A GP in Sheffield has told Pulse of her fury at ongoing drug shortages, after a vulnerable patient was left at risk of hospitalisation because no supplies of Creon (pancreatin) could be sourced.
Dr Sarah Jones, a GP partner at the Norwood Medical Centre, said they a patient with learning disabilities who lives in a home has been left with no medicine to treat a pancreatic insufficiency condition.
The patient needs pancreatin (brand name Creon), shortages of which are expected to last to 2026, and the only option their practice pharmacist could find would require her to take up to 100 packets of powder a day.
‘It came to a head yesterday because our practice pharmacist had spent half her day trying to find drug alternatives for patients.
‘One of those was Creon, which is a critical medicine, and she said the only thing I can do for this girl is give her some powder but she would have to consume 15 tubs for her morning dose, 20 for her lunchtime dose and 30 for her evening dose and so on. She can’t physically do that, no one could physically do that.
‘So I have nothing to offer this patient and I’m going to have to tell her we will have to see what happens if you don’t get any medication. It is an absolute disgrace.’
Dr Jones explained a likely outcome for the patient would be progressively more diarrhoea, which could make her ill enough to need hospital in itself, or malabsorption which will also lead to hospital.
‘She’s not going to understand what is happening to her. How can this be the reality in 2024, I feel so incensed about it.’
She added that she had been told Sheffield Hospitals were having to buy in Creon for patients at a significant cost. ‘Why isn’t NHS England or the Department of Health dealing with this, why is it being left to people all the way down the line.’
Last month a national patient safety alert was issued warning of limited supplies of pancreatic enzyme replacement therapies including Creon and said clinicians should only prescribe a month at a time.
The notification said the supply disruption of Creon capsules ‘is due to limited availability of active pharmaceutical ingredients and manufacturing constraints to produce the volumes required to meet demand’.
Some patients with cystic fibrosis who also rely on the drug have reported having to drive for hours to find stocks or ration their supply.
The National Pharmacy Association has warned pharmacists are having to increasingly turn people needing vital medication away and called on the main political parties to commit to tackling the issue.
More than three times as many serious shortage protocols (SSPs) were issued in the two-year period between 2022 and 2024, compared with 2020 to 2022, recent figures show.
The Creon issue is the latest in a long line of drug shortages that are taking up many hours of practice time and come up in ‘almost every other consultation’, Dr Jones said.
And it is the most vulnerable patients who are suffering the most, she added. GLP-1 receptor agonist drugs cause them particular problems because they have one of the highest proportions of diabetic patients in the city.
‘We’re having to limit the number of people we start on them and at the moment in Sheffield the decision is to just let the teaching hospital start the drug.
‘In the last two years the number of people I’ve had to start on insulin, who I wouldn’t have, is outrageous. That’s life shortening and it feels like a step back to the dark ages.
‘I’ve been a GP for 32 years and I’ve never experienced anything like this and there aren’t simple switches. It’s chaos.’
Dr Jones called on the Government to do more to alleviate shortages and hold pharmaceutical companies to account. For people to be able to easily access drugs like semaglutide privately while NHS diabetes patients are missing out is ‘morally and ethically, a disgrace’, she added.
‘The reality is people are suffering and are going to become severely unwell.’
In answer to a parliamentary question about shortages of Creon in May, Andrew Stephenson, minister for state in the Department of Health and Social Care said they were aware of a disruption in supply and had issued guidance to healthcare professionals.
‘We continue to explore all management options to manage this issue. We have asked the supplier to continue confirming their future forecasts, and to inform us of any further gaps in supply of Creon 25,000 gastro-resistant capsules,’ he added.
Viatris, the UK marketing authorisation holder and distributor of Creon, told Pulse that its third-party manufacturing partner Abbott has notified it of ‘a global supply constraint of Creon (pancreatin)’.
‘This is due to high global demand and reaching maximum manufacturing supply output, as a result, current production is unable to meet all demand. This is in no way a result of any quality, safety or efficacy concerns,’ a spokesperson said.
Viatris added that although Creon strengths 25,000 and 10,000 are ‘in constrained supply’ in the UK, the company’s ‘current expectation’ that it ‘will be able to meet the majority of demand’.
It is ‘currently receiving continuous supply’ of Creon from Abbott and ‘distribution of all approved strengths of Creon to our distribution partner and onwards to pharmacies in the UK will continue as shipments arrive,’ the spokesperson said.
They added: ‘Creon is a biologic product that is made using a complex manufacturing process. Given this complexity, the local supply status may vary. Viatris and Abbott entered a long-term strategic initiative to increase the supply output of Creon, which has already been started.
‘We appreciate and understand how important it is for individuals who rely on pancreatic enzyme replacement therapies (PERTs) to have access to Creon and understand the challenges this situation poses for patients.
‘It is recommended that patients affected should speak to their treating physician to discuss treatment options, according to their health needs and their relevant clinical history.
‘Viatris is maintaining regular dialogue with health authorities and patient associations to provide frequent updates on the supply status. Viatris is also in contact with Abbott daily and has been assured that they are taking all necessary measures to provide Creon in a timely manner to minimise the impact on patients.’
In January the Government set out a plan to tackle medicines supply issues which included an online portal will be set up to allow importers of essential goods – including medicines and healthcare supplies – to report disruption affecting their supplies.
It is possible to predict difficulties well ahead of actually running out, but the alternative is to source medications privately, at higher costs, from manufacturers in America.
There seems to be some plan to encourage this.
I wonder why?
The answer is to become self-sufficient in Pancreatin – by setting up government-owned factories to produce it in Britain !
Why ever do we NOT do this??????
Medicine supply issues across the board are now endemic. With a global supply chain and manufacture mostly outsourced the UK looks increasingly vulnerable.
But I doubt “nationalised” production would be countenanced even by a Labour Govt.