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HRT: Pharmacists can restrict quantity or substitute products under 10 new SSPs

Pharmacists can consider “different options” when supplying certain HRT products in light of “significant ongoing disruption” to stock levels, the Pharmaceutical Services Negotiating Committee (PSNC) has told pharmacy teams.

Following the ongoing supply issues affecting hormone replacement therapy (HRT) products, the Department of Health and Social Care (DH) has released an additional 10 serious shortage protocols (SSPs), PSNC wrote in an update this afternoon (May 20).

The new protocols are in addition to the three that were introduced on April 29 and can be implemented “with immediate effect”, PSNC added.

Each new protocol specifies whether pharmacists can either provide a reduced quantity of the specified HRT medicine, substitute it with a specific alternative, or “provide a reduced quantity of a specific alternative product”, PSNC wrote.

The SSPs listed on the NHS Business Services Authority (NHS BSA) website provide directions for supplying products including Estradiol (Oestrogel Pump-Pack 750 microgram per actuation) 0.06%, and Estriol (Ovestin 1mg) 0.1% cream.

The SSPs also include “specific patient counselling points, which must be taken into account when deciding whether supply in accordance with an SSP is suitable for a patient”, PSNC added.

Find the full list of SSPs and the details of what each protocol entails on the NHS BSA website.


Additional HRT stock


In a statement to the press, the DH wrote that the availability of Premique Low Dose has improved following the introduction of SSPs last month.

Some suppliers have also secured additional stock of those HRT products that are in short supply, following meetings with the DH, it added.

HRT tsar Madelaine McTernan said she is “very encouraged by the constructive engagement across the sector and enthusiasm with which suppliers and pharmacists are looking to work with us to meet this challenge”.


PSNC: SSPs do not help with capacity pressures


PSNC committee member Fin McCaul welcomed the DH’s “vote of confidence” in pharmacists’ ability to mitigate medicine supply issues, following the issuing of further SSPs for HRT products.

“But pharmacy teams will need to work quickly to familiarise themselves with all the details, and we are pressing DH to urgently confirm the endorsement guidance to ensure that contractors are correctly paid following use of the SSPs,” Mr McCaul added.

He said that while SSPs can help manage HRT supplies, pharmacy teams have to familiarise themselves with them and implement them, which “will not help to ease the time and capacity pressures that all community pharmacy teams are having to grapple with”.

Meanwhile, NHS England and NHS Improvement (NHSE&I) wrote in a bulletin to primary care teams earlier this week that prescribers should work with pharmacy teams to “identify available stock” of HRT products before prescribing.

“Prescribers in primary care are guided by local formularies but this does not prevent prescribing of a wider range of products (listed in the British National Formulary) if, for example, the formulary products are in short supply,” NHSE&I wrote. 

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