Medicine Shortages
Published on: 27th November 2024 | Updated on: 6th December 2024
Please note, this page is intended for community pharmacy teams. If you are a patient or member of the public who wishes to query the availability of a medicine you have been prescribed, the first step is to speak to a member of your local pharmacy team directly.
Medicines supply issues continue to be a daily battle for community pharmacy, as described in our 2024 Medicines Supply Report. A new report compiled by the RPS, Medicines Shortages: solutions for empty shelves, explores the issue further and calls on the Government to better manage medicine shortages and allow community pharmacists to supply appropriate alternatives when medicines are in short supply. Community Pharmacy England contributed to the findings of the RPS report and supports many of its recommendations.
Medicines supply chains are long and complex, and both the manufacture and supply of medicines are rigorously regulated. Whilst some supply issues can be localised, medicine shortages are often a national (and sometimes global) problem which can affect both the availability and pricing of medicines. Medicine shortages have been a growing issue following years of turbulence across supply chains with impacts linked to Brexit, COVID-19, war in Ukraine, and wider economic instability. The main causes of medicines shortages include:
- Manufacturing issues including shortages of raw materials, or supply disruption
- Issues with industry capacity and flexibility
- Discontinuation or commercial withdrawal of medicines from the market
- Intervention in market mechanisms used for pricing of medicines and drug reimbursement – low prices of medicines has made the UK a less attractive market for manufacturers and this is contributing to the reduction in supply chain resilience
- Medicine recalls and product quality issues
- Availability of raw ingredients including active pharmaceutical ingredient (API) shortages
- Unanticipated increased demand for medicines – this may be due to knock on effects of shortages of other medicines, leading to patients switching to other similar drugs
- Changing prescribing patterns in response to changing guidance of health needs
- Distribution and logistical problems, including capacity issues
- International trade barriers
- Excessive exporting due to currency fluctuations
- Suppliers withholding supply by hoarding stocks
- Quotas restrictions to manage stock allocations
The Healthcare Distribution Association (HDA) has produced an infographic identifies many factors that can impact up on medicines supply, as well as measures taken to help mitigate the risks of patients not receiving their medicines.
Pharmacy teams spend a lot of time trying to source prescription medicines as cost-effectively as possible, saving the NHS millions every year. However, the growing number of medicine supply problems is making this task tougher and tougher, with nine in ten pharmacy teams telling us that they are dealing with medicine supply issues on a daily basis.
Issues with medicines supply, drug shortages and market instability are now at the worst that pharmacies have ever seen, and these issues have become the highest point of concern for many. According to our 2024 Medicines Supply Report, pharmacies across the sector are reporting that medicine supply issues are worse than the previous year, with 99% of pharmacy team staff encountering them at least weekly, and 72% now facing multiple issues a day. Worryingly, 79% of pharmacy team members surveyed reported that patient health is being put at risk due to medicine supply issues.
If a pharmacy experiences difficulty in obtaining stocks of medicines from their usual wholesaler some manufacturers have contingency arrangements in place and our resource details the ones we are aware of.
The Department of Health and Social Care (DHSC) and NHS England have launched an online Medicines Supply Tool, hosted on the Specialist Pharmacy Services (SPS) website which provides up to date information about medicine supply issues. Pharmacy teams will need to register with an NHS mail email to access the Medicines Supply Tool.
DHSC can issue a Medicine Supply Notification (MSN) which will be cascaded to a pharmacies NHS mail address. We also publish brief summaries of these on our website.
