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…

  1. Confirmed with the wholesaler whether it’s short term or longer term unavailability, and whether there is a resupply date?
  2. Checked if your distributor might have stock in other depots that could be moved to your area?
  3. Contacted other wholesalers to see if they have stock? (Consider using more wholesalers outwith your usual ones)
  4. Contacted other local community pharmacies to see if they have stock 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 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 shortage and influences any drug reimbursement increases required to the Scottish Drug Tariff to cope with the impact: https://members.cps.scot/shortages/
  2. Contact the NHS Lothian Shortages team (Loth.ShortagesPC@nhs.scot) to investigate the possible shortage. If it is truly a new shortage, the Shortages team will quickly post alerts on GP prescribing systems to prompt them to write prescriptions for alternatives:

When reporting medicine shortages, please include:

  • your name
  • the pharmacy where you’re based
  • medicine details (name, form, strength)
  • wholesaler involved and any other relevant information.

The NHS Lothian Shortages team will investigate the suspected shortage. They will respond within a few working days to confirm the shortage or to provide any relevant information about availability. The shortages team are unable to provide individual advice on suitable alternatives.

If the shortage is confirmed by the NHS Lothian 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 shortages team to alert them and allow them to escalate if necessary: loth.medicineshortagesteamsc@nhs.scot.

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 from your own records to dispense a suitable alternative without contacting the prescriber or writing a CPUS. Examples include:

  • Changing the formulation – e.g. flucloxacillin capsules to liquid formulation or vice versa if one is out of stock.
  • Changing the strength and quantity – e.g. Rx for 56 candesartan 8mg tablets to 112 candesartan 4mg tablets (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 Prescriber Contacted (PC) endorsement can be applied when you have contacted the prescriber to discuss and agree the change you wish to make. Apply the endorsement electronically and to the paper copy. Examples include:

  • Switch from Glucophage 500mg tablets to generic metformin 500mg tablets. Note that when considering switching from a brand to a generic, you must take into account any clinical differences between the formulations.
  • Switch from one calcium and vitamin D supplement to another formulation of a similar strength.
  • Switch from Clinitas carbomer gel 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.

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

Returning Prescription to the Prescriber

If you are unable to dispense a suitable alternative and you therefore need to return the script to the prescriber, you should attach the NHS Lothian ‘Out of Stock (Alternative Medicine Request)’ form (see Useful Resources below) to the script when returning it. It is really helpful to include suggestions of available alternative medicines.

Please ensure that you have exhausted the options above before returning the prescription to the prescriber for an alternative.

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.

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.

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Last updated 13/05/25 EBR & CC