In response to a significant ongoing disruption to the supply of Estraderm MX® 50mcg and 75mcg patches, two new Serious Shortage Protocols (SSPs) have been issued by the Department of Health and Social Care (DHSC).

Effective 15 November 2022, SSP037 and SSP038 provides for the following:

SSP037 – for every Estraderm MX® 50mcg  patch originally prescribed, one Evorel® 50mcg patch must be supplied.
SSP038 – for every Estraderm MX® 75mcg  patch originally prescribed, one Evorel® 75mcg patch must be supplied

Both SSPs are currently set to expire on 13 January 2023.

The SSPs may be amended or revoked at any time  – PSNC will update contractors on any changes.

SSP037 for Estraderm MX® 50mcg patches

For prescriptions (NHS or private) requesting:
Supply permitted under SSPxxx:
Estraderm MX® 50mcg patches
Evorel® 50mcg patches

SSP038 for Estraderm MX® 75mcg patches

For prescriptions (NHS or private) requesting:
Supply permitted under SSPxxx:
Estraderm MX® 75mcg patches
Evorel® 75mcg patches

Both SSPs, authorised by the Secretary of State, have been developed by clinicians and provides pharmacists with procedures to follow in providing either of these suitable alternative products to help reduce the number of patients having to return to their prescriber for a replacement prescription.

Key points relating to SSP037 and SSP038

These protocols do 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 Estraderm MX® 25mcg patches and 100mcg patches – these strengths are not affected by supply disruptions and should continue to be dispensed in accordance with the prescriptions
SSP037 and SSP038 only allow substitution of Estraderm MX®50 or 75 patches with Evorel®50 or 75 patches, respectively.
The SSPs do not allow pharmacists to double up strengths for example, pharmacists cannot supply 2 x Estraderm MX®25 patches against a prescription ordering 1 x Estraderm MX®50 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 these SSPs
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 SSP037 and SSP038 respectively.

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 these SSPs and pharmacy teams are advised to read the documentation for SSP037 and SSP038 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 SSP037: Estraderm MX® 50mcg patches and SSP038: Estraderm MX® 75mcg 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 either Evorel® 50mcg patches or 75mcg 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:

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

Support in implementing the SSPs

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

PSNC’s Serious Shortage Protocols (SSPs) Endorsing Factsheet

PSNC 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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