Why are medicines shortages getting worse, and what can pharmacies actually do?

How bad are medicines shortages in 2026?

Supply problems are now a daily event in almost every pharmacy in England. Community Pharmacy England (CPE) surveyed more than 1,600 pharmacy team members and over 800 owners, covering more than 4,300 premises, between early January and early March 2025. Its 2025 Medicines Supply Report found that 87% of team members deal with supply issues every day. In 2022 the figure was 67%.

The detail behind that number matters. 61% of staff said problems arise several times a day. 81% said a wholesaler is out of stock of something every day. 74% of owners said their business spends longer sourcing medicines than ever before. And 73% said supply problems put patient health at risk, up from 51% in 2022.

The figures below are from CPE's 2025 Medicines Supply Report, with the 2024 report for comparison.

Some measures eased slightly between the two surveys. Fewer staff reported aggression, and fewer reported more than two hours a day on sourcing. But the daily frequency rose, and that is the number that shapes the working day. A problem that happens every day is no longer a crisis. It is a workload.

Why are shortages getting worse?

Because the causes are structural, and none of them has gone away. CPE's briefing for prescribers was updated in June 2025. It says shortages "have been a growing issue following years of turbulence across supply chains with impacts linked to Brexit, COVID-19, war in Ukraine, and wider economic instability". It also names "manufacturing problems and global market share" as drivers.

Three things follow from that list. First, many generic medicines are made in a small number of plants, often outside the UK. A quality problem at one site empties shelves in every country that buys from it. Second, the UK is one buyer among many. When stock is scarce, a manufacturer can send it to whichever market pays best. Third, demand moves. The product-specific shortages in CPE's 2025 report include Creon, Estradot patches, quetiapine, methylphenidate, antibiotics, isosorbide mononitrate and ramipril. Several of those are medicines whose prescribing has grown quickly in recent years.

Price sits underneath all of this. The Drug Tariff sets the price the NHS pays a pharmacy for each generic medicine. When the market price runs above the Tariff price, the pharmacy buys at a loss until DHSC grants a concession. Between May 2024 and April 2025, CPE received more than a million reports of medicines bought above the Tariff price. The mechanism, and its gaps, are set out in how price concessions work.

Which medicines are most affected?

The 2025 report points to ADHD, diabetes and epilepsy as the areas hit hardest, alongside the named products above. The Serious Shortage Protocol (SSP) record tells the same story. DHSC has issued 86 SSPs since the power took effect on 9 February 2019, under regulation 226A of the Human Medicines Regulations 2012. The list since mid-2024 reads like a map of the problem. Dates are from the NHSBSA SSP page.

Six protocols were in force on 12 April 2026: the four Estradot strengths and the two Creon restrictions. Pancreatic enzymes, HRT, antibiotics, cardiovascular and mental health medicines all appear. The common thread is not the therapy area. It is a product with few suppliers and a demand that does not fall when stock does. The rules for using one are in when pharmacists can substitute under an SSP.

What do shortages cost a pharmacy?

Time first, then money. In the 2025 survey, 39% of team members said they spend one to two hours a day finding alternatives, and 26% said more than two hours. That is paid staff time, and it displaces the services that earn fees.

The money shows up in the price concession count. A concession is the mechanism DHSC uses when a generic cannot be bought at the Drug Tariff price. CPE tracks how many are granted each month. The figures below are from CPE's 2024 and 2025 Medicines Supply Reports.

A concession covers only the month for which it is granted, and only at the price DHSC sets. CPE logged over a million reports of above-Tariff purchases in the year to April 2025. Not every report produces a concession. Where none is granted, the pharmacy is paid the Tariff price and absorbs the difference. CPE's 2024 report noted that about 30% of NHS pharmacy funding is delivered through medicines margin. A squeeze on purchase prices therefore hits the core of the business, not the edge.

Since April 2024 DHSC has paid retrospective top-ups where its own margin survey later shows a concession price was set too low. The first payment covered April to September 2023. Top-ups run quarterly and cover the quarter three periods earlier. The January 2026 round topped up four products, by between £2.71 and £15.55. It helps, but it arrives up to nine months after the loss.

What can a pharmacist do when a medicine is unavailable?

More than most teams use. The steps below are the ones CPE lists on its medicine shortages page, in the order most pharmacies run them.

The step-by-step version, with owings records and claim checks, is in how to run a shortages workflow.

What can't a pharmacy do?

Substitute on its own authority. Outside an SSP, a pharmacist cannot change the drug, strength, form or quantity on a prescription. Two 5 mg tablets in place of one 10 mg tablet needs the prescriber's agreement, however obvious the arithmetic. The NHS terms of service add a second limit. Under Schedule 4 of the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013, an NHS pharmacist must provide the drugs ordered "with reasonable promptness". Paragraph 9 lists the grounds for refusing. They are a prescription believed stolen or forged, an apparent error, a supply against the pharmacist's clinical judgement, violence or threats, a criminal offence, or a form missing the prescriber's identification. "We cannot get it" is not on the list.

Nor can you charge an NHS patient for the sourcing effort. The prescription charge is the only charge the law allows on an NHS item. What you can do is owe, signpost to another pharmacy, supply under an SSP, or get the prescription changed.

What is the sector asking for?

Three things, and they have not changed in two years. CPE's 2025 report asks for "continued progress to investigate and improve medicine supply chain resilience, from manufacturing through to community pharmacy supply to patients". It asks for "implementation of measures to give pharmacists more flexibility in making strength, quantity and formulation changes where there are supply issues". And it asks for "progress on work to look at ensuring fair access to margin, for instance looking at branded generics". The 2024 report made the same asks in different words, and added a review of pharmacy funding.

The Royal Pharmaceutical Society's 2024 report, Medicines Shortages: solutions for empty shelves, made the same central call: let community pharmacists supply appropriate alternatives when a medicine is short. CPE put the 2025 findings to MPs in a briefing in June 2025. The flexibility ask matters most to the working day. Every substitution that needs a prescriber's sign-off is a call, a wait and a second visit for the patient.

What is the government doing?

Managing the symptoms well, and the causes slowly. The tools DHSC and the MHRA use are set out below, with their status on 12 April 2026. Sources are the NHSBSA SSP list, CPE's concession pages, the DHSC export list on GOV.UK and the legislation named.

Wholesalers carry a legal duty of their own. Regulation 43(2) requires a wholesale dealer's licence holder to ensure "the continued supply of medicinal products to pharmacies" so that "the needs of patients in the United Kingdom are met". The duty applies within the limits of the holder's responsibility.

What has not happened, as of April 2026, is the flexibility. No general power lets a pharmacist change strength, quantity or form outside an SSP. The margin work CPE asked for is still an ask. For who holds which lever, and what each is doing with it, see who fixes the medicines supply chain.

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