Tackling medicines shortages: a complex problem requiring collaborative action

Medicines shortages are on the rise globally and look set to be further exacerbated by US President Donald Trump’s trade war.12345 This will come as no surprise to patients whose treatment has been disrupted, or to healthcare professionals who spend hours trying to source medicines. The Royal Pharmaceutical Society (RPS), supported by charities, patient groups, and supply chain representatives, recently released a report6 urging the UK government to create a national strategy to tackle this serious issue.

Charities working with patients have been sounding the alarm about drug shortages for some time. Epilepsy Action reported five times as many calls on the issue in 2024 compared to the previous year.7 In 2024, Healthwatch found that out of 1650 patients, 42% had problems sourcing medicines in the past 12 months.8 Patients and charities have also pointed out that communication and timely information about stock availability is lacking. Shortages are widespread, forcing patients to explore multiple avenues to source medicines, including potentially unsafe routes through unregulated online websites. This causes inconvenience, frustration, and anxiety to patients and their carers. Additionally, several recent Prevention of Future Death reports have involved the lack of availability of medicines for conditions including epilepsy and attention deficit hyperactivity disorder, and the shortage of antibiotics. These have been flagged as matters of concern by the coroner during investigations into a person’s death.9

Global medicine supply chains are complex, with the UK just one of many competitors. A multitude of factors contribute to medicines shortages, making quick fixes difficult when problems occur. Those most negatively impacted are patients, and their concerns must be central to any solutions. Shortages also significantly impact healthcare professionals, adding to workloads and increasing pressure on an already strained system.

Medicines shortages can be broadly categorised into either supply-based or demand-based issues.10 One contributory factor to supply-based issues is the global consolidation of generic manufacturing supply chains, which account for 80% of medicines used in the UK.11 Falling profits have resulted in a reduction in manufacturing sites, especially in China and India. In addition, competitive procurement in the UK has driven down the prices of generic medicines. While this initially appears to benefit taxpayers, it may undermine the resilience and robustness of the supply chain. Where the UK competes globally for medicines supply, reduced financial returns may make the UK less attractive to manufacturers and suppliers.

The RPS report recommends that the government boosts the UK’s medicines manufacturing infrastructure to allow for a more rapid response to shortages.6 This could take the form of implementing policy levers, including the life sciences innovation manufacturing fund, to support both commercial manufacturers and NHS hospital based manufacturing units. Although this would be costly, it could be particularly effective for critical medicines if the government were prepared to underwrite the associated risks. However, while the notion of the NHS manufacturing its own generic drugs might seem appealing, in reality there would be significant financial risk to the taxpayer and no guarantees that it would solve the problem, as it would face the same supply chain issues as existing manufacturers in an already over-burdened and volatile market. An alternative solution would be to build improved resilience and monitoring into existing supply chains and NHS procurement contracts.

Other economic factors, such as the community pharmacy contractual framework, pose a risk of financial loss to contractors supplying medicines on behalf of the NHS, especially during medicine shortages, when purchase prices can exceed fixed NHS drug tariff reimbursement rates. Hidden costs include extra hours spent by healthcare professionals sourcing medicines, additional patient consultations required to change prescriptions, and the knock-on effect on waiting lists. Patients also spend their time and money visiting multiple pharmacies to source medicines, potentially exacerbating health inequalities.

Despite these challenges, a great deal of effort is being made to ensure access to medicines in the UK. The majority of the billion or so prescriptions dispensed in primary care are done so without issues.1213 However, even though only approximately 2.5% of medicines reimbursed by the NHS are reported to be in shortage,14 the increasing volume and intricacy of these shortages are being felt across the system. What is clear is the need for timely system wide co-operation to enable improvements and greater transparency and understanding of supply chain issues. The headline recommendations of the RPS report for a UK wide strategy for shortages, enabling community pharmacists to make minor amendments to prescriptions and improving reporting and communication, all seem like a sensible way forward. A multidisciplinary, cohesive approach is essential to manage deficiencies effectively and ensure patients get the medicines they need, when they need them. While pharmacies are the visible face of medicine shortages for patients, the answers lie in collaboration with prescribers and all components of the supply chain to strengthen the UK’s resilience when they occur.