Eluned Morgan MS, Minister for Health and Social Services
Since March 2015, there has been a more than 90% increase in the number of prescriptions for Hormone Replacement Therapy (HRT) in Wales. In the face of increasing demand, a number of HRT products across the UK are in short supply.
These supply problems are limited to a small number of HRT products, but for those women who are unable to have their usual HRT prescriptions dispensed, the implications can be significant.
This statement sets out the action being taken to ensure women are able to continue obtaining HRT – or a clinically equivalent medicine – to meet their needs.
On 29 April, together with the rest of the UK, we implemented Serious Shortage Protocols (SSPs), allowing community pharmacists to limit the quantity of three HRT products – Oestrogel gel, Ovestin cream, and Premique low-dose modified-release tablets – which are experiencing supply issues, to no more than the equivalent of three months’ treatment.
On 23 May, further SSPs were published, limiting supplies of Sandrena gel sachets and Lenzetto spray. Limiting supplies in this way will help ensure more women are able to access the HRT they need now, while manufacturers take action to increase supply of these products in the medium and longer-term.
In some cases, it may be necessary for women to use a different form of HRT product. The British Menopause Society has produced comprehensive guidance for clinicians on the equivalence of HRT products and switching between them. This guidance was shared with GPs and community pharmacists earlier this month.
Switching between HRT products should be a shared decision between a woman and a clinician with experience in prescribing HRT. In limited circumstances, it may be appropriate for a community pharmacist to dispense an alternative HRT product where it is clinically equivalent. Four further SSPs were published on 23 May allowing community pharmacists to supply specified alternative forms of HRT against prescriptions for Oestrogel, Ovestin, Sandrena and Lenzetto where appropriate counselling takes place and only with a woman’s consent.
The UK Government is responsible for maintaining the continuity of supply of medicines to the UK, and my officials are continuing to work closely with their counterparts in the UK Government and with the NHS to maintain the supply of medicines and ensure women are able to get the medicines they need.
Improving continuity of supply of HRT is just one part of improving care for women experiencing the menopause.
I expect all health boards to provide a full range of services, in accordance with National Institute for Health and Care Excellence (NICE) guidelines, including the requirement to adopt an individualised approach at all stages of diagnosis, investigation and management of menopause and the need to refer women to a healthcare professional with expertise in menopause if treatments do not improve menopausal symptoms or they have ongoing troublesome side effects.
To support the development of improvements to menopause services in Wales, we are setting up an all-Wales menopause task and finish group with representation from primary care, secondary care and patient representatives. We are aware that there are local arrangements that might be scalable across Wales and we would like to ensure that best practice is shared across the country.
Finally, I have agreed to take part in the UK Menopause Taskforce announced earlier this year. The purpose of the taskforce is to share best practice, accelerate delivery of menopause-related programmes of work, and take a holistic view of the menopause as a life event faced by every woman.
We will continue to keep the availability of HRT products and the success of these measures to improve availability under review.