This page contains Frequently Asked Questions (FAQs) on Serious Shortage Protocols (SSPs) last updated on 20 November 2019.
This page will continue to be updated as details are confirmed with NHS England and Department of Health and Social Care (DHSC).
Q. How will pharmacies receive information on updates to SSPs?
A. Pharmacy teams will be notified of any new SSPs or changes to an existing SSP via NHSmail, the NHS Business Services Authority (NHSBSA) website, via the PSNC newsletters, the latest news section of our website and you can also check the PSNC Live SSPs page.
Q. When may supply in accordance with an SSP be refused?
A. Contractors may refuse to supply an alternative product or quantity in accordance with the SSP, if the supervising pharmacist considers that supply of the different or alternative product or quantity is unreasonable or inappropriate. Contractors must refuse to supply an alternative product or quantity in accordance with the SSP, if such a supply has already been made in accordance with the presented prescription.
Q. Do patients have to consent/agree to SSP supplies?
A.Yes, patient consent/agreement is required for supply of an alternative product or quantity in accordance with an SSP.
Q. Do patients pay prescription charges for SSP supplies?
A. Generally, prescription charges are payable for the supply of alternative products in accordance with SSPs, if they were payable for supply under the original prescription. The exception to this is that no prescription charge is payable if the patient is supplied with a smaller quantity of drug or fewer appliances than originally prescribed. This exception was proposed by PSNC and accepted by DHSC Ministers in order that patients that pay the prescription charge are not disadvantaged by the use of an SSP.
Q. If the prescribed item cannot be obtained after the expiry of an SSP, can I continue to make supplies of the alternative(s) specified in the expired SSP until stock of the prescribed item becomes available?
A. No. Once an SSP has expired/been withdrawn it is no longer valid for use and you must dispense in accordance with the prescription. If the prescribed item remains unavailable, the patient should be referred back to the prescriber for an alternative.
Q. Do the other provisions of the terms of service apply to SSP supplies?
A. Yes. SSPs are now part of the Essential Dispensing Service, part of Schedule 4 of the NHS Pharmaceutical Regulations and, broadly, the terms of service apply; including, for example, that contractors must provide appropriate advice as required and maintain appropriate records.
Specific amendments in the NHS (Amendments Relating to Serious Shortage Protocols) Regulations 2019, to ensure the terms of service are relevant to SSPs, include:
- Measuring and fitting for appliances (Reg. 8 (4))
- Relevant standards and formula (Reg. 8 (5))
- Original pack dispensing (Reg. 8 (10))
- Suitable containers (Reg. 8 (15))
- Alternative to referral for an appliance (Reg. 10 (2)(b)
Q. What about reimbursement, remuneration and endorsements for SSP supplies?
A. Reimbursement – is for the medicine supplied in accordance with an SSP, not the originally prescribed medicine or appliance.
Remuneration – the same fees and allowances are paid for SSP supplies as are paid for medicines and appliances supplied against prescriptions. In 2019/20 a contingency of £10 million is being set aside to fund any supplies made in accordance with SSPs. If an SSP is introduced, contractors will receive a fee of £5.35 per item for any necessary supply in accordance with SSPs (in addition to usual dispensing fees for the item). Should this £10m contingency budget not be needed, it will be paid to contractors in the Transitional payments from February 2020.
Q. When endorsing a prescription for an SSP do I have to endorse the pack size?
A. Pharmacy teams should endorse the prescription or token in line with the endorsement requirements specified in the protocol. It may be beneficial to endorse the pack size to remove any ambiguity and aid processing at NHSBSA if the free text ‘Dispensed Additional Information’ field can accommodate the extra characters.
Q. When endorsing a prescription for an SSP, does the SSP number need to be included?
A. No. The SSP number is not required as the originally prescribed drug and the presence of ‘NCSO’ endorsement against it will help identify that the protocol that was used to make a supply. Additionally, as there are limited character spaces in the free text ‘Dispensed Additional Information’ field, keeping endorsements minimal is ideal.
Q. What are the correct requirements for SSP endorsements?
A. Pharmacy teams are advised to refer to the individual protocol for specific endorsement requirements. Pharmacy teams are required to endorse the prescription with ‘NCSO’ (No Cheaper Stock Obtainable) to indicate that a supply was made in accordance with an SSP. The use of the NCSO endorsement will indicate to the NHSBSA that an SSP was used, i.e. that the originally prescribed product was not dispensed by the pharmacy and a different quantity or product was supplied in accordance with an SSP.
To ensure correct payments (fees and reimbursement) for products supplied under an SSP, pharmacy teams are generally required to endorse the following information on the paper prescription or where issued using EPS, using either the original electronic prescription or its associated dispensing token (as outlined in Part II of the Drug Tariff):
- NCSO – to indicate that the supply was made in accordance with an SSP;
- Details of product supplied in accordance with the SSP (drug name, quantity, strength, formulation, supplier name or brand) *;
- Quantity supplied*;
- Pack size – best practice where multiple pack sizes are available; and
- Invoice price – only if NHSBSA has no list price available on dm+d.
