Introduction

While we continue to formally review the long-term arrangements for national supply disruption escalation, this guide sets out the steps that NHS trusts, integrated care boards (ICBs) and NHS England regional procurement or regional EPRR (emergency preparedness, resilience and response) teams should take when seeking to report and resolve potential or actual disruptions to the supply of medical equipment and consumables.  It also sets out the mechanism by which regional EPRR teams can inform NHS Resilience nationally (formerly the national EPRR team).  

Note: Medicines shortages/disruptions are out of scope of this process. They will be managed by the NHS England Commercial Medicines Unit and/or the Department of Health and Social Care (DHSC) Medicines team, escalating to NHS Resilience when considered necessary.

For the purpose of this guide the term supply disruption is defined as a product’s unavailability via a normal supply route. Where this is the case it is always recommended that a clinically appropriate alternative is identified and purchased instead.

Throughout we refer to trust/ICB to recognise the differing procurement arrangements that may exist across systems. Regardless, trusts should ensure that their ICBs are fully sighted on any actual or potential supply disruptions they are facing.

Escalating a potential disruption – step by step

NHS trusts/ICBs should follow the below steps when experiencing a medical equipment or consumable supply disruption.

Step 1: Trust/ICB identifies an actual or potential supply disruption

Should a trust/ICB or clinical network identify an actual or potential product supply disruption (for example, a company notifies them of this), initial views on product use and the acceptability of alternatives should be sought. Clinical and procurement professionals’ views are essential in this, and input and advice would usually come from relevant lead clinicians for the service(s) impacted and the trust’s procurement lead. Trusts may also wish to inform their EPPR lead at this stage. Trusts should liaise with relevant ICB contacts at this point including ICB heads of procurement where these posts exist. ICBs without a head of procurement post should establish and communicate the official/team that is the designated point of contact for providers and NHSE in these circumstances.

The below checklist can be used to ensure key information is captured in case the disruption requires further escalation. It is provided as an example and is not exhaustive.

Initial answers to the below questions in the checklist should be investigated and recorded at trust level. It is ideal that a shared understanding of the local position is held across trust decision-makers before moving to step 2 of escalation.

Supply escalation checklist

Step 2: Trust/ICB discusses potential mitigations with NHS Supply Chain and/or supplier

Once confident there is an issue, trusts/ICBs should check their method of ordering the product:

NHS Supply Chain stocked product

If the product is normally ordered via NHS Supply Chain, trusts/ICBs/NHS England regional teams should login to the NHS Supply Chain’s website to:

• check why the item (stock) is unavailable. Is there a current Important Customer Notice (ICN)? The existence of an ICN will indicate that the disruption is known about (for NHS Supply Chain provided products only), and it will provide details on alternatives, mitigations, and clinical guidance where a change of practice may be necessary.
• contact NHS Supply Chain Customer Services and/or their account manager to raise a query. Residual stock can often be found, or alternatives suggested by the NHS Supply Chain team
• discuss with clinical colleagues in your organisation if any direct or indirect alternatives that are available in stock that could be considered as an interim substitution

If the product is listed on NHS Supply Chain’s catalogue/framework, trust/ICB colleagues should first call NHS Supply Chain (via the trust’s local customer representative) for support in managing the disruption.

Note: NHS Supply Chain’s main method for keeping customers aware and informed of important service-related issues is via Important Customer Notice (ICN). These notices keep customers informed of current temporary supply issues, discontinued products, product updates and more. ICNs are available via Important Customer Notices (ICNs) » NHS Supply Chain

Product not purchased or available via NHS Supply Chain

Where the product is not purchased via NHS Supply Chain, trusts/ICBs should contact their existing suppliers/wholesalers or managed services provider (where relevant). They should check why the product is not available and whether any direct or indirect alternatives are in stock that the trust/ICB clinical teams could consider as an acceptable interim substitution while the disruption is resolved.

Note: Individual product suppliers can also escalate supply disruptions to National Supply Disruption Response (NSDR).

If step 2 does not resolve the issue, move to step 3.

Step 3: ICB EPRR or procurement team (where these exist) support trusts to secure short-term mutual aid at system level

If initial liaison with NHS Supply Chain and/or the individual manufacturer or supplier has been unsuccessful and no suitable alternative is available, the trust/ICB should:

• liaise with other NHS organisations in the ICB, the ICB EPRR lead and where relevant, system partners such as social care to understand stock levels of existing and inbound stock and if peer organisations are facing the same challenges
• discuss if mutual aid is available within the ICB on a temporary or long-term basis – and if so, for what length of time

If mutual aid is not available within the ICB or offers only a temporary solution to a likely long-running disruption, then trusts/ICBs should move to step 4.

