Update for pharmacies: SSPs and supplies of antibiotics for Strep A treatments

The supply situation re antibiotics remains extremely challenging for contractors and over the past week much work has been underway by both PSNC and the LPCs to seek resolutions at both a national and local level. This article provides the latest information as of 23rd December, as well as links to some new support materials for contractors.

We remain in contact with DHSC. The supply and reimbursement situation is untenable for contractors with this current crisis being just the latest problem that pharmacies are unfairly having to grapple with. We are continuing to make clear and firm representations on this to Government – they have a duty to assure the supply of medicines and must find urgent solutions.

Serious Shortage Protocols

Last week, DHSC issued eight Serious Shortage Protocols and these have been updated further this week. These SSPs enable pharmacists, exercising their professional skill and judgement, to dispense different formulations against many Penicillin V (Pen V) prescriptions and, if another formation is unavailable, another antibiotic in an order of priority as listed in the relevant SSP.

DHSC has published the SSPs and guidance on each SSP on the NHSBSA website.

Updates to the SSPs were issued on 23rd December.

SSPs are part of contractors’ Terms of Service and part of pharmacy practice (and thus should be covered by normal professional indemnity arrangements) and the RPS has published an illustration (note this was updated on 28th December) to assist supervising pharmacists in their decision-making on these SSPs. Of the eight SSPs, the first three involve formulation changes and are all similar, and the subsequent five involve dispensing an alternative antibiotic and again are all similar.

PSNC has issued briefings to explain how SSPs work and how contractors should claim for a prescription when supplying an alternative formulation or medicine to that prescribed. Recognising the additional pressure that using SSPs puts on pharmacy teams, PSNC has also published some Points to Consider for these SSPs. But pharmacists and contractors should also ensure they are familiar with the SSPs and specific endorsement guidance for each SSP.

Read our guidance on the points to consider when using SSPs for Penicillin V

Supply of Antibiotics

There is considerable concern about wholesale supplies during the Christmas and New Year period and PSNC has been raising these with DHSC as well as liaising with HDA, which represents the larger full-line wholesalers. It is clear from the information we have received that:

• DHSC has been receiving daily updates of stock from wholesalers and is liaising with manufacturers and others to seek to maintain supplies;
• The eight Pen V SSPs DHSC has issued enable pharmacies to provide alternative formulations or antibiotics, as appropriate and in accordance with the SSPs;
• Hospitals have been seeking to ensure that they have sufficient stock to meet demand – and there may be local arrangements for pharmacies to access such stock (some LPCs have been involved in setting up these mutual schemes);
• Pharmacies locally may be able to help each other with stock. DHSC indicated that pharmacies may supply small quantities of a medicine to another pharmacy to meet a patient’s individual needs without the requirement of a Wholesale Dealer’s Licence; and
• HDA wholesale distributors have a 24/7 emergency call-out service which is available every day of the year, including over the Christmas and New Year holiday periods.

Martin Sawyer, HDA Executive Director indicates that:

HDA wholesale distributors are working very closely with the DHSC and NHSE in order to manage antibiotic supplies, and the main wholesalers are providing daily stock data of these critical products to DHSC, NHSE and the devolved nations. Deliveries into wholesale depots from manufacturers have been good this week – but demand has remained very, very high. Accordingly, community pharmacy is reminded of HDA wholesale distributors 24/7 emergency call-out service which is available every day of the year, including over the Christmas and New Year holiday periods.

Ongoing Pharmacy Pressures

PSNC will remain in contact with DHSC and will issue any further updates to contractors over the Christmas and New Year period.

The current situation for all community pharmacies is unworkable – financial, operational and medicines supply pressures must all be resolved urgently. We are continuing to make very clear and strong representations to Ministers and Government on this, including in the recent open letter to the Secretary of State for Health. Government must resolve the crisis in community pharmacies urgently, and we and others will keep working tirelessly to make this happen.