The reign of Boris begins…
Boris Johnson has caused quite a storm in his first few weeks of Prime Minister, while many of his pledges have been viewed with caution, new funding opportunities could represent opportunities for industry.
Nearly new funding announced
The new Prime Minister, Boris Johnson, has announced an extra £1.8bn funding for the NHS.
The funding will go towards new equipment and upgrades to 20 hospitals, primary care services and a £6m backlog of maintenance projects.
Johnson said the funding will mean “more beds, new wards, and extra life-saving equipment”, which may represent opportunities for industry. You can view the 20 areas that have been cited as receiving extra funding by following this link.
Sceptics were quick to point out that the funding is not “new money” but is largely being funded by last month’s request from NHS England that trusts cut their capital spending plans by 20 per cent.
This, as senior policy analyst at Nuffield Trust Sally Gainsbury explained, is: “The equivalent of giving someone cash then banning them from spending it, only to expect cheers of jubilation when you later decide they can spend it after all.”
A sticking plaster for social care
The Prime Minister’s promise to “fix the crisis in social care once and for all” has also been met with criticism.
Cynics voiced that, although focus on the problem is welcome, publishing a white paper “within weeks” without proper research, analysis and reasoning, is likely to mean that the policy is destined to fail.
The Guardian highlighted that just to get back to the levels of access to help that existed in 2009-10 would cost at least £8bn a year in England alone. It will be interesting to see the government’s fresh approach to resolve the problem.
Investing in artificial intelligence
Johnson also pledged to provide £250m of funding for the NHS to set up a national artificial intelligence (AI) lab to enhance care and research.
The lab will use capabilities in AI to improve the detection of diseases, automate admin tasks to free up staff to care for patients and provide a more personalised service to patients.
The lab will sit within NHSX, a relatively new organisation that has been trusted with overseeing the digitisation of the health and care service. This makes it an extremely important organisation for industry to engage with.
Bracing for Brexit
In the wake of comments from the Royal Society and other science groups that a no deal would be the “worst option” for UK science, Johnson has also announced plans to introduce a fast-track visa scheme to make it easier for top scientists to work in the UK, amid reports that Brexit is already discouraging researchers from coming to the country.
Plans to invest £434m in medicine stockpiling and freight capacity in order to prevent drugs shortages in the event of a no-deal Brexit were also announced.
In other news…
Care Quality Commission quality ratings
The Care Quality Commission’s (CQC) annual reports and accounts demonstrated that almost a fifth of practices in England previously rated as ‘good’ have deteriorated to a lower rating.
Find out which category the practices in your area fall into – can improvements or failures be linked to the work you are undertaking in the area?
Primary care networks
The Health Foundation and Community Network have produced useful guides that explain the role and responsibilities of primary care networks (PCNs).
From July 2019, all patients in England should be covered by a PCN. They will be in charge of structured medicines review and optimisation (as outlined in the briefing by the health foundation), which makes them extremely important organisations for industry. (Follow the links to learn more about them).
The Department of Health and Social Care has also published purchasing point information for pharmaceutical buying groups in the NHS that have access to Commercial Medicines Unit (CMU) contracts.
NHS Medicines Procurement in England is coordinated through a structure headed by the CMU, which sits within the Specialised Commissioning Directorate of NHS England. The CMU is responsible for awarding and managing frameworks for licensed medicines for the regional purchasing groups in compliance with public procurement regulations.
Four in 10 emergency admissions to hospital from care homes could be avoided with better provision of preventive primary care, community support, or NHS care on site says a study by the Health Foundation.
Public and mental health
Detail on the updated Public Health Outcomes Framework indicators have also been published following a government consultation and a five year plan to improve mental health services has been released.
Have a question related to any of the topics covered here? Ask MIA
The carrot and the stick
The past fortnight has seen lots of useful information published for industry representatives that are looking to develop their strategies around the specific needs of NHS organisations and their wider health economies. Whether you are looking to develop your understanding of the financial outlook of the organisations in your area, or if you are hoping to target your products to areas of need, the sources available this week are brimming full of useful opportunities and resources for industry.
Department of Health and Social Care annual report paints a “challenging” picture
The Department of Health and Social Care’s Annual report and accounts 2018/19 presents a stark picture of the NHS, with many of the core waiting time and access targets being missed.
These include A&E, referral to treatment, cancer treatment, diagnostic tests and ambulance response standards.
