In response to a significant ongoing disruption to the supply of Estradot® 100micrograms/24hours patches, a Serious Shortage Protocol (SSP) has been issued by the Department of Health and Social Care (DHSC).

Effective today 21st August 2023, SSP057 provides that for every Estradot® 100micrograms/24hours patch originally prescribed either one Evorel® 100 patch or one Estraderm® MX 100 patch must be supplied. SSP057, authorised by the Secretary of State, has been developed by clinicians and provides pharmacists with procedures to follow in providing a suitable alternative product to help reduce the number of patients having to return to their prescriber for a replacement prescription.

For prescriptions (NHS or private) requesting:
Supply permitted under SSP057:
Estradot® 100micrograms/24hours patches
Evorel® 100 patches
Estraderm® MX 100 patches

The SSP may be amended or revoked at any time but currently expires on Friday 8 September 2023 – we will update contractors on any changes.

Community Pharmacy England previously reported that the NHS Business Services Authority (NHSBSA) received a number of EPS SSP claims which did not meet the requirements for a valid SSP claim. A large number SSP claims continue to be deemed invalid by the NHSBSA due to incorrect endorsements applied by PMR systems and/or pharmacy staff. We recommend pharmacy owners to regularly reconcile the value of SSP fees on their payment schedules against the number of SSPs declared on the FP34C submission form. Please refer to our new guidance on reconciliation of SSP claims.

If there is a payment discrepancy and it is believed that the correct SSP endorsing guidance was followed, pharmacy owners may consider requesting a re-check of relevant prescriptions and the NHSBSA will be able to rectify the payments or explain why the claim was unpaid.

Pharmacy teams are reminded to follow the SSP-specific guidance to ensure endorsements are applied correctly, and we also have guidance supporting teams raising PMR-specific claiming issues with their suppliers. Click here for more Top Tips on claiming for SSPs. 

Key points relating to SSP057

This protocol does not allow for the quantity supplied to be less than the number of days prescribed on original prescription.
There are no SSPs in place for other strengths of Estradot® patches – these strengths are not affected by supply disruptions and should continue to be dispensed in accordance with the prescriptions
SSP057 only allows the substitution of Estradot® 100micrograms/24hours patches.
Ensure that patients considered unsuitable for inclusion are promptly referred to their prescriber for further advice.
The supervising pharmacist should ensure that the patient’s prescriber is notified when supplying a patient in accordance with this SSP
The supervising pharmacist, using their professional judgement determines that swapping the patient to a different brand of a patch would not be suitable for the patient
For endorsing requirements please refer to NHSBSA’s supporting guidance for SSP057.

Pharmacists must exercise their professional judgement to ensure the alternative products are suitable for the patient.

Contractors will receive an email to their shared NHSmail account informing them of this SSP and pharmacy teams are advised to read the documentation for SSP057 in full and to implement the protocol with immediate effect. Pharmacists are required to read and comply with the requirements outlined within the individual SSP as published on the NHSBSA website for SSP057: Estradot® 100micrograms/24hours patches.


Reimbursement is for the medicine supplied in accordance with the SSP and not the originally prescribed medicine i.e. in this instance contractors will be reimbursed the reimbursement price for Evorel® 100 patches or Estraderm® MX 100 patches. The reimbursement price will account for VAT payment. Supply in accordance with the SSP will result in the following fees being paid to the contractor and products supplied in accordance with an SSP is to be considered VAT zero-rated:

One Single Activity fee (currently £1.27)
One SSP fee (£5.35)

Support in implementing the SSP

The following resources have been developed to support pharmacy teams in using these protocols.

Current versions of SSPs

Serious Shortage Protocols Operational Guidance

Serious Shortage Protocols Questions & Answers

Serious Shortage Protocols (SSPs) Endorsing Factsheet

Briefing 023/19: Serious Shortage Protocols – A guide for community pharmacy teams

Background information on SSPs

Further information on what SSPs are and when they may be used is available via the links below.

Serious Shortage Protocols (SSPs) on-demand webinar

Serious Shortage Protocols (SSPs) webpage

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