Medicines shortages: what to tell patients, prescribers and your own team

What is the actual work during a shortage?

A community pharmacy cannot manufacture a medicine, cannot compel a wholesaler to allocate stock it does not hold, and cannot accelerate a manufacturing recovery. Almost everything within a pharmacy's control during a shortage is therefore communication, and communication is the element most frequently left to improvisation by whoever is at the counter when the patient arrives.

That allocation of effort is inverted. The supply position occupies the manager's attention whilst the communication, which is the part the pharmacy actually determines, receives none. The consequence is a shortage which is handled competently in the dispensary and badly at the counter, and patients experience only the second of those.

Three audiences require different things. Patients require to know what is happening, what it means for them specifically and what happens next. Prescribers require enough information to act once rather than repeatedly. And the team requires a single answer which everyone gives, since a shortage handled with five different explanations produces patients who believe the pharmacy is disorganised rather than that the market is.

What should be established before speaking to anyone?

Four facts determine everything which follows, and establishing them takes minutes at the start of a shortage rather than being reconstructed conversation by conversation.

Whether the shortage is national or local. This is the single most consequential fact, since it determines whether directing a patient elsewhere is helpful or cruel. The published supply notifications establish it, and a pharmacy which has not checked is guessing.

Whether a protocol is in force. Where a Serious Shortage Protocol applies, the pharmacy may be able to resolve the matter without prescriber contact at all, which transforms the conversation. Our guide to protocols sets out the conditions, and the operational failure it describes, in which a pharmacy refers patients back for a fortnight without realising a protocol existed, is a communication failure before it is anything else.

What the clinical alternatives are. The published guidance accompanying a supply notification ordinarily addresses this, and a pharmacy which has read it can conduct a useful conversation with a prescriber rather than merely reporting a problem.

What stock actually exists, and for whom. Including whether other branches or nearby pharmacies hold any, and what is already owed to whom.

What does the patient conversation require?

Four elements, in order, and the order matters because a patient who has not been told the first will not absorb the third.

Name the situation accurately. A national shortage is a national shortage and should be described as such. This is not a device for managing the patient's expectations but the single most useful piece of information they can be given, for reasons the following section develops.

State what it means for them. Not for patients generally but for this patient, taking this medicine, with this much remaining. A patient with three weeks of supply is in a different position from one with two days, and the conversation should reflect which they are.

State what the pharmacy is doing. Specifically, whether that is sourcing, contacting the prescriber, applying a protocol or arranging a partial supply. A patient who understands that work is occurring waits considerably better than one who suspects it is not.

State what happens next, with a time attached. Including when the pharmacy will make contact, and committing to contact irrespective of whether the position has changed, since silence is interpreted as neglect and a patient who has heard nothing by Thursday will telephone on Thursday regardless.

Where the patient is distressed, and shortages of medicines for pain, mental health and chronic conditions frequently produce distress, the conversation requires acknowledgement before information. A patient who feels dismissed will not retain what they are told afterwards.

Which phrases help, and which multiply the problem?

Three further formulations repay attention. Avoid promising dates obtained informally, since wholesaler expectations move and a patient who arranged their week around a date which slipped has been failed twice, whereas one told what is known and when they will hear again has been treated honestly. Avoid attributing blame in terms which will require correction, since a confident explanation of a manufacturer's conduct which proves inaccurate damages the pharmacy rather than the manufacturer. And avoid the passive construction which describes the problem without identifying who is doing what, since patients hear it as an absence of action.

What makes the prescriber conversation useful?

A practice dealing with a shortage receives the same information many times from many pharmacies and from many patients, which produces inconsistent outcomes and consumes clinical time at both ends. Three habits improve it materially.

Batch by product rather than by patient. One message identifying the affected product, the patients concerned, the clinical position and a proposed approach permits a practice to respond once. The same content delivered as eleven telephone calls occupies a morning and produces eleven separate decisions which may not agree with one another.

Arrive with a proposal rather than a problem. A pharmacist who has read the supply guidance and can suggest a clinically appropriate alternative, with the reason, is conducting a professional consultation. One who reports only that an item is unavailable has transferred the work rather than shared it.

Confirm in writing what was agreed. Particularly where a substitution or a change of quantity was authorised verbally, since the record protects the patient, the prescriber and the pharmacy, and a shortage generates enough exceptions that memory is an inadequate system.

