‘Pharmacy bingo’: the communities bearing the brunt of the medicine shortage crisis
A global shortage of medicines is creating even more barriers for Muslim communities in accessing healthcare
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About a year and a half ago, Shaida Sebil Bunyat started to notice there was something different about the medication she was receiving to treat her epileptic seizures. She did not recognise the packaging and the tablets were a different size. Bunyat says the pharmacist did not tell her they were giving her a different brand. “They just gave it to me without my consent.” Speaking from her home in Halifax, she has just returned from a two-hour round trip to Bradford to collect her monthly prescription from her usual pharmacy.
Bunyat was diagnosed with stress-induced epilepsy when she was 11 years old. Now 24, she’s been going to this particular pharmacy, which she knows well and feels comfortable using, for two years. But over time Bunyat has increasingly been given alternative brands or versions of the medication that she needs due to national shortages in supplies. She’s noticed that her seizures have increased in frequency, from two or three a month, to recently three in one night. She worries how her body might react to a different medicine brand. “The drugs are all from different brands, the packaging is different,” she says. “I understand they all do the same thing, but realistically, you don’t know what’s in them or what you’re taking.”
Bunyat is one of many patients in the UK who have been affected by growing medicine shortages, a problem that has now reached a critical level, according to experts. Research published by the Nuffield Trust health think tank in April has shown that global supply chain problems have caused a “shock rise” in shortages of life-saving drugs used to treat many conditions, including epilepsy, diabetes and ADHD. The number of notifications by drug companies warning of impending shortages has more than doubled in three years. Epilepsy Action, a charity providing information, advice and support for people with the condition, says their helpline received more than four times more calls about medication supply between January and May compared to the same period last year.
Local pharmacies across the UK are now sounding the alarm, with Community Pharmacy England’s latest report in May indicating that 99% of staff are encountering medicine supply issues at least weekly, and 79% say patient health is being put at risk as a result.
The shortage is an international problem, and there has been a “big spike in the last two to three years”, says Mark Dayan, head of public affairs at Nuffield Trust. He refers to significant global events including the Covid-19 lockdowns, inflation and price hikes, and conflict in Ukraine as all contributing to the crisis. While Brexit may not be a driving factor, it certainly has not helped Britain’s response to the crisis, as the UK can no longer collaborate with EU member states to find solutions.
This broader context is significantly affecting pharmacies, with an additional impact on minority communities. A few months ago, Iqra Jalil was at her local pharmacy in Nottingham when she overheard a couple who did not speak English as a first language, and who did not understand what the pharmacist was telling them: the medicine they needed was not in stock. Jalil, who is a doctor, translated the situation into Urdu for them. “They said that the system was totally new to them, and that they had only been in England for a month or so,” Jalil says. “It really made me feel for them. It was once upon a time that our parents were in that position, and the medicine could have been really important to them.”
Jalil, a member of the British Islamic Medical Association, says patients often go to the pharmacy only to find their medication is not in stock, and then have to go back to the GP for further support and to find alternatives. “All of this takes time, causing a delay to the patient requiring the medicine and putting a strain on already stretched GP appointments,” she says.
“Pharmacy shortages have always existed to some extent, but broadly speaking, these were few and far between, and were very well managed so patients saw little impact,” says Ifti Khan, committee member at pharmacists’ representative body Community Pharmacy England. “Over the last few years it seems to have gotten worse and worse, with more and more medicines experiencing shortages.” This in turn is impacting patients’ health, with potential consequences including incorrect or incomplete dosages, or skipping treatment altogether.
Khan has also heard references to “pharmacy bingo”, with patients forced to visit several pharmacies to find the correct medicine and dosage. “It’s very distressing and very upsetting. Medicines are the way that patients manage their condition, that’s their lifeline, and without that, it causes pain and anxiety,” says Khan. Community Pharmacy England’s report also indicated that 97% of pharmacists reported patient frustration, and 84% said they have experienced aggression because of medicine supply issues.
Almost three-quarters of pharmacy staff estimate spending one to two hours a day or more trying to obtain medicine stock or alternatives. “It’s a huge amount of time for pharmacists, and a huge amount of money as well,” says Dayan. “This will be causing a lot of distress and extra time for patients … I’m sure there are some instances where people have missed doses.”
That uncertainty around whether her pharmacist will have the correct drug and brand is a constant source of anxiety for Bunyat. “It makes me worry because if they haven’t got it, I don’t know what I’m going to do.”
For the British Muslim community, there are specific impacts and nuances that should be taken into account by both health professionals and policymakers, say experts. “I see it all the time where a lot of Muslims have multiple comorbidities and there’s a higher prevalence,” says Khan. “They are struggling to get hold of blood pressure and diabetic medication. Especially with diabetic medication, it’s difficult to get an alternative, and it’s that to-ing and fro-ing which causes anxiety.” Jalil agrees, referring to her experience acting as impromptu translator in her local pharmacy. “Many in the Muslim community already have a barrier in front of them,” she says, which could include language or mobility issues.
On top of this, many pharmacies across the country have closed in recent years due to cuts in government funding, which has particularly affected vulnerable communities. National Pharmacy Association figures show a record 403 pharmacies closed in 2023. “Most of these pharmacies that are closing are in deprived communities, and are often where there are a large number of Muslim patients,” says Khan. Birmingham and Manchester had the most pharmacy closures in the UK between 2016 and 2023. “These patients are still being serviced, but the queues are bigger, the pharmacy is busier, and sometimes they are having to travel a little bit further to get to a pharmacy, and all of that has a knock-on effect.”
Ahead of the upcoming general election, and with concerns around the NHS and healthcare high on the agenda for British Muslims, Khan hopes that patients and communities will speak to their MPs about medicine shortages. “If everyone can raise the issues they’re experiencing, like their local pharmacy is closing, and make their MP more aware of it, this is an opportune moment that we can use.”
Raising awareness is also important to Jalil, who says there should be greater attention paid to cultural sensitivities in pharmacies, GP surgeries and hospitals, including language and ways of explaining the shortage to those who may not immediately understand. “Medicine is advancing so quickly and we are diagnosing more diseases which demand more treatment. With that, our problems with medicine shortages need to be tackled before they become really bad. They are bad now, but people aren’t actually aware,” she says.
At a policy level, Dayan would like to see the UK being more transparent, specific and communicative about medicine shortages. The European Medical Agency publishes a list of drug shortages, for example, but the UK does not. “This guessing game just creates more uncertainty,” he says. Nuffield Trust’s report also recommends that formal trade agreements and health frameworks between the EU and UK should reopen to help alleviate medicine supply issues and other aspects of health security in the UK.
Although the shortage issues are out of her control, “I try my best to look after myself, to take my medication on time — I do everything I can,” says Bunyat. She ensures she takes photographs of and documents anything related to her epilepsy, as she has had experiences where a healthcare professional has not believed she has the condition, and has been denied emergency medication. “Sometimes I feel like it’s because I’m Muslim, they don’t care,” she says.
Despite the challenges, she remains resilient, and has empathy for others who may be experiencing the same thing. “Epilepsy is really scary, but I want people to know that it’s going to be alright. I have had faith in myself that I could persevere.”
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