Drug shortages derail CCGs' budgets.

Financial plans of clinical commissioning groups are being derailed by emergency hikes in prices of generic drugs, which have led to soaring costs, The BMJ has learnt. Last month The BMJ reported that ongoing shortages of generic drugs cost the NHS £38m in November 2017, as the government agreed more emergency price increases to boost stocks. An examination of board papers by The BMJ has found that many CCGs are reporting significant risks to their financial plans as a result of the price increases. Included are some of the most financially stricken CCGs that were ordered by NHS England and NHS Improvement to draw up radical cost savings plans this year as part of the capped expenditure process (CEP). NHS Clinical Commissioners, the body that represents CCGs, said that data from the prescribing tool PrescQIPP showed a 10-fold year on year increase in CCGs’ costs relating to drugs on “No cheaper stock obtainable” (NCSO) lists—from £25m between April and November 2016 to £254m in the same period in 2017. Julie Wood, chief executive of NHS Clinical Commissioners, told The BMJ, “We are very concerned about it. It is a massive increase, and it is having an effect on CCGs’ bottom-line financial position. We are in discussion with NHS England and the Department [of Health and Social Care] to understand why it is happening and what might be done to resolve it, and to deal with the consequences for CCGs.” Among the CCGs reporting pressure was NHS Cambridgeshire and Peterborough CCG, which said that the “unprecedented increase in price concessions” was one of the main reasons it was struggling to achieve its forecast of a £15.5m deficit for the end of 2017-18. The CCG is currently £8.1m over budget for the year, £2m of which is due to an increase in GPs’ prescribing costs. NHS Vale of York CCG, which is currently £19.5m over budget— £3.5m over its projected plan—said that there was an extra £2.1m pressure on its drugs budget this year because of NCSO. Andrew Green, clinical and prescribing lead for the BMA’s General Practitioners Committee, said, “The reasons [for the shortages] are complex, but many stem from consolidation within the production process reducing the resilience in the supply chain, combined with the low cost of many generics, which reduces incentives to invest. “We urgently need a warning system to alert GPs to shortages, as currently the first we know about it is when an upset patient returns to our surgeries unable to source their medication.” A Department of Health and Social Care spokesperson said, “If there are supply issues affecting a generic drug, we work closely with the pharmaceutical industry, the MHRA [Medicines and Healthcare Products Regulatory Agency], and the NHS in order to mitigate the impact on patient care. The generics drugs market is particularly volatile at present due to shortages of supply and other factors, but we still have some of the cheapest prices in Europe.”