The number of providers in deficit has also risen to 107 from 101 last year, although somewhat surprisingly, the report states that the health and care system delivered an overall financial balance.
Although, we must not forget the £600m in-year support that was provided by the treasury.
Industry can however expect the tight grip on the NHS budget to continue while the system works to strike ‘the right balance across performance, transformation, quality and safety - and living within its financial means.
Industry should use the report to identify where your products could help to support improvements to these targets, it also contains useful information about how funding is allocated, as displayed in the chart below
Deficits depicted in the King’s Fund quarterly monitoring report
The King’s Fund latest Quarterly Monitoring Report (QMR), presents a similar picture.
The think-tank states that although the NHS is going through a time of ‘relative plenty’ when compared to the recent past, the underlying financial, staffing and performance challenges facing health and care continue.
According to the survey of finance directors:
- More than a quarter (27 per cent) expect their trust to be in deficit at the end of the current financial year
- Four-fifths (81 per cent) expect the NHS provider sector to miss the target set in the NHS long-term plan for it to be in balance in 2020/21
- A similar proportion (79 per cent) expect the NHS to miss the target in the long-term plan that deficits in all NHS organisations will be eliminated by 2023/24
The King’s Fund says that this suggests that money that has been earmarked to invest in improving services may be needed to cover unplanned deficits, potentially putting the ambitions set out in the long-term plan at risk.
NHS performance is also described as below par, largely due to waiting times not being met.
On a positive note, the 2019 GP patient survey showed that patient experience is overwhelmingly positive, with nine out of ten patients saying that they have confidence and trust in their GP and ‘feel listened to and involved in decisions about their care’.
This highlights that patients having a greater say in the treatments that they receive and the products that are used.
However, the report states access to GPs remains “a significant problem”, a view that is mirrored in the latest hospital performance figures where the number of people waiting for planned hospital treatment reached a record 4.5 million in May.
Publication of the CCG annual assessment report represents opportunities for industry
Of most use to industry will be the publication of CCGs annual assessment report, which contains data which rates CCGs across 58 different metrics that range from financial stability to leadership and the quality of service provision.
This information is vital to those of you that are looking to develop strategies that are aligned to the needs and requirements of the NHS.
It is worth noting, CCGs that are rated inadequate are subject to closer monitoring and required to take remedial action, while those that have been rated outstanding and gain additional funding and freedom to act. Look for performance trends and integrate them into your strategy.
A big freeze for community pharmacy
Another blow to the NHS finances was the publication of the community pharmacy contract which revealed that funding has been frozen at £2.59bn for the next five years.
Despite a real-terms cut to their budget, pharmacist will have an increased clinical role going forward, making them increasingly important stakeholders for industry.
Of note to industry will be:
- medicines use reviews are being phased out over the next two years. Instead, clinical pharmacists will review medicines in primary care networks, where the pharmacist will have access to patient records and be able to adjust prescribing
- establishment payments paid to pharmacies that dispense a certain number of prescriptions annually are being phased out
- the Community Pharmacist Consultation Service will launch in October 2019 (combining the Digital Minor Illness Referral Service and the NHS Urgent Medicine Supply Advanced Service into one service). Pharmacists will receive £14 per consultation
- pharmacists will also receive £5.35 for each item supplied under the serious shortage protocols, which came into force in July 2019
Funding opportunities for industry announced
The Government has announced the decision to invest £16 million in 13 precision medicine projects from UK-based small or medium-sized enterprises (SMEs) that aim to improve the diagnosis and treatment for cancer and heart disease, amongst others as part of the Government’s modern Industrial Strategy.
Medical companies also have the chance to win a slice of £22m to develop digital pathology technologies, which could help medical professionals diagnose diseases.
The NHS also announced plans to test a first-of-its-kind ‘subscription-style’ payment model that will help incentivise companies to develop new drugs needed to tackle resistant infections.
Companies are set to be paid based on the value the medicine brings to the NHS, for example whether it targets a high-priority infection, rather than for the sheer number they sell. This will make the UK the first country in the world to trial a new way of paying for antibiotics and may represent an approach that could be rolled out to other clinical areas.
In addition the government has confirmed it is renewing the Better Care Fund for the current financial year of 2019-20 bringing the pooled funding to more than £6.4bn.
NICE has announced plans to review how it develops guidance on drugs, focusing on issues such as modifiers used in decision making and dealing with uncertainties in evidence.
