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Supply Issues & Shortages – DHSC and NHSE&I Guide

The DHSC and NHSE&I jointly published a Guide to Managing Medicines Supply and Shortages in November 2019.

The guide sets out the approach taken by the DHSC Medicines Supply Team and NHS&I Commercial Medicines Unit, with information on: intelligence; information gathering; risk assessment; categorisation; escalation routes; management options and communication methods.

The DHSC and NHSE&I teams and the multi-disciplinary pan-system Medicines Shortage Response Group assign shortage issues to one of four tiers:

  • Tier 1 (low impact): These supply issues are likely to carry low risk. Management options should result in patients being maintained on the same licensed medicine.
    • Covered by DHSC monthly Supply Issues Updates (available via SPSPrescQIPP – when logged-in).
  • Tier 2 (medium impact): These supply issues require more intense management options (such as using low risk therapeutic alternatives, unlicensed imports or alternative strengths or formulations), which may carry a greater risk to patients/health providers than Tier 1 issues, but which are considered safe to be implemented locally without further escalation.
  • Tier 3 (high impact): These supply issues are more critical, with potential change in clinical practice or patient safety implications that require clinical or operational direction to the system. The response is nationally coordinated and guided and the NHS may invoke the Emergency Preparedness Resilience and Response (EPRR) function.
  • Tier 4 (critical): These supply issues require additional support from outside the health system and trigger the use of dedicated national NHS EPRR incident processes and procedures in order to provide additional support for the management of the shortage.

Update March 2020 – a link to the Guide has been posted, with some explanatory notes, on the NHS England website @