What should pharmacies tell patients during medicine shortages?

What is the actual work during a shortage?

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

That allocation of effort is upside down. The supply position occupies the manager's attention, while the communication — the part the pharmacy actually determines — receives none. The result is a shortage handled competently in the dispensary and badly at the counter. Patients experience only the second.

Three audiences need different things. Patients need to know what is happening, what it means for them specifically and what happens next. Prescribers need enough information to act once rather than repeatedly. And the team needs a single answer everyone gives. A shortage handled with five different explanations produces patients who believe the pharmacy is disorganised, not the market.

What should be established before speaking to anyone?

Four facts determine everything that follows. Establishing them takes minutes at the start of a shortage, rather than being pieced together conversation by conversation.

Whether the shortage is national or local. This is the single most consequential fact: it determines whether directing a patient elsewhere is helpful or cruel. The published supply notifications establish it, and a pharmacy that 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 contacting the prescriber at all — which transforms the conversation. Our guide to protocols sets out the conditions. The operational failure it describes — a pharmacy referring 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 usually addresses this. A pharmacy that has read it can have 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. The order matters: 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 next 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 happening waits far better than one who suspects it is not.

State what happens next, with a time attached. Say when the pharmacy will make contact, and commit to contact whether or not the position has changed. Silence reads 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 often produce distress — the conversation needs 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. Wholesaler expectations move, and a patient who arranged their week around a date that slipped has been failed twice. One told what is known, and when they will hear again, has been treated honestly. Avoid attributing blame in terms that will need correcting. A confident explanation of a manufacturer's conduct that proves inaccurate damages the pharmacy, not the manufacturer. And avoid the passive construction that describes the problem without saying who is doing what. 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 many patients. That 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 lets a practice respond once. The same content delivered as eleven telephone calls occupies a morning and produces eleven separate decisions that 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. 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. Together they 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. Record it somewhere visible, update it once daily through a named person, and share it with 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 given a sentence uses it; a team given a situation improvises. And improvisation under pressure produces the phrases the previous section warns against.

What about written communication?

A notice and a website statement cut telephone volume substantially and reach the patients who have not yet arrived — 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. A statement may describe a national shortage, explain what patients should do and set out how the pharmacy is responding — but it may not promote a prescription-only medicine. Nothing should suggest that this pharmacy holds stock others do not. That invites an unmanageable influx, and it is often untrue by the time it is read. And anything published should be dated and reviewed. A notice describing a shortage that resolved a month ago undermines every other statement the pharmacy makes.

The most useful written content is usually the least dramatic. State 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. It should be made as one — not by order of arrival, and not by which patient is most insistent.

The criteria should be set in advance by the responsible pharmacist, applied consistently and recorded. Relevant considerations usually include the clinical consequence of interruption for the individual and whether alternatives exist for that patient. They also include whether the patient is stabilised on the specific product where substitution carries risk, and vulnerability — including the capacity to travel or to manage a change.

Two practical points follow. The decision is far easier to explain to the patient who receives nothing when the criteria were set before the queue formed. The pharmacist is applying a policy, not making a judgement about the person in front of them. And a partial supply, where clinically appropriate and lawful, often serves more patients better than a complete supply to fewer. It does generate owings, which must then be tracked and honoured.

What should be written down?

A shortage generates exceptions, and exceptions need records — for reasons that become apparent afterwards rather than during.

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

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

Which two responses should be avoided?

Shortage conditions push pharmacies toward two responses that 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 more force during a shortage, not less. A pharmacy buying outside the licensed chain has imported the illegal market's defining defect into its own dispensary. And it has done so for a product whose scarcity is exactly 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 without a protocol or prescriber authorisation. Where a protocol exists, use it. Where one does not, the prescriber conversation is the route, however inconvenient. The distinction has a separate guide because it is the point where good intentions most often produce regulatory difficulty.

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

Key takeaways

FAQs