The review will cover NICE’s technology appraisals, highly specialised technologies, medical technologies, and diagnostics assessment programmes.
Topics under consideration include:
- dealing with uncertainty in evidence and how to reduce it
- how data analytics and real-world evidence are used
- the challenges in assessing new technologies such as cancer drugs that target tumours based on their genetic characteristics and expensive cell and gene therapies
- how quality of life is incorporated into economic analyses and considered
- methods to assess clinical and cost effectiveness of the position of technologies in the care pathway
Proposals will be presented for public consultation in summer next year.
A new online hub has been launched to share and develop ideas around patient safety, from clinical pathways, to data sharing, telehealth or apps, which may represent opportunities for industry.
The government has announced plans to set up the most comprehensive “composite health index” yet which will track whether the population’s health is getting better or worse and the stark difference between rich and poor when it comes to illnesses such as cancer, diabetes and heart disease.
A report commissioned by The Salvation Army has revealed that rural communities are being worst hit in the adult social care crisis.
Adult social care is largely funded by local business rates, council tax and other local charges but areas with lower house prices, fewer businesses cannot raise as much money as more urban areas.
This has led to deep levels of funding inequality across the entire country and prevents most local authorities from providing adequate social care for older residents – this will be important for industry representatives in these areas to consider and keep an eye on developments.
In a column for Digital Health News, Dr Neil Paul describes the struggle of introducing innovation to primary care, which includes some useful tips for industry.
The Care Quality Commission has published a series of case studies which set out how digitally-enabled care can offer significant benefits to patients and the NHS has teamed up with Amazon to bring Alexa to patients useful information - does industry need to play a role in ensuring patients receive the most up to date accurate information?
A few words prompt lots of action at NHS England and NHS Improvement’s monthly board meeting
Publication of the Long Term Plan Implementation Framework has sparked a flurry of activity within the NHS, as local health systems work to develop their strategic plans, which will dictate the priorities of the NHS for the next five years. Industry should prepare to take action.
Long-term plan implementation framework revealed
NHS England and NHS Improvement board meetings are an excellent source of information for industry representatives that want to stay on top of the latest NHS developments.
The June 2019 meeting was no different with the publication of several important documents, including the hotly anticipated Long Term Plan Implementation Framework.
The framework sets out the expectations for local health economies’ (sustainability and transformation partnership and integrated care systems) strategic plans, which are being developed over the summer.
The plans will form the foundation of system changes over the next five years to 2023/24 and will demonstrate how funding will be prioritised. It is important that industry engages with the process before spending decisions are taken.
Of particular interest to industry will be the frameworks:
- Outline of additional streams of funding to help systems achieve their plans (p28).
- The requirement for each area to include a digital strategy and investment plan in their plan.
- Calls for the NHS to achieve cash releasing productivity growth of at least 1.1% a year – which will directly impact industry.
Measures that have been proposed to achieve these savings include:
- The implementation of electronic tools (including e-rostering and e-job planning).
- Increasing the role of pharmacy staff with treating patients.
- Maximising the buying power of the NHS through the use of the Purchase Price Index and Benchmarking Tool, Getting It Right the First Time and Support Supply Chain Coordination Limited.
Improving patient safety is also highlighted as an area where substantial cost savings can be made. The framework requires that local health systems set out how they will contribute to the improvements described within the National Patient Safety Strategy, which was also published recently.
Safety initiative aims to help realise savings and improve quality within the NHS
The NHS Patient Safety Strategy will be of particular interest to people working in pharmacovigilance, patient safety and quality roles, as it contains information on:
- The replacement to the National Reporting and Learning System (p20).
- The Medicines Safety Improvement Programme (MSIP) (p50), which aims to reduce the estimated 237m medication errors that occur in England every year, by focusing on high-risk drugs and vulnerable patients.
- Encouraging innovation as an essential factor to achieve improvements to safety, which may represent opportunities for industry (p60).
Clarity on QOF and the QP contract
The NHS England and NHS Improvement board meeting also provided more understanding on elements of the new GP contract, including the first draft modules of the revised quality and outcomes framework (QOF), which will be pleasing to those selling to primary care.
The report published by Ian Dodge, national director of strategy and innovation, details the initial pipeline of new quality improvement modules for QOF and as these are directly related to the amount of funding received by GPs they represent a large opportunity for industry professionals selling to primary care to work in partnership with the NHS.