Where a protocol is in force, none of this may be necessary, which is the practical value of establishing that first.

How is the team briefed?

The recurring failure is inconsistency. A patient told on Monday that stock is expected Wednesday, on Wednesday that nobody knows, and on Friday that the pharmacy is doing everything it can, has received three answers which together convey disorganisation, even where each was accurate when given.

A short daily position addresses it. Which products are affected, whether each shortage is national, whether a protocol applies, what the current expectation is, and what the agreed form of words is. Recorded somewhere visible, updated once daily by a named person, and communicated to everyone who speaks to patients including delivery drivers and dispensary staff who answer the telephone.

The agreed form of words matters more than it appears. A team which has been given a sentence uses it, whilst a team which has been given a situation improvises, and improvisation under pressure produces the phrases the preceding section warns against.

What about written communication?

A notice and a website statement reduce telephone volume substantially and reach the patients who have not yet arrived, which is the population a counter conversation cannot serve. Both are worth producing for any shortage lasting beyond a few days.

Three constraints apply. The advertising boundary operates here as everywhere, such that a statement may describe a national shortage, explain what patients should do and set out how the pharmacy is responding, whilst it may not promote a prescription-only medicine. Nothing should suggest that this pharmacy holds stock which others do not, both because it invites an unmanageable influx and because it is frequently untrue by the time it is read. And anything published should be dated and reviewed, since a notice describing a shortage which resolved a month previously undermines every other statement the pharmacy makes.

The most useful written content is ordinarily the least dramatic, comprising what is affected, that the cause is national, what a patient should do, and when the position will next be reviewed.

How is genuinely limited stock allocated?

Where stock exists but is insufficient, a pharmacy is making a clinical allocation decision, and it should be made as one rather than by order of arrival or by which patient is most insistent.

The criteria should be established in advance by the responsible pharmacist, applied consistently and recorded. Relevant considerations ordinarily include the clinical consequence of interruption for the individual, whether alternatives exist for that patient, whether they are stabilised upon the specific product in circumstances where substitution carries risk, and vulnerability including the capacity to travel or to manage a change.

Two practical points follow. The decision is considerably easier to explain to the patient who receives nothing when the criteria were determined before the queue formed, since the pharmacist is applying a policy rather than making a judgement about the person in front of them. And a partial supply, where clinically appropriate and lawful, frequently serves more patients better than a complete supply to fewer, though it generates owings which must then be tracked and honoured.

What should be written down?

A shortage generates exceptions, and exceptions require records for reasons which become apparent afterwards rather than during.

The essential set comprises what was owed to whom and when it was supplied, what was agreed with which prescriber and when, what was supplied under any protocol together with the protocol identifier, what any patient was told about timing so that the next conversation begins where the last ended, and what was purchased and at what price, which is the evidence the reporting mechanism described in our price concessions guide depends upon.

The final item is regularly omitted because it feels commercial rather than clinical. It is, in the aggregate, how the reimbursement position is corrected for the whole sector, and a pharmacy absorbing an above-Tariff purchase without recording it has withheld the evidence which produces the correction.

Which two responses should be avoided?

Shortage conditions produce pressure toward two responses which convert a supply difficulty into a regulatory one.

Purchasing outside the licensed supply chain. The offer of stock from an unfamiliar source arrives precisely when a pharmacy is most inclined to accept it, presented as pragmatism and priced accordingly. The provenance discipline set out in our analysis of the enforcement cases applies with greater force during a shortage rather than less, since a pharmacy purchasing outside the licensed chain has imported the illegal market's defining defect into its own dispensary, and has done so in respect of a product whose scarcity is precisely what makes counterfeit supply attractive to those producing it.

Substituting without lawful authority. The pressure to supply something sufficiently similar is real, well-intentioned and unlawful in the absence of a protocol or prescriber authorisation. Where a protocol exists it should be used, and where one does not the prescriber conversation is the route, however inconvenient. The distinction between these positions is the subject of a separate guide because it is the point at which good intentions most frequently produce regulatory difficulty.

A third response warrants mention without belonging in the same category. Excessive ordering against anticipated shortage, conducted across many pharmacies simultaneously, converts a manageable supply constraint into an unmanageable one, and the sector's collective interest lies in ordering to need even where an individual pharmacy's interest appears to lie elsewhere.

Key takeaways

FAQs