Why do you need a shortages workflow?
Because shortages are now a daily task, not an occasional problem. Community Pharmacy England's (CPE) 2025 Medicines Supply Report, based on fieldwork from January to March 2025, found that 87% of pharmacy team members deal with supply issues every day. 61% face them several times a day. 81% said a wholesaler is out of stock of something every day. 39% of staff spend one to two hours a day finding alternatives, and 26% spend more than two hours.
A task that happens several times a day needs a routine. Without one, each shortage is handled by whoever picks up the phone, in whatever order they think of, with the record kept in their head. That is how owings get lost, above-Tariff purchases go unreported, and patients get three different answers in a week. The background is covered in why medicines shortages are getting worse. This guide covers what to do about it, in six steps you can write straight into an SOP.
Step 1: source before you owe
Exhaust the options before you owe anything, and do it in a fixed order. Most pharmacies stop at their main wholesaler. CPE's shortages page lists more places to look, and the order below is the one that finds stock fastest.
| Where to look | What you get | Notes |
|---|---|---|
| Every wholesaler account you hold. | Stock, or an out-of-stock flag with a due date. | Check each account, not only the main one; short-line wholesalers often hold lines the full-liners do not. |
| Manufacturer contingency lines. | Direct orders when wholesalers have no stock, often dispatched within 24 hours. | CPE lists about 30 manufacturers with phone or portal orders, including AstraZeneca, GSK, Lilly, Novo Nordisk and Pfizer; the page was updated on 31 March 2026. |
| Medicines Supply Tool on the SPS website. | DHSC's Medicine Supply Notifications, expected resupply dates and recommended alternatives. | Login required. Notifications are graded from tier one (low impact) to tier four (critical, national incident processes). |
| Other local pharmacies. | A supply today for the patient, at the cost of the item. | Signposting is one of the options CPE names in its briefing for prescribers. |
| Specials and unlicensed imports. | An unlicensed version when no licensed product exists. | Needs a prescription written for the unlicensed product; on EPS the prescribing line must say "Special Order", "Drug Tariff special order" or "Import (country)". |
Record what you checked and when, even when the answer is no. That log is what you show the prescriber, the patient and, if it comes to it, the inspector. It also feeds step five. CPE's shortage form asks for the steps taken and the time spent. The form is only for stock you could not obtain from any supplier or manufacturer.
Step 2: record the owing properly
An owing is a promise, so it needs a record on both sides of the counter. The NHS terms of service set the standard. Under paragraph 5(2) of Schedule 4 to the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013, an NHS pharmacist must provide the drugs ordered "with reasonable promptness". Paragraph 7 adds that, if a person asks, you must give an estimated time, and a revised estimate if the item is not ready when promised. An owing slip with no date fails that test.
- Patient, item, strength and form, quantity supplied, quantity owed and the date.
- Who made the decision and what they checked: wholesalers, contingency line, Medicines Supply Tool.
- The expected date, and the date you gave the patient. Make them the same date.
- The prescription's location and status, so the balance can be dispensed and the claim completed without a search.
- A closing entry: supplied in full, prescriber changed the item, or patient no longer needs it. Tell the prescriber when it is the last of these.
Then run the owings list every day, not when a patient rings. Chase anything older than a few days against the wholesaler's due date. Where the wait is stretching and the patient has little supply left, move to step three or four rather than waiting for stock that may not come. Split the list by cause: a manufacturer problem with a resupply date can wait; a line with no date cannot.
Step 3: check for a Serious Shortage Protocol
Check the NHSBSA list before you ring anyone, because a Serious Shortage Protocol (SSP) can save the call. An SSP is a written protocol issued by ministers under regulation 226A of the Human Medicines Regulations 2012. It lets a pharmacist supply a different quantity, strength, form or product without going back to the prescriber. DHSC has issued 86 since the power took effect on 9 February 2019. In April 2026 six were in force: four Estradot patch strengths and two Creon strengths.