Primary care networks go live
July also saw the official roll out of primary care networks (PCNs), an important new provider that industry should be aware of.
PCNs were announced as a key part of the NHS Long Term Plan, with all general practices being required to be in a network by June 2019.
Approximately 7,000 surgeries across England have come together to form 1,200 primary care networks to deliver a wider range of specialist care services.
Long Term Plan Implementation Framework: System Support Offer, published alongside the implementation framework, contains a wealth of useful information for industry representatives. Key stakeholders leading on making changes to priority areas within the NHS are listed, alongside the key actions that they are undertaking, which industry may be able to support. We suggest you scan the document to see what information is relevant to the area that you work.
The NHS England and NHS Improvement board meeting also saw the publication of a list of seven medications and treatments which should not be prescribed in primary care, because it believes they have “low clinical effectiveness” or “more cost-effective products are available”.
NHS England has pledged funding for children’s hospices will rise to £25m a year, advocating that investment in “medical advances mean the NHS can help seriously ill children and young people with more complex health issues live longer, more fulfilling lives”.
In comparison, social care is still in dire straits, as emphasised by the House of Lords Economic Affairs Committee’s report, which describes social care funding as a “national scandal”.
Changes could be on the horizon to the National Institute for Health and Care Excellence health technology assessments (HTA) and guidance development processes.
NICE and Myeloma UK outlined the findings of a research project that showed scope for the better use of quantitative patient preference data in HTAs.
Currently, patient perspectives are provided by a small number of patients in narrative form, but the system does not always capture how treatments are valued by patients, as patient experience can be particularly hard to quantify compared against other evidence such as clinical trial data.
The changes could help ensure new treatments reflect the needs and preferences of patients and family members.
NICE has also launched a consultation looking to extend the use of data that helps to inform its independent committees who produce its guidance.
Public Health England has published a series of data and analysis tools which will be of use to industry professionals in strategic roles that are looking to target products and services to areas of need.
The resources cover a wide range of public health areas, including:
- Specific health conditions – such as cancer, mental health, cardiovascular disease.
- Lifestyle risk factors – such as smoking, alcohol and obesity.
- Wider determinants of health – such as environment, housing and deprivation.
- Health protection, and differences between population groups, including adults, older people, and children.
Want more information on any of the topics covered here? Ask an expert.
NHS Confederation Conference 2019: Key messages for industry
Niall Dickson, Chief Executive of the NHS Confederation has called for extra investment in technology to help “transform patient experience” and to achieve closer collaboration between the NHS and the life sciences industry.
Speaking at the Confederation’s annual conference last week, Dickson announced that in support of this ambition, the Association of the British Pharmaceutical Industry and NHS Confederation have published a joint report demonstrating opportunities where patients, the health service and key suppliers can benefit from collaboration. However, the report also highlights where difficulties currently lie.
NHS England Chief Executive Simon Stevens revealed that the much-anticipated NHS Long Term Plan Implementation Framework will be published next week.
This will include a more transparent financial regime for trusts, with more realistic control totals and a rules-based, predictable regime so that all financial routes will be visible across organisations.
Anita Charlesworth, director of research and economics at the Health Foundation, gave a stark warning that hospital activity will need to rise by at least 2.7 per cent a year by 2023/24 to keep up with current demand. However, she said current funding levels will not be sufficient for this level of growth.
A new ambition for cross-sector collaboration with the life sciences industry
Next Prime Minister must not duck social care challenge, says NHS Confederation
“Our service model needs to continue to change” - Simon Stevens
Stevens’ push on capital funding, social care and public health welcomed by NHS Confederation
ABPI publishes guidelines on working with patients and achieving greater collaboration with the NHS
The NHS and life science industry are failing to collaborate effectively, according to a new report published by the Association of the British Pharmaceutical Industry and NHS Confederation.
A new ambition for cross-sector collaboration with the life sciences industry to support NHS sustainability and transformation highlights a number of barriers that have resulted in collaborative projects between the NHS and industry failing to get off the ground and falling short of expectations. These include:
- A lack of sustained resources.
- The NHS being set up to deal with immediate matters, not the exploration of future models.
- Difficulty of scaling projects, which means that the NHS has engaged in a plethora of successful local programs but failed to spread them around the country.
- NHS bodies being “actively instructed not to deal with industry by their local leadership”.