* The drug details and quantity supplied and endorsed will depend on the specific SSP.
If the above SSP endorsements cannot be applied using your system supplier, pharmacy teams are advised to endorse and submit SSP claims using the corresponding EPS token and mark the original item on EPS electronic claim message as ‘Not Dispensed’.
Q.I have received a prescription for ‘Drug X’ 28 tablets. I only have 14 tablets in stock, however, there is a valid SSP in place for ‘Drug X’ allowing substitution of tablets to capsules. Can I dispense the 14 tablets of ‘Drug X’ that I have in stock and use the SSP to supply the remaining balance as capsules?
A. No. Should you wish to use the stock you currently have on your shelf you should dispense the prescription as per usual processes, clearly endorsing the quantity to show that 14 tablets only were dispensed. Alternatively you can consider supply of the capsules in accordance with the SSP for ‘Drug X’ .
Q. How should I submit an SSP claim if my PMR system does not appear to support all the required endorsements to submit a valid SSP claim electronically?
A. In order to remove any ambiguity and avoid the risk of incorrect endorsement, NHSBSA advise that all the required SSP endorsements should be present within the free text ‘Dispensed Additional Information field’, where possible. If the SSP endorsements cannot be accommodated on the EPS claim message (for example, due to character limit restrictions), pharmacy teams are advised to submit the SSP claim using the corresponding EPS token. When making a submission using a token always remember to mark the electronic claim message as ‘not dispensed’ or ‘ND’.
Q. I have a prescription for two items; one item covered by an active SSP and the other for a non-SSP item. The item covered by SSP is supplied within the period of SSP validity but the non-SSP item is only part-dispensed with an owing for the patient. The balance of the non-SSP item is not dispensed to the patient until after the expiry of the SSP. Will I be reimbursed for an SSP if the prescription is submitted for payment after the SSP expiry date?
A. Pharmacy teams have to submit their claim for the SSPs in the usual manner, i.e. by the 5th of the month following that in which supply was made. However, any prescriptions with mixed (SSP and non-SSP items) may be claimed up to three months after the SSP expires to help deal with claims for any owings on the prescription. Using the example of SSP01 which expired 25 October, the final cut-off for submission to be reimbursed for this SSP would be with your December bundle (submitted by the 5th of January).
Please note that SSPs cannot be supplied past the period of SSP validity. Any other items on the prescription (such as an owing) can continue to be dispensed as usual but must be submitted for payment within three months of expiry of the SSP.
Q. How can I ensure that the paper prescriptions and tokens with SSP claims are seen by an exception handler at NHSBSA?
A. All paper prescriptions and tokens which SSP claims must be placed in the red-separator on top of the bundle before submitting to the NHSBSA in the usual way.
Q. If a prescription or token with an SSP claim is not endorsed with a formulation, quantity or strength, would the prescription (or a copy of) be returned to the contractor for clarification?
A. Where insufficient information is available to enable the NHSBSA to process an SSP claim, the prescription or token shall be returned to the contractor to endorse the prescription form (or copy of the original form) with the information requested. Returned prescriptions shall be priced using the Drug Tariff relevant to the month in which the prescription form (or copy) is returned to the NHSBSA. If the initials ‘NCSO’ are missing on any SSP claim, the prescription or token will not be returned to the contractor and any reimbursement will be based on the original prescribed order.
Q. I have submitted a prescription with an SSP claim to NHSBSA but omitted the endorsement of ‘NCSO’; will NHSBSA return the prescription to us for clarification?
A. No. To be reimbursed for supplies made against an SSP, the endorsement ‘NCSO’ must be present. Failure to endorse ‘NCSO’ would result in the prescription being reimbursed based on the original prescribed order.
Q. For SSP03 (Fluoxetine 40mg capsules), I have submitted the claim message below, will I be reimbursed correctly?
A. No. For every Fluoxetine 40mg capsule, SSP03 allows a pharmacist to supply:
2 x Fluoxetine 20mg capsules.
In this example, Fluoxetine 40mg capsules x 60 are prescribed. Under SSP03, the pharmacist would be required to supply a quantity equivalent to the number of days prescribed on the original prescription i.e. Fluoxetine 20mg capsules x 120 capsules. A quantity of 30 has been endorsed by the pharmacist, which could either indicate:
- the pack size used for supply, or
- that the quantity supplied is less than the number of days specified on original prescription.
Whilst the correct formulation has been endorsed as per SSP03; the quantity has not been doubled up to cover the original order. This SSP claim is invalid and the NHSBSA will reimburse based on the endorsed quantity of 30 capsules i.e. treat as indication of less given.
The image below shows the correct endorsement:
For more information on endorsing SSPs see our Serious Shortage Protocols (SSPs) Endorsing Factsheet
Q. How will payments for SSPs claimed appear on my Schedule of Payments?
A. The Schedule of Payment will include two single lines – one for total VAT and other for fees (if applicable).