Step 4: NHS trust reports potential supply disruption to the National Supply Disruption Response (NSDR), via the dedicated helpline, 0800 915 9964, and inform regional EPRR (for information)

If ICB-level mutual aid is at risk of exhaustion, does not resolve the disruption or is not available, trusts should raise the potential issue with NSDR. If you become aware that a disruption to supply could be system wide, please alert NSDR irrespective of whether the product disrupted is specialist or low volume or is common or high volume.

The NSDR acts as a single point of contact when a trust or ICB has a supply disruption, and its supplier has exhausted all other options available to maintain supply.

A disruption can be reported to NSDR via the dedicated helpline 0800 915 9964 (freephone number in the UK) or 0207 972 1071. The line is open Monday to Friday 9am to 5pm except public holidays. If calling NSDR out of hours, please leave a message detailing the reason for the call. This will usually be picked up the next working day. Access to the DHSC-run Express Freight Service is available 24/7 should this be needed in extremis.

A disruption can be reported by a trust/ICB, manufacturer, supplier, NHS Supply Chain, DHSC workstream and/or any health or care organisation. An organisation that reports a supply disruption to the NSDR is classed as the ‘originator’ and will be kept informed of case investigation and management progress for the duration of the investigation.

NSDR is a UK-wide service designed to work alongside existing disruption response arrangements in the UK and works closely with the NHS and national governments of Scotland, Wales, Northern Ireland and the Crown Dependencies. It can access clinical and commercial advice from NHS England, as well as escalate to the DHSC’s Operational Response Centre (ORC) and NHS Resilience where there is a national disruption and/or a risk to life.

Trusts/ICBs should inform their regional EPRR team and procurement/supply teams where they exist that they have reported the disruption to NSDR (in most cases an informal conversation between trust/ICB and region will already have occurred).

Step 5a: NSDR conducts initial investigation and liaises with originator of query

NSDR will request information on the supply disruption to record the issue on the case management system.

If the trust/ICB has completed the supply escalation checklist set out at step 1, this will ensure that you have clinically validated information  which can will provide the core information that NSDR colleagues require to open a case.

A case number will be assigned to the disruption and an investigation will start.

NSDR will be able to confirm with the originator trust/ICB whether the disruption is already known about nationally and is being actively managed. It will often already have been notified by a number of originators or a supplier and information on the expected duration of the disruption and advice from the supplier can be shared.

NSDR will assign complex case investigation management (CCIM) resource to the disruption and a case manager will contact the originator for detailed information on the product, including patient impact and likely date stock is exhausted, and relevant stakeholders will be contacted for further information.

This will include:

• liaising with the supplier for details of the disruption and its recovery plans
• contacting NHS Supply Chain or other distributors/wholesalers that stock the product to determine whether any stock can be released to fulfil the trust’s immediate need
• investigating alternative products and contacting their suppliers

The trust/ICB or clinical network should not raise disruptions repeatedly once NSDR has opened a case. NSDR will keep the query originator updated (frequency to be determined on a case-by-case basis) on any developments.

Step 5b: Trust/ICB updates and formally escalates supply disruption to the regional operating centre/EPRR team (and regional procurement teams where they exist) for support

Trusts, ideally via ICBs, should use the information gathered using the checklist in Step 1, plus any information from initial investigation by NSDR, to provide an initial briefing to support formal escalation to regional operation centres (ROCs).

This information will supersede the information previously provided to regional EPRR (see step 4) as trusts/ICBs will now be requesting formal support from regional EPRR to manage the disruption. This might involve seeking inter-regional mutual aid.

The below table provides the ROC contact details including hours of operation.

Contact details for regional operations centres

Step 6: Regional operations centre and/or EPRR team escalate to national EPRR

If no solution involving regional mutual aid can be found and/or despite support from NSDR or NHS Supply Chain a significant risk of disruption remains that puts patients’ safety at risk, the regional EPRR team may wish to consider escalation to the National Operations Centre (NOC).

Should the regional EPRR team wish to escalate the supply disruption for consideration as a national incident, regional EPRR teams and/or ROCs should email NOC giving details of the disruption and the steps taken to date to remedy and mitigate it. This should include:

• details of trust/ICB discussions with supplier or NHS Supply Chain to date
• details of mutual aid within ICB and inter-regionally (requests and aid received)
• alternative products used and details of order placed (if any)
• details of any actions taken by NSDR in response to supply disruption and latest update on ongoing case management

Escalations should be sent to england.nationaloperationscentre@nhs.net copying in the EPRR duty mailbox england.eprr@nhs.net to ensure action if the disruption is urgent:

During working hours (9am to 5pm Monday to Friday) the NOC will escalate the issue to the System Resilience team in NHS Resilience for consideration and liaison with NSDR/NHS Supply Chain.

Outside working hours, a response should be expected the next day or when escalated during a weekend, on Monday. If the escalation is urgent, it will be considered by the EPRR on-call team.

Publications reference: PRN01270