- Distrust towards biopharma companies due to a belief that businesses put profits over patients.
The report identified more than 10 actions the NHS and industry should take to make improvements.
This week also saw the publication of a guide by Veeva on how to optimise engagement with healthcare professionals through digital channels.
The report states that more effective digital engagement can unlock access to hard-to-reach healthcare professionals and build relationships with customers that have “gone dark” in recent years.
Finally, in the quest to achieving greater collaboration between the NHS, industry and patients, the ABPI have published a new guide for pharmaceutical companies working with patients.
The guide contains information on how to “work successfully, collaboratively and ethically with patients and patient groups and in line with the ABPI Code of Practice”.
ABPI report: A new ambition for cross-sector collaboration with the life sciences industry to support NHS sustainability and transformation
NHS Confederation: A new ambition for cross-sector collaboration with the life sciences industry
Veeva: Reaching HCPs in the Age of Digital Engagement
Collaboration is better than competition, proposed NHS legislative changes rule
The Health and Social Care Committee believes that collaboration, rather than competition, is a better way for the health and care system to respond to today's challenges, according to their new report.
NHS Long-Term Plan: legislative proposals supports NHS England and NHS Improvement's suggestion to repeal section 75 of the Health and Social Care Act 2012.
It also recommends that the law should rule out non-statutory providers holding an Integrated Care Provider contract and supports the proposal to give the Secretary of State powers to create new NHS trusts.
The report states that competition rules add costs and complexities, without corresponding benefits for patients and taxpayers in return. In comparison, it says that collaboration represents a better way to manage the rising demands on health and social care, improve joined up care for patients and deliver better value for taxpayers.
However, the Health and Social Care Committee warned that NHS should not become a monopoly as this would not be in the best interests of patients.
Niall Dickson, chief executive of the NHS Confederation, said in response to the report: “Our big worry in the NHS England/Improvement proposals was what looked like a move to greater centralisation – even if that isn’t the intention. We all want local NHS organisations to work more collaboratively but that will not happen by stripping away local autonomy and giving more powers to the centre.
“And while we support the Committee’s view that NHS England/Improvement should come together under a single national leadership, we share its concerns that the centre could become too powerful. That’s why we are pleased the MPs agree that the centre should not start to direct mergers, acquisitions and the capital spending limits of foundation trusts.”
King’s Fund: NHS long-term plan: legislative proposals
NHS Confederation: Step in the right direction - NHS Confederation welcomes MPs’ report
National Health Executive: NHS Providers chief executive Chris Hopson gives his verdict on NHS long-term plan legislative report
CQC report advocates for better medicines management
The Care Quality Commission has published a report that aims to improve medicines management across health and social care providers.
Medicines in health and adult social care: Learning from risks and sharing good practice for better outcomes identifies areas of risk where medicines errors commonly occur and highlights areas of improvement. In particular, the report advocates the positive impact of involving pharmacy professionals in decisions.
The CQC said: “We know that people’s physical and mental health outcomes improve when medicines are used in the best or optimal way. When they are not prescribed or administered correctly they can cause harm.
We want to encourage improvement by sharing what we have found through our regulatory work and giving examples of how some providers have reduced these risks.”
CQC: Medicines in health and adult social care: Learning from risks and sharing good practice for better outcomes
Digital Health.Net: Special Report: Medicines Management
Mental health spending varies widely across England
Mind, the mental health charity, looked at mental health spending across 42 NHS regions and found that there is nearly a two-fold difference across England.
Surrey Heartlands spent the least - £124 per person last year - compared with South Yorkshire and Bassetlaw, which spent more than £220.
What is NHSX?
NHSX is the new joint organisation for digital, data and technology. Its mission statement is to make sure patients and staff have the digital technology they need.
The new body's responsibilities include:
- Supporting the use of new technologies by the NHS, both by working with industry and via its own prototyping and development capability.
- Setting national policy and developing best practice for NHS technology, digital and data – including data-sharing and transparency.
- Setting standards – developing, agreeing and mandating clear standards for the use of technology in the NHS.
- Ensuring that NHS systems talk to each other across the health and care system.
- Helping to improve clinical care by delivering agile, user-focused projects.
- Ensuring that common technologies and services, including the NHS App, are designed so that trusts and surgeries do not have to reinvent the wheel each time.
- Making sure that all source code is open by default so that anyone who wants to write code for the NHS can see what the service needs.
