Will UK government proposals address the problem of medicines shortages?

Medicines shortages are not a new problem — the complex nature of the medicines supply chain, from raw materials through to manufacture and distribution, lends itself to issues.

However, since 2021, reports of medicines supply problems have increased, with the number of reports from manufacturers to the government on potential supply problems growing by almost 70% between 2021 and 2023, increasing from an average of 82 notifications per month in 2021 to 137 per month in 2023. 

This increase has been attributed to various factors, including shortages of raw materials and packaging materials; geopolitical factors, such as trade barriers related to Brexit; and disruption to supply chains owing to the COVID-19 pandemic.

ADHD medication, HRT, antibiotics and anti-epileptics are just some of the medicines hit hardest by shortages, owing to surging demand and manufacturing issues.

These shortages have had a major impact on pharmacists and patient safety. In response to the Royal Pharmaceutical Society’s (RPS) Workforce Wellbeing Survey, results of which were published in February 2025, more than half (56%; n=3,665/6,487) of pharmacists said the repercussions of medicines shortages had directly impacted their mental health over the past year.

And these shortages have even resulted in patient deaths, with coroners raising concerns in December 2024 over ADHD and epilepsy medication shortages in two prevention of future deaths reports.

In July 2025, the All-Party Parliamentary Group on Pharmacy published its ‘Inquiry into medicines shortages in England’, in which it highlighted that shortages have “shifted from isolated incidents to a chronic, structural challenge”, calling for greater patient input to address the issue.

Following this, in August 2025, the Department of Health and Social Care (DHSC) published a series of proposals on tackling the problem — but will they do enough?

Current picture

While reports of medicines shortages have risen since 2021, with numbers peaking in 2024, data from the government’s discontinuation and shortages (DaSH) portal — which marketing authorisation holders use to submit notifications relating to potential medicine shortages, discontinuations or updates on current medicine supply issues —show there has been a decrease in supply notifications each month since January 2025  (see Figure 1).

However, speaking at the Company Chemists’ Association’s (CCA) inaugural conference — held in London on 11 September 2025 — Mark Dayan, Brexit programme lead at the Nuffield Trust, said supply chain issues are still worse than they were before the COVID-19 pandemic.

Describing it as an “international phenomenon”, he noted that “a big increase” in medicine shortages has been observed in countries across Europe and North America, and in Australia, “particularly as we emerged from the most intense phase of the COVID-19 pandemic and the start of the cost-of-living crisis around 2022”.

Giving suggestions as to why this may be, Dayan said: “In the long term, pressure on generics prices from Western countries in general was very intense for a long period of time, and that tends to push consolidation of supply chain further back to manufacturing. That then creates a degree of inherent fragility, both because profit margins are quite low and because the concentration of production means that there isn’t a lot of backup products.”

He added that this “implies that what we’re dealing with, in part, is a problem of total supply”.

Enabling pharmacists to do more

Admittedly, community pharmacists are at the end of the supply chain and it is not their responsibility to solve shortage issues, despite frequently having to spend time on them. Data from The Pharmaceutical Journal’s 2025 salary and job satisfaction survey show 40% of pharmacists (n=220/552) are spending two to five hours a week on activities related to shortages.

As part of its proposals, the DHSC announced it would consult on enabling community pharmacists to have the flexibility to supply an alternative strength or formulation of a medicine that is out of stock. It launched its consultation on 18 September 2025.

The proposals would benefit patients in the short term, according to William Pett, head of policy, public affairs and research at Healthwatch England.

“A consultation on pharmacist flexibilities, for example, could enable more people to get help via substitute medicines while they wait for supply issues with their prescribed medicine to be fixed,” he explains. 

Pharmacy bodies have long called for pharmacists to be able to make medicines substitutions in the event of a shortage. The RPS first floated the idea at a meeting with the DHSC in 2018 on Brexit contingency plans.

It has since renewed its call as one of 20 recommendations in its report ‘Medicines shortages: solutions for empty shelves’, published in November 2024. This has been echoed by Community Pharmacy England (CPE), the National Pharmacy Association and CCA. 

Alwyn Fortune, policy and engagement lead for Wales at the RPS, says the organisation “warmly welcomes” the government’s plans.

“Giving pharmacists greater flexibility to supply an alternative strength and quantity of medication, or formulation, during shortages is a long-awaited change that would ensure patients get timely access to medicines, reduce unnecessary GP referrals and make better use of pharmacists’ clinical expertise.” 

Suraj Shah, drug tariff and reimbursement manager at CPE, also welcomes the proposal. “CPE has long advocated for improvements in the medicines supply chain, and we welcome DHSC’s proposals to introduce pharmacist flexibilities around substitution.

“This is a positive step forward, recognising the clinical expertise of pharmacists and their vital role in maintaining continuity of care during disruptions to medicine supplies.”

However, Henry Shelford, chief executive of ADHD UK, says the proposal does not address medication switches. “It completely fails to address that some medications – like most ADHD medications — can’t be changed by pharmacists or GPs, and there doesn’t appear to be any mitigation to change serious shortage protocols to allow that to happen.

