Civility in healthcare: Enhancing teamwork, safety, and satisfaction

The UK is grappling with significant medicine shortages, a crisis that has profound implications for public health and patient safety. Geopolitical factors such as Brexit, the war in Ukraine and the COVID-19 pandemic have contributed to supply chain disruptions and drug shortages. Economic factors, including inflation and currency fluctuations, have further strained the ability of suppliers to meet demand.  

The Government has described medicine shortages as “an ongoing issue that the Department of Health and Social Care has been managing for many years” with a report by The Nuffield Trust citing a ‘shock rise’ in shortages of life-saving drugs like antibiotics and epilepsy medication.  

The impact of shortages on GPs

These medicine shortages have a profound impact on doctors, affecting their ability to provide optimal care and placing additional stress on their professional responsibilities. When essential medications are unavailable, doctors are forced to spend time and resources searching for alternatives, which can delay treatment and negatively impact patient outcomes. This often involves consultations with pharmacists, other healthcare providers, and sometimes patients, to identify suitable substitutes that might not be as effective or familiar. 

In a recent survey by MDDUS, 90% of GPs reported that the shortage of prescription medicines is severely hampering their ability to practice safely. Of the 397 GPs surveyed, 94% reported an increase in their workload caused by having to find suitable alternatives for unavailable drugs.  

Many doctors have also faced unacceptable aggression or complaints from frustrated patients who can’t get their usual medications. This, coupled with the impact of knowing that often a patient’s care is being adversely affected by the shortages, is negatively affecting many clinicians’ mental wellbeing. In fact, three quarters of GPs surveyed say they are facing debilitating moral distress because they cannot access the medicines they know their patients need. Understandably, the risk to patients and clinicians of a prescribing error is heightened in these circumstances.

What doctors can do in the face of medicine shortages

In some circumstances, doctors might be able to prescribe an alternative drug to treat a patient’s symptoms. The GMC’s guidance on ‘Good practice in prescribing and managing medicines and devices’ states that doctors ‘must only prescribe drugs when you have adequate knowledge of your patient's health. And you must be satisfied that the drugs serve your patient's need.’ 

If a particular medicine is out of stock and you are considering prescribing an alternative, you must think about the following: 

1. Is the request necessary? 

• Is there a genuine national shortage of the original drug or could it be obtained from another pharmacist? 
• How urgent is the request? When will the patient run out of medication? Might the drug be available before then?
• Bear in mind that in some circumstances the safest clinical approach might be that the patient temporarily discontinues the medication. 

2. Can you justify your prescribing decision? 

• Ensure any alternative drugs you prescribe are safe, appropriate for the patient and within your competence. 
• Make sure you check the patient’s history, other medications and allergies before prescribing an alternative drug. 
• Take into account any local or national guidance available, which may have been amended to take account of drug shortages. 
• Consider whether you should seek any further advice from experienced colleagues or pharmacist before deciding whether to prescribe an alternative. 
• If you are thinking about prescribing an unlicensed medication, be aware of the GMC’s guidance, which sets out when an unlicensed medication might be appropriate and actions you should take when prescribing it. 

Maintaining good patient relationships when there are medicine shortages

Medicine shortages can be frustrating and undermine the doctor-patient relationship. Patients may become frustrated or anxious when their prescribed medications are unavailable and doctors may struggle to maintain trust and provide reassurance. The need to frequently adjust treatment plans can also lead to increased medical errors and complications, further burdening healthcare professionals. 

Doctors should listen with empathy to any concerns or frustrations their patients have and provide reassurance that their health is a priority. They must keep patients informed about any changes to their medications, and make sure they understand the reason for any drug changes, including the risks and benefits as well as any side effects and contraindications. Doctors must also make patients aware of any changes to dosages and frequency compared with their usual medications.  

If prescribing alternative drugs to a patient, document the reasons for these changes including any advice you have sought and discussions with the patient. 

Doctors should seek support, if needed

The pressure to manage medicine shortages can contribute to burnout among doctors, many of whom already work in high-stress environments. Administrative tasks associated with tracking and reporting shortages, coupled with the emotional toll of seeing patients suffer due to lack of necessary medications, can exacerbate the mental and emotional strain on healthcare providers. It is therefore crucial doctors recognise the impact of managing shortages on their own health and wellbeing and seek expert support where needed. 

Further reading 

This page was correct at the time of publication. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

1 The price of incivility. Porath C, Pearson C, Harvard Business Review 2023 Jan-Feb; 91(1-2): 114-21, 146