Management of Stock Shortages

Management of stock shortages

Stock shortages will occur periodically due to outside factors and can cause anxiety and may impact on patient care.

Please note the guidance ‘A guide to managing medicines supply and shortages¹’ from the Department of Health and Social Care with NHS England and NHS Improvement for both primary and secondary care. This document outlines the national, regional and local management and communication routes for medicines supply issues to ensure continuity of supply and ensure that patients receive the treatment and medication required. These are followed in BNSSG.

In summary, when a medicine is unavailable:

• Where possible an alternate drug from the formulary should be used.

• Where there is no alternate drug on the formulary a non-formulary option may be considered in discussion between primary and secondary care.

• Once the stock shortage has resolved the formulary drug should be reinstated.

 The Specialist Pharmacy Service has developed a new Medicines Supply Tool, which can be accessed via the website here. Please note a log in is required to access this tool.

A Serious Shortage Protocol (SSP) may be issued if the Department of Health and Social Care (DHSC) decide there is a serious shortage of a specific medicine or appliance. SSP updates are available via the NHS Business Services Authority website here.

The Royal Pharmaceutical Society (RPS) published a report  in November 24 'Medicines Shortages: Solutions for Empty Shelves' which calls on the UK Government to create a national strategy to both prevent and manage medicine shortages that would streamline efforts across the NHS, reduce inefficiencies caused by duplication of effort and ensure information and guidance for professionals and patients is available as soon as shortages occur.

References:

1. Document Title: A Guide to Managing Medicines Supply and Shortages. Publishing approval number: 000920. November 2019

Supply disruptions of medicines used in the treatment of attention deficit hyperactivity disorder (ADHD)

There are supply disruptions affecting a wide range of medicines used in the treatment of attention deficit hyperactivity disorder (ADHD).

The medicines supply notification is available here.

Please see Managing ADHD Medicines Shortages and BNSSG Patient Information Leaflet about methylphenidate

Medicine Supply Notification (MSN) Desmopressin 10microgram/dose nasal spray

Desmopressin 10microgram/dose nasal spray is out of stock with an anticipated re-supply date of early September 2025.  Please see attached MSN for full details or the SPS Medicines Supply tool.

If further advice needed the endocrinology team can be contacted:

• NBT contact diabetesandendocrinologyadmin@nbt.nhs.uk or in urgent situations contact endocrine directly via switchboard 0117 9505050 between 1-4pm weekdays
• UHBW contact adultendocrinenurse@uhbw.nhs.uk or in urgent situations contact endocrine directly via switchboard 0117 9230000 between 9am-5pm weekdays. Out of hours please contact medical registrar on call
• For paediatrics, please contact paediatric endocrinology nurses PENS@uhbw.nhs.uk

Please note, some patients may be proactively contacted by their specialist with information on switching. 

Intermittent Shortages of Creon 10,000 and 25,000 gastro-resistant capsules

There are currently intermittent shortages of Creon 10,000 and 25,000 gastro-resistant capsules across the UK. These shortages are also having an impact on supplies of other dosages and brands of pancreatic enzyme replacement therapy (PERT) as demand for these alternative products grows. In response to this situation, a group of specialist pancreatic cancer dietitians and cystic fibrosis dietitians have developed a Position Statement: Pancreatic enzyme replacement therapy (PERT) shortage – advice for the management of adults with pancreatic exocrine insufficiency which provides advice for prescribers and dietitians on what to do if a patient is running low or cannot get PERT.

Please see Specialist Pharmacy Services website for stock updates.

The two main suppliers of PERT in the UK have set up customer support lines to help identify areas with recent deliveries. However, it is possible these deliveries may have already been allocated to specific patients.
• Viatris (Creon®) 0800 8086410 (for patients and pharmacists)
• Zentiva (Nutrizym®): 08448 793188 (for pharmacists) and 08000 902408 (for patients)

Please see the Neonatal & Paediatric Pharmacy Group position statement on the Shortage of Pancreatic Enzyme Replacement Therapy (PERT) in neonates and children for information only. This has been written in response to National Patient Safety Alert.

National Patient Safety Alert (NatPSA) Dec 2024 - Shortage of Pancreatic enzyme replacement therapy (PERT) - Additional actions: This alert contains actions which are in addition to those outlined in the National Patient Safety Alert (NatPSA/2024/007/DHSC) issued on 24th May 2024. 

Pathway for patients who cannot obtain PERT supplies using their usual nominated pharmacy

Medicine Supply Notification: Pabrinex® (Vitamins B and C) Intravenous and Intramuscular High Potency solution for injection ampoules

Department of Health and Social Care (DHSC) has issued a medicine supply notification for Pabrinex® (Vitamins B and C) Intravenous and Intramuscular High Potency solution for injection ampoules.

• Pabrinex® Intravenous (IV) injection will be out of stock from August 2024 with an anticipated resupply date of October 2025.
• Pabrinex® Intramuscular (IM) injection is being discontinued 31st July 2025. 

Please see the SPS website for more information on this stock shortage. We are developing local guidance to support alternatives to this shortage, pending approval. If you need more local information, please contact the BNSSG ICB medicines optimisation team for details bnssg.medicines-optimisation@nhs.net

Medicine Supply Notification: Quetiapine 50mg, 150mg, 200mg, 300mg and 400mg modified-release tablets

Please see the SPS supply tool for information about this MSN. 

Please see attached information with actions and recommendations. These recommendations are in line with advice from our specialist colleagues within Avon and Wiltshire Mental Health Partnership NHS Trust and their Medicines Information Bulletin.