“In the last shortages, I needed my ADHD prescription altered to what was then available and was told it would be a two-year wait. These proposals do not appear to address that issue.”

Manufacturing and demand forecasting

A huge part of the medicines supply chain is manufacturing, and this is therefore where a large proportion of problems happen.

Speaking at the CCA conference, Ken Pullman, director of medicines policy and strategy at NHS England, acknowledged that the supply chain is complex, with disruption a “multifaceted issue”.

However, he added that “60% of problems [in the supply chain] are in manufacturing”.

Data from the government’s DaSH portal for 2024 back this up (see Figure 2). 

“We know some of the problems are about unexpected changes in demand. So how do we work together to fully understand that … some of it is about just simply sharing information?” Pullman asks.

Some of the government’s proposals are based on exactly that; for example, improving visibility of supply chain data and improving the accuracy of demand forecasting.

Mark Samuels, chief executive of Medicines UK, says that the organisation supports this principle, but flags that “it’s important to recognise that manufacturers often receive limited notice themselves — making timely alerts to supply partners challenging”.

Ross Maclagan, distribution and supply chain policy manager at the Association of the British Pharmaceutical Industry, says that improving the visibility of data is one of the “many things we can do better in terms of collaboration and communication” when it comes to the supply chain.

He brings in the idea that AI and other technologies could help with this. “As we move into a more modern world, AI can help with forecasting supply and spotting issues more quickly. These technologies, along with the shift away from paper prescriptions toward integrated systems like SAP, Oracle, advanced analytics, AI and blockchain, can all play a role in strengthening the supply chain.

“There are a number of companies now offering AI-driven supply chain solutions to support forecasting and switching. For example, when an originator brand faces competition from generic manufacturers, AI can help manage product switching, discontinuations, and new line launches. It can also learn from similar past launches, making forecasting much more accurate.”

Another government proposal focuses on bringing more manufacturing capabilities to the UK.

“Clearly it is not viable to produce all medicines domestically, but by investing in domestic manufacturing we can help diversify our supply and reduce our dependency on imports,” the government says.

Maclagan supports this but says that investment in the UK should be focused on innovation. “There is good opportunity to invest in the UK, but it probably needs to be focused. That might be on new advanced medicines, new technologies and so on — whether that’s nuclear medicine, CAR-T blood cell treatments and similar innovations — rather than, for example, producing paracetamol. 

“Investment needs to be focused, because we can’t realistically bring everything back and presume we’ll never have a supply problem again,” he adds.

Buffer stocks

Another of the government’s proposals focuses on increasing suppliers’ compliance with meeting eight-week buffer stock targets for secondary care.

“Most suppliers are compliant, but we are continuously seeking to improve this to a 100% compliance rate,” the government says in the proposal document.

However, Maclagan is cautious about this, observing that it may take the focus away from addressing supply issues. “The more agile pharmaceutical manufacturing can be, the quicker it can plug a supply gap. Take Europe as an example: if there’s a problem in Portugal, the focus should be on solving it there. But if every country copies each other by building buffer stocks — 8 weeks here, 12 weeks there — manufacturers end up managing stockpiles globally instead of addressing the actual issue,” he says.

“That lack of agility can make the situation worse. Approaches that seem sensible at first can create unintended consequences, which is why we’ll continue working with the DHSC to ensure any measures they introduce are appropriate.” 

Shelford argues that the proposal “reads like a D-rated paper from a first-year business studies student”. 

“It’s an overly simplistic solution that will overstock simple, abundant medications and understock complex, scarce medications. It fails to use available data to predict the safety stock we need — it doesn’t consider the calculated confidence of supply we need, nor cycle stocks, lead times, variability of demand, or materials risk.” 

Challenges on the horizon

Evidently, there are already many challenges facing the UK’s medicines supply chain, but there may be more coming. 

Dayan told CCA conference delegates that there is “an emphasis in the EU on opening the grounds for more land-based procurement, potentially including favouring purchasing within the EU to help encourage things to be sure there”. 

“That probably throws a couple of challenges to the UK, some of them at NHS at ministry level, but some of them issues of foreign policies. So how do we work with the EU?” he asked.

Another issue could be the implications of US President Donald Trump’s tariffs. In its ‘Pharmacy pressures survey’ report, published in June 2025, CPE, along with health secretary Wes Streeting, acknowledged that tariffs are “likely to have an impact on UK medicine supply”. 

“Medicines imported at higher cost, coupled with rising prices in Europe, could have a knock-on effect on the UK market. Factors like these create uncertainty and risk of drug price inflation, likely having an impact on the wider NHS.”

The consensus among pharmacy bodies seems to be that the government’s proposals are a good starting point, but there are still points to iron out.

Samuels says: “We must also address broader factors affecting supply resilience, including medicines security. Striking the right balance between onshoring manufacturing and strengthening trade agreements with key partners, such as India and the EU will be critical, for example.”