The conditions are tight. The pharmacist must use "professional skill and judgement" to decide the substitution is reasonable and appropriate, and the patient must agree. If the pharmacist thinks the alternative is not suitable, the patient goes back to the prescriber. CPE confirms SSPs cover any valid prescription, private as well as NHS, unless the protocol says otherwise. The NHS terms of service back this up. Paragraph 9(2B) of Schedule 4 requires you to refuse the original item once an alternative has been supplied under the SSP. Paragraph 9(2C) lets you refuse where the pharmacist judges the SSP supply inappropriate and cannot supply the original in a reasonable time.
For the claim, endorse the SSP reference number, the product supplied, the quantity, the pack size and the invoice price where the protocol asks for it. Submit SSP claims by the 5th of the following month. The Drug Tariff pays £5.35 for each SSP supply on top of the item. No prescription charge is due for a reduced quantity supplied under a quantity-restriction SSP. The full decision path is in when pharmacists can substitute under an SSP.
Step 4: contact the prescriber with a specific alternative
Ring with a proposal, not a problem. Regulation 214 of the Human Medicines Regulations 2012 requires a prescription-only medicine to be supplied in accordance with a prescription. So outside an SSP, the prescriber has to authorise any change of drug, strength, form or quantity. The fastest way to get that authority is to do the work first. Name the product that is in stock, its strength and form, and the quantity. Say what dose change it implies, and give the resupply date for the original if there is one.
CPE's briefing for prescribers, updated in June 2025, tells practices what pharmacies need from them. It asks prescribers to write generically where appropriate and to avoid extended durations while a line is short. It asks them not to switch groups of patients without asking local pharmacies, and to set aside time for pharmacy queries. Quote it if a practice pushes back. Where a practice will not engage, a message via the practice's pharmacy team usually moves faster than a receptionist queue.
Two emergency routes shorten the wait. Under paragraph 6 of Schedule 4, an NHS pharmacist may supply before receiving the prescription in a case of urgency, provided the prescriber undertakes to give a prescription within 72 hours. Under regulation 225, a pharmacist may make an emergency supply at the patient's request after an interview, if the medicine was previously prescribed and there is an immediate need. The limit is 30 days' treatment for most medicines and five days for Schedule 4 and 5 controlled drugs. The supply needs an entry in the pharmacy record and "Emergency Supply" on the label.
Step 5: get the reimbursement right
Margin is lost in this step more than any other, and mostly by omission. Three mechanisms apply. Price concessions are not claimed. When a generic can only be bought above the Drug Tariff price, you report it to CPE, with the product, price paid, pack size and wholesaler, by single-item form or spreadsheet. CPE checks the reports and asks DHSC for a concession. DHSC announces decisions in batches through the month, and CPE posts each update. If a concession is granted, every pharmacy is reimbursed at that price for the month automatically. No report, no evidence; no evidence, no concession. Concessions apply to products in Parts VIIIA, VIIIB and VIIID of the Tariff. Since April 2024 DHSC has also paid quarterly retrospective top-ups where its margin survey shows a concession price was too low. Between May 2024 and April 2025 DHSC granted 1,524 concessions, an average of 127 a month. See how price concessions work for the mechanism and its gaps.
SSP supplies need the endorsement in step three, and a claim by the 5th of the following month. Specials and imports need the most care. The Drug Tariff Part IIIA fees and endorsements are set out below; specials rules are from CPE's unlicensed specials page.
| Supply | Endorse | Paid |
|---|---|---|
| Generic bought above Tariff price. | Nothing extra; report the price to CPE. | Concession price for the month if one is granted; otherwise the Tariff price. |
| SSP supply. | SSP number, product, quantity, pack size, invoice price where required. | Item plus £5.35 SSP fee; claim by the 5th of the following month. |
| Special listed in Part VIIIB or VIIID. | "SP"; "BB" for broken bulk on Part VIIID lines. | Tariff price plus the £20 unlicensed medicine fee. |
| Special or import not in the Tariff. | Quantity, pack size, price per unit less discount or rebate, the manufacturer's or importer's MHRA licence number and the batch number. | Invoice price with no discount deducted, plus the £20 fee; no broken bulk or out-of-pocket claims. |
Paper prescriptions for unlicensed medicines go in the red separator at month end. Keep the supply records for five years: source, date, recipient, prescriber, quantity, batch number and any certificate of analysis or conformity. Where the concession gap is large and the patient has several days' supply, it can be reasonable to wait a day or two for a wholesaler due date or a concession update. Where the patient has none, supply, report and move on. Patient need decides; the report protects the margin either way.
