Extension of Pen V SSPs and removal of azithromycin and clarithromycin as alternatives

Update 31/01/23 – The Department of Health and Social Care (DHSC) has issued the following updates for the Phenoxymethylpenicillin V (Pen V) Serious Shortage Protocols (SSPs):

SSP extension

SSP040 – SSP047 – The expiry dates for all 8 Pen V SSPs have been extended to Tuesday 28 February 2023. These SSPs were previously due to expire on 31 January 2023.

SSP amendments

SSP043 – SSP047 – These 5 Pen V SSPs were amended on 31 January 2023 to remove listed formulations of Azithromycin and Clarithromycin as alternative antibiotics to Pen V.

Only the following oral antibiotics listed in the priority order below can be supplied using these SSPs:

  • Amoxicillin
  • Flucloxacillin
  • Cefalexin
  • Co-amoxiclav

If the prescribed duration is longer than 10 days erythromycin is the preferred substitution.

Pharmacists should ensure they are using the latest versions of SSPs and endorsement guidance on the NHSBSA website.

The RPS published an illustration that summarised the substitution options provided by the SSPs, this has been updated to reflect these changes

All current oral antibiotic SSPs

SSP SSP endorsement guidance SSP Expiry
SSP040 Phenoxymethylpenicillin 125mg/5ml oral solution sugar free (issued 15/12/2022) SSP040 guide 28 February 2023
SSP041 Phenoxymethylpenicillin 250mg/5ml oral solution sugar free (issued 15/12/2022) SSP041 guide  28 February 2023
SSP042 Phenoxymethylpenicillin 250mg/5ml oral solution (issued 15/12/2022) SSP042 guide  28 February 2023
SSP043 Phenoxymethylpenicillin 125mg/5ml oral solution (issued 16/12/2022) SSP043 guide  28 February 2023
SSP044 Phenoxymethylpenicillin 125mg/5ml oral solution sugar free (issued 16/12/2022) SSP044 guide  28 February 2023
SSP045 Phenoxymethylpenicillin 250mg/5ml oral solution (issued 16/12/2022) SSP045 guide  28 February 2023
SSP046 Phenoxymethylpenicillin 250mg/5ml oral solution sugar free (issued 16/12/2022) SSP046 guide  28 February 2023
SSP047 Phenoxymethylpenicillin 250mg tablets (issued 16/12/2022) SSP047 guide  28 February 2023

Original article published 16/12/22

Further to significant ongoing disruption affecting supply of Phenoxymethylpenicillin (Pen V) in which three SSPs were released on 15/12/2022, the Department of Health and Social Care (DHSC) has issued a further five new Serious Shortage Protocols (SSPs).

The new SSPs, introduced with immediate effect, allow community pharmacists to consider different oral antibiotic preparations, to enable the continued supply of antibiotics to patients and mitigate the ongoing supply disruptions affecting Phenoxymethylpenicillin.

Effective today, 16th December 2022, SSP043-SSP047 have been authorised by the Secretary of State to provide pharmacists with procedures to follow in providing suitable alternative oral antibiotics to substitute Phenoxymethylpenicillin. The protocols aim to help reduce the number of patients needing to return to their prescriber for a replacement prescription. For each SSP, DHSC has included specific patient counselling points which must be taken into account when deciding whether supply in accordance with an SSP is suitable for a patient.

Before supplying an alternative antibiotic, the pharmacist must consider if a suitable supply can be made by using an alternative formulation of Phenoxymethylpenicillin in accordance with relevant SSP. Where that is not possible only specified antibiotics can be substituted for prescriptions for duration of no longer than 10 days, in order of preference depending on availability and the dosing needs for the patient (see specific SSP for details).

Pharmacy teams are advised to read the documentation in full for all SSPs published on the NHSBSA’s website.

The Royal Pharmaceutical Society (RPS) has developed a flowchart explaining how the SSPs work that contractors may find useful.

In response to the issuing of SSPs, Gordon Hockey, PSNC’s Director, Legal, said yesterday:

“We asked DHSC to introduce Serious Shortage Protocols (SSPs) to help mitigate the ongoing supply disruption affecting the availability of phenoxymethylpenicillin (Pen V) and are pleased to see that some have now been introduced. However, PSNC was not involved in the development of these protocols and our team is urgently clarifying some points to provide contractors with additional guidance and to seek assurances around the reimbursement of any alternatives supplied. We will issue our additional guidance as soon as possible.

More widely, PSNC has also been pressing DHSC to think broadly about what other measures could help to manage the current situation and consider the introduction of greater flexibilities, such as allowing pharmacists more professional discretion to amend prescriptions separate to SSPs.”


Reimbursement and remuneration

Reimbursement is for the medicine supplied in accordance with one of the above SSPs and not the originally prescribed medicine. The reimbursement price will account for VAT payment. Supply in accordance with on of the above SSPs will result in the following fees being paid to the contractor:

  • One Single Activity fee (currently £1.27)
  • One SSP fee (£5.35)

Useful resources

PSNC Briefing 023/19: Serious Shortage Protocols – A guide for community pharmacy teams

Serious Shortage Protocols (SSPs) webpage

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