asian, Caribbean and black ethnicities. It makes no attempt to explain why the risk to BAME groups should be higher. An earlier draft of the review which was circulated within government last week contained a section which included responses from the 1,000-plus organisations and individuals who supplied evidence to the review. Many of these suggested that discrimination and poorer life chances were playing a part in the increased risk of COVID-19 to those with BAME backgrounds. HSJ understands this section was an annex to the report but could also stand alone. Typical was the following recommendation from the response by the Muslim Council of Britain, which stated: “With high levels of deaths of BAME healthcare workers, and extensive research showing evidence and feelings of structural racism and discrimination in the NHS, PHE should consider exploring this in more detail, and looking into specific measures to tackle the culture of discrimination and racism. It may also be of value to issue a clear statement from the NHS that this is not acceptable, committing to introducing change.” One source with knowledge of the review said the section “did not survive contact with Matt Hancock’s office” over the weekend. Read full story Source: HSJ, 2 June 2020