Shortages

Medicines Shortages

 

​​If your pharmacy is informed by a particular wholesaler that a medicine is out-of-stock, this may indicate a bigger medicines shortage.  To try and preserve continuity of a patient’s medicines wherever possible, have you…

  • Confirmed with the wholesaler whether it’s short term or longer term unavailability, and whether there is a resupply date?
  • Checked if your distributor might have stock in other depots that could be moved to your area?
  • Contacted other wholesalers to see if they have stock? (Consider using more wholesalers outwith your usual ones)
  • Contacted other local community pharmacies to see if they have stock that you can ‘swap’ in order to fulfil the prescription?

 

If you have followed these steps with no success, then please check the NHS Lothian Primary Care and Community Pharmacy Shortages webpage (see link below) to see if this already a known shortage.  If it isn’t already a known shortage, it’s really important you report this immediately through two main channels:

 

1) Community Pharmacy Scotland Shortage Reporter – this alerts the Scottish Government to the lack of the medicine and influences any drug reimbursement increases required to the Scottish Drug Tariff to cope with the impact of this shortage.

NOTE: You can also use this site to report medicines that are only available at prices above the Scottish Drug Tariff price.  This will influence Drug Tariff Amendments which can be backdated for the whole month so  you may still  be fully reimbursed for drugs costs!

https://www.cps.scot/news/shortage-reporter-launch

 

2) Contact the NHS Lothian Shortages team to investigate the possible shortage; if it is a definite new shortage, the Shortages team will quickly post alerts on GP prescribing systems to prompt them to write prescriptions for alternatives.

Loth.ShortagesPC@nhslothian.scot.nhs.uk

When reporting medicine shortages, please include your:

- name

- pharmacy where you're based

- drug details (name, form, strength)

- wholesaler involved and any other relevant information.

  

What happens next, once you’ve reported it to the NHS Lothian Shortages team?

They will investigate the suspected shortage and come back to you within a few working days to confirm the shortage or to provide any relevant information about where the item should be available. 

  • IF the shortage is officially confirmed by the NHS Shortages team
  • AND the item is Specialist Initiation or requires review by a Specialist in Secondary Care

ONLY THEN should you contact the secondary care team to alert them and allow them to escalate if necessary:  Medicineshortageshospital@nhslothian.scot.nhs.uk

 

TWO Possible Ways you can still dispense Medicine for the Patient

1) PMR Endorsing

The PMR endorsement can be applied when you have used information you have available to you on your own records in order to dispense a suitable alternative without needing to contact the prescriber or writing a CPUS.  Examples include:

  • Changing the formulation – you can change, for instance, flucloxacillin capsules to a liquid formulation or vice versa if one is out-of-stock.
  • Changing the strength and quantity - patient presents with Rx for 56 candesartan 8mg tablets which are out-of-stock, so you can change it to 112 candesartan 4mg tablets and adjust the directions to keep the total daily dose the same.

Both of these scenarios can be dealt with by adding the PMR endorsement to the prescription both electronically and on the paper copy.

 

2) ‘Prescriber Contacted’ Endorsing

The PC endorsement can be applied when you have made contact with the prescriber to discuss and agree the change you wish to make. Apply the endorsement electronically and to the paper copy.  Examples include:

  • Prescription is written as Glucophage 500mg tablets but you cannot obtain this so you wish to switch to the generic metformin 500mg tablets (Please note that when considering switching from a brand to a generic you must take into account any clinical differences between the formulations)
  • Prescription for Accrete-D3 but you cannot obtain so you wish to switch to TheiCal-D3.
  • Clinitas carbomer gel OOS, and you wish to change to a suitable alternative.

You should not use a PC endorsement to switch from generic to brand, or brand to brand - this would require a new prescription.

Also, PC endorsements would not be appropriate where any change would require further monitoring - for example, drugs with a narrow therapeutic range.

 

Returning Script to the Prescriber for Alternative

If you are unable to dispense an alternative and you therefore need to return the script to the prescriber for an alternative, you should ideally attach the NHS Lothian ‘Out of Stock (Alternative Medicine Request)’ form (see Useful Resources below for template) and attach it to the script to be returned to the GP.  It is really helpful to include suggestions of available alternative medicines that you are comfortable suggesting. 

Remember, you already have the power via endorsement to change formulations (e.g. cream to ointment) or strength (e.g. 'one Fluoxetine 40mg capsule daily' to 'two Fluoxetine 20mg capsules daily') without having to return the script to the prescriber.

 

Useful Resources

NHS Lothian Shortages Page (you may need to ask your IT support team to whitelist this web address if you cannot see it):

http://intranet.lothian.scot.nhs.uk/Directory/PharmacyServices/Medicines%20Shortages/Pages/default.aspx

These pages contain information on current medicines shortages​ relevant to Primary Care and Community Pharmacy (usually excluding Specialist Use Only medicines). Please note: the NHS Shortages team manning the email inboxes are unable to give specific advice on alternative medicines – prescribers should check the British National Formulary and East Region Formulary for potential suitable alternatives.

Out of Stock (Alternative Medicine Request) form template which pharmacies can send to GP surgeries

dm+d is a useful resource to check status of products, who the manufacturers are and what alternatives there are

Specialist Pharmacy Services (SPS) shortages page have regular updates on shortages monitored by Department of Health and Social Care (DHSC) including MSNs (issued by English Government) and MSANs (issued by Scottish Government) – you will need to register for an account which is free 

Nutricia Oral and Enteral Nutrition weekly stock update, includes stock available from HomeCare services - sign up to their email mailing list to receive their weekly update

British Menopause Society gives information on HRT availability and some advice on alternatives and switching. 

TRAVAX website gives updates on travel vaccine availability

SHOW website displays Medicine Supply Alert Notices (MSANs) released from Scottish Government Serious Shortage Protocols currently active within NHS Scotland

Government Drug Safety updates can be sent directly to your inbox - click “Get Email” at the bottom

Boots Pharmacy  have launched an online stock checker (only Boots stores and not a guarantee of availability)

Medicines Information (NHS Lothian) has many useful resources that can help make prescribing decisions when looking for alternatives during a medicine shortage.  (You may need to ask your IT support team to whitelist this web address if you cannot see it).

NEWT guidelines provides advice for patients with enteral feeding tubes or swallowing difficulties, for instance whether a tablet can be crushed instead of swallowed. Log in details for NEWT are required - ask your Pharmacy Manager/Owner to set up