ICBs should put in place local mitigation plans to ensure patients are not left without pancreatic enzyme replacement therapies (PERT), amid shortages of the medicine.
PERT, which is used in the treatment of pancreatic exocrine insufficiency such as in cystic fibrosis, pancreatic cancer and pancreatitis, has no clinical alternative.
ICBs have been told to put in place local mitigation plans when patients are unable to obtain medicines from pharmacies or dispensing GPs in their areas, and to cascade any local management plans to pharmacies and GPs.
A national patient safety alert was first sent out on 24 May 2024, outlining the shortages. However, an updated alert was sent on 18 December with additional actions, including those for ICBs (see box for actions).
The alert said many ICB regions have escalation processes in place for when patients are unable to access PERT, such as centralised ordering processes for unlicensed imports and collaborations between pharmacies, GPs and local trusts to create an ‘emergency pathway’.
But, it urged ICBs to make sure they do this by 31 January 2025 to ensure patients are not left without the medicine.
The notice said: ‘The supply issue is impacting primary care suppliers to a much greater extent than secondary care suppliers due to the supply channels available to each sector. This is increasing pressure on secondary care supplies as some patients unable to obtain stock locally are being referred to local secondary care supplier.
‘Several specialist importers have confirmed they can source unlicensed PERT; please note there may be other companies that can also source supplies. The enzyme composition of unlicensed imports may differ from UK licensed products; please refer to the datasheet accompanying these products.’
Actions required by national patient safety alert
Actions for clinicians and prescribers of PERT to be completed 31/01/2025
To remain in place only until the supply issues have resolved (see SPS Medicine Supply Tool)
- Clinicians should continue to follow the actions set out in the National Patient Safety Alert (NatPSA/2024/007/DHSC) issued on 24th May 2024.
- NHS provider trust pharmacy procurement teams should ensure that where quantities greater than current demand are required, unlicensed imports should be considered.
- To ensure that patients are not left without PERT, Integrated Care Boards (ICBs) should:
- Put in place a local mitigation plan for instances when patients are unable to obtain stock from their community pharmacy or dispensing GP.
- Cascade any local management plan to all community pharmacies and GP practices within the region, as well as local trust pharmacy teams.