Step 6: tell the patient what happens next
Give the patient four things: what is happening, what you have done, what happens next, and when. In the 2025 survey, 95% of team members said patients are inconvenienced by shortages and 79% had faced aggression over them. A clear message with a date removes most of the heat. Say the medicine is short nationally when the Medicines Supply Tool confirms it, so the patient does not blame the pharmacy or the practice. Give the date you expect stock, or the date the prescriber will be in touch. Tell them not to change or stretch doses without advice, and how to contact you.
CPE's "Where's my medicine?" leaflet, updated in June 2025, and its counter poster do the explaining when the queue is long. Scripts for the harder conversations, including the patient who has run out, are in what to tell patients during shortages.
Write the six steps as one SOP, one page, in the order above, and put it where the phones are. Name who runs the owings list each morning and who sends the CPE reports each week. Train every dispenser to run steps one, two and six without a pharmacist. Keep steps three and four with the pharmacist, because both rest on clinical judgement. Then measure it, or it will drift back to improvisation within a month.
How do you know the workflow is working?
When five numbers move the right way. Pull them from the PMR each week and put them next to the rest of your operating figures; see which numbers a pharmacy owner should check every week.
- Open owings, and how many are older than seven days. The second number should be near zero.
- Owings closed by a prescriber change, as a share of all owings. It shows whether step four is being used or avoided.
- Items bought above Tariff price, and how many were reported to CPE. The two numbers should match.
- SSP supplies made, and whether every one was endorsed and claimed by the 5th.
- Staff hours logged on sourcing. The 2025 survey suggests one to two hours a day is typical; if yours is higher, the routine is not being followed.
Review the SOP each quarter against the live SSP list, the contingency contacts and the current fees, all of which change. The point of the workflow is not to make shortages disappear. It is to make sure that when one happens, the patient gets a date, the record gets an entry and the margin gets reported.
Key takeaways
- 87% of pharmacy teams handle supply issues daily and 26% spend more than two hours a day on them, so shortages need an SOP, not improvisation.
- Source in a fixed order: every wholesaler account, the manufacturer's contingency line, the Medicines Supply Tool, other pharmacies, then specials.
- Every owing needs a dated record and a dated slip; Schedule 4 requires supply with reasonable promptness and an estimated time on request.
- Check the NHSBSA SSP list before ringing the prescriber; six SSPs were in force in April 2026, and each supply earns £5.35 with a claim due by the 5th.
- Outside an SSP, regulation 214 means the prescriber must authorise any change; ring with a specific alternative, and use the 72-hour urgent supply route where it fits.
- Price concessions are reported, not claimed: report every above-Tariff purchase to CPE, then reimbursement at the concession price is automatic for the month.
- Specials earn a £20 fee but only with the right endorsement, and their records must be kept for five years.
Sources and further reading
- Medicine shortages (Community Pharmacy England)
- Price concessions (Community Pharmacy England)
- Drug Tariff (NHSBSA)
- Serious Shortage Protocols (NHSBSA)
- Unlicensed specials and imports (Community Pharmacy England)
- Manufacturer contingency arrangements (Community Pharmacy England)
- NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013, Schedule 4: terms of service of NHS pharmacists
FAQs
Every owing needs a paper trail.
A shortages workflow only works if the wholesaler checks, the SSP decision, the prescriber call and the patient conversation all sit on the record. Dataforge PMR logs each step against the prescription, so the next pharmacist, and the inspector, can see what happened and when.
See Dataforge PMR