Dr James Davies, co-author of Medicines Shortages: Solutions for Empty Shelves from the Royal Pharmaceutical Society, suggests steps to take when dealing with medicines supply problems

Medicines shortages occur for all sorts of different reasons and at any one time about 3-4% of all medicines are unavailable. While that number may be small, the impact on patients and pharmacy teams is significant.

RPS has recently published Medicines shortages: Solutions for empty shelves, a report which reviews the causes of medicines shortages and sets out several recommendations to help improve the current situation.

During the research, we heard of many of the challenges that pharmacists face in accessing the medicines for their patients, and some of the lengths that pharmacists go to help source medications for their patients.

Here are some top tips of things to do or consider when faced with the shortage of a medicine:

1. Check the NHS/DHSC Medicines Supply Tool on the SPS website

When medicines aren’t available it is important to understand the reasons and the likely cause of the shortage – pharmacists and patients want to know the reasons. During the research we discovered that many community pharmacists weren’t aware of and weren’t using the Medicines Supply Tool on the SPS (Specialist Pharmacy Service) website.

This website is free to access by anyone with an NHS email address, and contains information directly supplied by the Department of Health and NHS England about supply issues. It describes the latest information they have received from manufacturers as well as guidance on the alternative medications that may be available as well as likely re-supply dates. We recommend bookmarking this site and checking it whenever you can’t get hold of a medication to understand if it is a nationally recognised issue. This will also tell you if a Serious Shortage Protocol is in place for the medicine and what alternatives and endorsement you can use.

2. Check suppliers

On average, most community pharmacies work with about 10 different wholesalers. Different wholesalers use different systems, and we hear that the wholesaler’s computer ordering systems aren’t always up to date due to the fast-moving nature of stock. Wholesalers often impose quotas and restrictions in times of shortage, and there are many challenges with getting accurate stock information. As a result, calling a wholesaler may be the best route. If they don’t have the medicine, it’s important to try to ascertain when it’ll be available, if all manufacturer brands, strengths, forms and pack sizes are affected and if other depots have stock to send you. You may need to consider dispensing a branded medicine against a generic prescription if available and appropriate. In this case, it’s not a shortage but the medicine may be available over the Drug Tariff price, and therefore it is vital this issue is reported.

3. Report the issues to CPE (England), CPW (Wales) or CPS (Scotland)

We often hear from community pharmacists that they have concerns about pricing but have not taken steps to inform their representative organisation of the issues they are facing. It is essential that if you can’t get hold of the medication, you need to report it to the relevant organisation. This information is shared with the Department of Health and helps them to identify potential shortages and to ensure that sufficient supplies are brought into the UK. Reporting these shortages also allows contactor organisations to negotiate price changes when shortages occur and drive-up market prices.

4. Contact your Community Pharmacy Clinical Lead (CPCL) or equivalent

There were many innovative ideas shared with us about how to address and manage supply shortages. If you are experiencing problems with a particular medication, then contact the local representatives within your ICB (or equivalent in Wales and Scotland). In some areas, WhatsApp or email groups have been created to help pharmacists contact each other to identify stock for specific patients. In addition, the CPCLs can help support the interface between community pharmacy and general practice, where the only option is to ask the prescriber to supply an alternative medication.

5. Communicate, communicate, communicate

Once you have established that there is a genuine shortage and why it’s happening, it’s vital to let the patient know what is going on. We heard from patient groups again and again about the frustration and anxiety they feel when they can’t get hold of their medication – and this is often taken out on the pharmacy team.

It is important to let the person know all options and involve them in the decision-making process so they can make an informed choice. This may involve contacting the prescriber, and when doing so, being clear about the possible alternatives and suggestions. Some practices have set up processes to make it easier for pharmacists to request changes – find out what works best for your local practice, especially contacting the practice pharmacist.

Managing medicines shortages isn’t easy. It’s an incredibly challenging issue and conversation to have, and often there is no simple resolution.

Tackling medicines shortages relies on all parts of the supply chain – prescribers, manufacturers, wholesalers, pharmacies and patients – working together with government to make a difference. At grassroots level, pharmacy teams in settings across healthcare feel the impact daily and are a vital point of contact for patients.

There are no easy answers, but we will use our new report to help advocate for improvements for pharmacy teams, such as the ability to make minor substitutions to prescriptions in order to improve patient care.

Read the RPS report Medicines shortages: Solutions for empty shelves

Take a look at our guide: Dealing with medicines shortages in community pharmacy