- Reforming procurement – helping the NHS buy the right technology through the application of technology standards, streamlined spend controls and new procurement frameworks that support NHS standards.
- Setting national strategy and mandating cyber security standards, so that NHS and social care systems have security designed in from the start.
- Championing and developing digital training, skills and culture so NHS staff are digital-ready.
- Delivering an efficient process for technology spend, domain name management and website security.
Twitter – NHSX
NHS Assembly line-up announced
A full member list of the NHS Assembly has been announced, ranging from GPs and patients, to health and care system leaders.
The forum will support delivery of the NHS Long Term Plan and advise NHS England and NHS Improvement.
NHS Assembly members are drawn from national and frontline clinical leaders, patients and carers, staff representatives, health and care system leaders and the voluntary, community and social enterprise sector.
More than 500 people applied to sit on the Assembly, with the successful applicants chosen based on their individual knowledge, skills and experience.
NHS England - NHS Assembly announced to help deliver the Long Term Plan
Determinants of health infographic
GoInvo has produced an infographic detailing how 89% of health occurs outside of the clinical space through genetics, behavior, environment and social circumstances. These factors are known as the social determinants of health.
It illustrates how medical care only contributes to a small portion of overall health. The most prevalent issue in medical care is the lack of access to health services, as well as a decreasing level of health literacy in the general population.
GoInvo - Determinants of Health
Medtech landscape review
A new report provides a useful review of the medtech landscape - an industry that accounts for over 86,000 jobs in the UK.
The AHSN Network review looks at how the NHS spends approximately £6 billion a year on medical technology and how the industry negotiates the innovation pathway when seeking uptake for its products.
AHSN Network website - New report maps the MedTech landscape for innovators in England
Medical Director reports on access standards
The NHS National Medical Director has published a clinical review of standards across the NHS, to determine if any older targets needed updating.
Professor Stephen Powis claims that patients should see four main benefits:
- "The NHS will be rolling out short waits for a far wider range of important clinical services."
Patients should benefit from newly established standards covering areas such as mental health and community health services that previously have been neglected.
- "Greater emphasis will be given to standards that help improve clinical quality and outcomes."
Eg, earlier diagnosis of cancer and faster assessment and treatment for major emergencies such as heart attacks, stroke and sepsis.
- "We want to lock-in short waits for A&E and planned surgery."
The current A&E and elective care targets will be changed. Eg, they do not distinguish between the hospital where 10% of patients wait five hours to complete their A&E treatment versus the hospital where 10% wait eleven hours.
- "The new standards will help, rather than penalise, hospitals who modernise their care."
Eg, if a GP is able to discuss a patient’s diagnosis directly with a hospital specialist, so that the patient doesn’t have to travel to a hospital outpatient appointment, that makes the hospital’s waiting time statistics look in the way the statistics are currently calculated.
NHS England document - Clinically-led Review of NHS Access Standards
Failing to capitalise
A think tank says a short-termist approach has led to years of declining and inadequate capital spending, which has put patient care and staff productivity at risk for the NHS in England.
The Health Foundation warns in a report that an ageing infrastructure, combined with a substantial and growing repairs backlog could undermine ambitions to transform the health service.
Health Foundation document - Failing to Capitalise
CCGs and the NHS Long Term Plan
MPs have published a report examining proposed changes to the structure of NHS commissioning organisations.
It describes how the NHS Long-Term Plan intends for integrated care systems to cover the whole of England by 2021, leading to a reduction in the number of clinical commissioning groups (CCGs).
The report finds that many CCGs are currently underperforming, and concludes that they will need to improve as they take on responsibility for commissioning services across larger populations. The committee of MPs add that getting the commissioning structures right will be an important part of delivering the NHS Long-Term Plan.
House of Commons Committee of Public Accounts document - Clinical Commissioning Groups
Hospitals experiencing medicine shortages
Hospitals are struggling to source drugs amid uncertainty over the UK’s future relationship with the EU, health leaders have warned.
Some hospitals are reporting difficulties in obtaining around 160 drugs per day, which is more than five times what they would normally expect.
NHS Providers, which represents trusts in England, told BBC's Newsnight programme that one trust had reported a shortage of 300 different drugs.
The NHS has been told not to stockpile medicines, as the Government claims plans are in place to ensure supplies are continued in the event of a no-deal Brexit.
BBC News website - Unprecedented drug shortage linked to Brexit, NHS bosses say