Shortages of medicines
Key points- Many 'shortages' are not nationwide. They can happen because one wholesaler or local pharmacy is out of stock.
- Nationwide shortages may involve only one brand, strength, or formulation.
- The Department of Health and Social Care (DHSC) publishes a monthly index of all national shortages.
- If you need to swap a patient to a completely different medicine then there are many factors to consider, including whether it is your role to do this or a job for a specialist (see e-learning below for more).
Info sources
✦ MIMS has a drug shortages tracker on its home page.✦ Manufacturers' customer services departments can clarify if a shortage is real, the products affected, and how long it will last. They may also have alternative ordering processes in place when a shortage occurs.
✦ The SPS website has notifications about national shortages. They explain the problem and can offer solutions such as alternative suppliers or medicines. A password-protected section of the same website has a regular DHSC bulletin on a wider range of shortages in alphabetical order, but you must register with the site using an NHS email address and be logged on before you can see this.
✦ Specialist clinical organisations such as Royal Colleges may offer advice for some shortages.
✦ Look in the BNF or eMC to see what alternative brands or products might be suitable for your patient.
✦ NHSE has a national guide to managing shortages explaining how you will be notified about them and explaining how they are categorised in terms of risk from Tier 1 (low impact) to Tier 4 (critical).
Decision making
It is not possible to cover every eventuality, but the five questions below may help you make decisions about managing a medicine shortage.
1. Can the medicine be stopped? (It is no longer required, not essential, or there are non-drug options.)
No Yes ⇨ Stop the medicine if it is safe and appropriate (e.g. consider withdrawal reactions).
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2. Is this a local supply problem? (e.g. one wholesaler out of stock; one pharmacy out of stock.)
No, it's a national shortage Yes ⇨ Obtain from a different supplier; try another pharmacy.
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3. Does DHSC guidance or other Info source above assist you? (NB you must register with the SPS site before you can see DHSC guidance.)
No Yes ⇨ Follow DHSC or other guidance
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4. Can you swap to a different brand or formulation of this medicine? (BNF, MIMS, or eMC may help with options.)
No Yes ⇨ Swap to different brand or formulation, if suitable
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5. The patient may need to switch to a different medicine. Is it your role to do this?
No ⇨ Refer to prescriber Yes ⇨ Our-e-learning below may help you
Our e-learning examines some of the issues you need to think about if swapping a patient to a new medicine because their current one is unavailable. It only takes about 15 minutes. Click here to start.