By Matt Johnson, Community Pharmacist, Jersey

From the outside, Jersey can look insulated - a small island, separate government, different health system. In reality, when it comes to medicines supply, we are more exposed than almost anywhere else.

That’s because Jersey doesn’t have its own medicines pricing system. We rely on the UK Drug Tariff to value medicines, even though none of the UK government funding applies here. When reimbursement shifts in England, Jersey absorbs the impact immediately - but without the same safety nets, scale, or optionality.

In short: when the UK sneezes, Jersey catches pneumonia.

A pricing system that doesn’t match reality

The Drug Tariff is built around assumptions that simply don’t hold in Jersey.

It assumes:

  • Multiple wholesalers

  • Rapid substitution when stock doesn’t arrive

  • Same-day or next-day delivery

In Jersey, we have three main wholesalers. If one can’t supply, there often isn’t an alternative. If a delivery misses a boat, the delay can be a week - longer in winter, or for temperature-sensitive products.

Yet reimbursement is still based on UK mainland pricing, including concession prices derived from wholesalers we cannot access.

That’s not just inefficient. It actively pushes pharmacies into decisions where the least bad option is still a financial loss.

Why “shortages” are often the wrong diagnosis

One of the most misunderstood aspects of medicines supply - both in Jersey and the UK - is the idea of “unexpected shortages”.

In many cases, there is no sudden absence of product. What breaks first is price viability.

I was recently asked for my professional opinion about the current co-codamol supply issue, my answer was straightforward:

“I haven’t seen a supply problem. I’ve seen a pricing problem.”

The product exists. The question is whether pharmacies can buy it at a price that doesn’t guarantee a loss.

Once pricing signals break, behaviour across the supply chain changes rapidly. Manufacturers redirect stock. Wholesalers de-prioritise lines. Pharmacies stop holding buffer stock. What looks like a sudden shortage is often the final stage of a process that has been quietly building.

Logistics amplify every crack in the system

Jersey magnifies these pressures.

Winter temperature restrictions can halt many liquid supply lines entirely for months. Fridge products can be returned to the UK if a ferry is delayed - refunded, reordered, and often delayed again. Credits must be chased. Stock uncertainty becomes normal.

As a care-home focused pharmacy responsible for hundreds of vulnerable patients, “sending someone down the road” isn’t an option. If the medicine is needed, we absorb the cost.

That might be survivable in isolation. It isn’t survivable as a system.

Overlay this with the wider funding environment and the picture worsens.

Dispensing fees can be frozen. Costs continue to rise. Minimum wage increases are mandated. Yet pharmacies are allowed no meaningful ability to offset these pressures - no co-payments, no PGDs, no alternative income routes.

Any “uplift” tends to arrive packaged as additional services, pulling pharmacists away from core dispensing work while leaving the underlying economics unchanged.

It’s a pattern UK pharmacy will recognise immediately.

The long game is being lost

This isn’t a new problem. It’s the result of well over a decade, possibly two decades, of consecutive UK Governments driving medicine prices ever lower and calling it efficiency.

Paying the cheapest possible price is not a badge of honour. In any other sector, it would be recognised as a warning sign.

You can optimise for the lowest price, or you can optimise for resilience and reliability. You cannot do both indefinitely.

Small markets like Jersey feel the consequences first - fewer suppliers, thinner margins, less tolerance for shock. But the direction of travel is the same.

What needs to change

Medicines shortages don’t “come out of nowhere”. They arrive after economic signals have been ignored for too long.

If governments want secure supply, they have to pay for systems that can survive volatility:

  • Pricing stability, not constant erosion

  • Reimbursement that reflects real-world logistics

  • Early visibility of stress, not retrospective declarations

Until then, we will keep misdiagnosing the problem - and acting surprised by outcomes that were entirely foreseeable.