Blog | Fixing the prescribing loop

If you’ve ever worked in community pharmacy, you’ll know the feeling of a prescription coming in, a quick scan of the shelves and a check of the ordering system before bashfully wandering back to the counter to apologise to a patient that an item is out of stock... again.

On the rare days we were on top of the electronic prescriptions and aware of the long-term supply issues, we could get ahead of the problem. But even then, it meant sending prescriptions back to the surgery and hoping for an alternative to be issued before the patient arrived to collect their repeat medication. Even as a team of pharmacists and technicians who valued great relationships with the local prescription clerks and GPs, it was still an incredibly frustrating part of the job, and no amount of shared wholesaler data ever quite solved it.

Fast forward to today, I now work as a pharmacist account manager supporting medicines optimisation and pharmacy teams across health boards and integrated care boards. And guess what? A unique blend of global challenges — from manufacturing hurdles to shifting geopolitical landscapes — has created a situation where demand is outpacing supply for certain products. The recent government paper, Managing a robust and resilient supply of medicines - GOV.UK, acknowledges what community pharmacists and primary care prescribers have been saying for years; prescribers need live information on medicine shortages at the point of prescribing. It’s a welcome move. The plan is to integrate shortage alerts and resupply dates directly into prescribing software, so clinicians can make informed decisions before the prescription is even issued.

This will be supported by information guides for patients, GP surgeries and community pharmacies — offering advice on what to do during a shortage and where to find the most up-to-date advice on national supply issues. Patients will also receive an explanation of why the medicine may be in short supply and advice on who can support them with any concerns.

Serious shortage protocols (SSPs) have existed for years, allowing pharmacists to appropriately substitute the prescribed product for an alternative specified in the active SSP. Further expansion of their use would give community pharmacists far more flexibility to solve an issue for a patient without fear of inadequate reimbursement or the need to return to the prescriber.

For discontinued products, suggesting an alternative can be simple. Many prescribers have a hard time remembering that a branded ear spray was recently discontinued and an even more difficult time remembering the generic alternative.

ScriptSwitch® Prescribing – Clinical Decision Support already sits within GP systems, and offers real-time prescribing guidance, cost-effective alternatives and alerts that can be as simple as, “Your regular ear spray is discontinued, but here’s a suitable alternative that’s actually in stock.” Auto-populating the patient record when the recommendation has been accepted is a bonus. There’s no need for prescribers to scribble down or screenshot the alternative. They can simply accept the recommendation and move on with their day.

With a reliable and well-maintained source of truth and transparent supply chains data, ScriptSwitch could unlock even greater potential. In recent months, medicines optimisation teams have created supply alerts for products like branded fentanyl patches, insulin cartridges and topical creams. Within an hour, a team can publish a message to all prescribers, notifying them of a supply issue at the point of prescribing, and where appropriate, suggesting suitable alternatives. Alerts can also include embedded links to recently updated formulary pages, helping prescribers to quickly consider other treatment options. While these tools are undoubtedly helpful, they still rely heavily on feedback following frustrating experiences and limited data drawn from fragmented systems.

One of the key initiatives in the NHS’s Fit for the future: 10 year health plan is a move toward a single national formulary. In theory, it’s a great idea, standardised prescribing, reduced variation and better outcomes. Plenty has been written about it, both positive and critical. But if the supply chain isn’t stabilised, we risk creating a formulary full of medicines that aren’t actually available. That’s not just frustrating — it’s potentially unsafe.

We need to make sure these changes aren’t just policy on paper. Let’s work together — pharmacists, GPs, software providers and policymakers — to build a prescribing ecosystem that’s resilient, responsive and real-time.

Because patients (and prescriptions) shouldn’t have to bounce between pharmacy and surgery like a game of NHS ping-pong. And prescribers shouldn’t need a memory palace to recall a growing list of medicines in limited supply, or the full name of a discontinued ear spray.

Disclaimer

This article was prepared by Ben Cole in a personal capacity. The views, thoughts and opinions expressed by the author of this piece belong to the author and do not purport to represent the views, thoughts and opinions of Optum. Any general health information contained in this article is for information purposes only and is not a substitute for your doctor’s care.

About the author

Ben Cole

Pharmacist Account Manager

Ben works with NHS Medicines Optimisation teams in England, Scotland and Wales to support safe, cost-effective prescribing and improve health outcomes. Before joining Optum, Ben spent over a decade in community pharmacy, holding leadership roles with national chains where he managed teams, drove service delivery and supported local healthcare initiatives.