A medication supply notification will be classified as either:
| Tier | Impact | Description |
| One | Low | These supply issues are likely to carry low risk and management options and should result in patients being maintained on the same licensed medicine. |
| Two | Medium | These supply issues will require more intense manage options (such as using therapeutic alternatives, unlicensed imports or alternative strengths or formulations), which may carry a greater risk to patients/health providers than Tier 1 issues, but which are considered safe to be implemented at sub-regional level without further escalation. |
| Three | High | These supply issues will be more critical, with potential change in clinical practice or patient safety implications that require clinical or operational direction to the system. They will be expected to generate public and clinician concern. The response will be nationally coordinated and guided and the NHS may invoke its Emergency Preparedness Resilience and Response (EPRR) function. |
| Four | Critical | These supply issues will require additional support from outside the health system and will trigger the use of dedicated national NHS EPRR incident processes and procedures in order to provide additional support for the management of the shortage. Clear links and command and control mechanisms between the Medical Devices and Clinical Consumables Clinical Response Group, NHSE&I Central EU Exit Team, EPRR functions at both NHSE&I and ORC/DHSC, and Cabinet Office will be utilised. |
These will detail the anticipated duration* and recommendations to help manage the shortage such as the capacity of an alternative manufacturers product to meet the additional demand.
*Please note the anticipated duration and any resupply date quoted are subject to change and therefore it is important to check the Supply Tool for the latest information. Community Pharmacy England will only publish a summary of the initial notification and not at each subsequent update.
Individual manufacturers may have information available on their website detailing the latest supply position for their products:
Pharmacy teams are asked to report any new medicine shortages (where you have been unable to source stock from any supplier) not already listed on the SPS website using our online reporting form. The Community Pharmacy England medicine shortage reporting form is intended for use by primary care teams only. We will then collate these reports and escalate them to the DHSC medicines supply team to investigate.
If a medicine is not affected by a shortage but is unavailable to purchase from your supplier(s) at or below the Drug Tariff listed price, please report the pricing issue to Community Pharmacy England to consider a request for a price concession.
The Department of Health and Social Care (DHSC) and NHS England (NHSE) have published guidance on the management of medicines supply and shortages, which outlines the processes they follow to try and address any shortages. There are a range of measures that DHSC and NHSE can take to alleviate the supply issues. Examples include
- Issuing Serious Shortage Protocols
- Taking regulatory action to approve new medicines or, in exceptional circumstances, extend medicine expiry dates
- Restricting medicines exports
If a prescription requests a licensed product which is unavailable due to shortage or supply issue, an unlicensed product cannot be dispensed against such a prescription unless the prescriber has specifically ordered this on the prescription. Where a prescriber considers an unlicensed product appropriate for a patient, the prescription must be written accordingly. EPS prescriptions need to state;
- ‘Drug Tariff special order’ if the alternative product is in Part VIIIB or Part VIIID, or
- Import (Country) if available as an Import; or
- ‘Special Order’ in the prescribing line.
Pharmacy teams are reminded that where a prescriber wishes you to dispense an import, prescriptions must be annotated ‘Special Order’ in the prescribing line. All paper prescriptions for unlicensed medicines should be placed in the red separator for the end of month submission.
With EPS prescriptions, prescribers must select the Actual Medicinal Product (AMP) entry for Special Order where listed. If no option for Special Order is available, a paper prescription should be obtained if the prescriber wishes to issue a prescription for an unlicensed product – written as ‘product name (Special Order)’. If a prescriber adds supplementary information for example ‘unlicensed special’, ‘sugar-free’ or a brand name into another field (for example the dosage instructions) and that ‘changes the prescribed product’, this will not be taken into account for reimbursement purposes.
- Quantity dispensed
- Pack size
- Price per unit less any discount/rebate
- Manufacturer/importer MHRA license number
- Batch number
- Specials procurement fee endorsement of ‘SP’
Once paper prescriptions have been appropriately endorsed, they should be placed in the red-separator.
Our short video talks through prescriptions containing supplementary product information and advice on what to do.
Pharmacy owners can help raise awareness of this issue using our new resources:
- Medicines Supply Poster and Digital Screen files (for display in your pharmacy)
- Social Media Assets (for use online)
- MP Briefing (to share with local politicians)
Further support is available on our Medicines Supply and Price Concessions Resources webpage.
Further Resources
A guide to managing medicines supply and shortages (DHSC and NHSE)
Medicine Shortages: A briefing for ICSs, GPs and other NHS prescribers
Information on medicines supply for patients
Department of Health and Social Care and ABPI Guidance
Department of Health and Social Care and BGMA Guidance
For more information on this topic please email ds.team@cpe.org.uk
