Everyday medicines could soon be in such short supply that Britain will face a crisis situation, leading pharmacy figures are now warning.
The situation was already grave before the war began with Iran, with shortages of common drugs such as antibiotics and even aspirin – but the conflict may soon lead to shortages of medical supplies such as syringes and ‘honestly everything’, Sir Jim Mackey, head of the NHS, said on Tuesday.
But with medicines specifically, the UK now faces ‘a perfect storm’ which experts fear will lead to record shortages of prescription drugs affecting even vital cancer medicines.
Those already in short supply include essential medicines such as aspirin taken by millions to reduce the risk of heart attacks or strokes, the blood pressure tablet ramipril; the antidepressants sertraline and mirtazapine; folic acid for women hoping to conceive; and the antibiotic amoxicillin – a development described as ‘very worrying’, Dr. James Davies, director of research and insights for the Community Pharmacy England, (CPE), which represents community pharmacies in England.
‘We have received more reports from pharmacies having problems obtaining medicines at appropriate prices than in any month since we started collecting this data in 2019,’ he told the Mail. The CPE is calling on the Department of Health to take urgent action as figures reveal shortages last month are soaring and the situation shows no sign of abating.
‘We were told by some suppliers and manufacturers that we should expect this to get worse,’ says Leyla Hannbeck, the chief executive of the Independent Pharmacies Association.
According to the NHS, the there were already shortages of prescription drugs before the Iran conflict, but now the situation is even more concerning
‘This was even before the conflict in the Middle East and now with the war affecting the situation it is even more worrying,’ she told the Daily Mail.
‘We don’t want to scare people about dying, but many people are dependent on their medicines to keep them going and their treatment will be affected or delayed by this.
‘Right now, for example, there are some cancer medicines that we cannot get hold of common medicines for blood pressure are in increasingly short supply too.’
Julia Halpin, who runs Being Well, a private pharmacy in Hove, says supplies of other crucial medicines including carbamazepine – a drug used to treat epilepsy is ‘really hard to come by, which may result in real patient harm’ while she says Estradot, a popular brand of HRT patch is currently ‘completely unavailable’ from her regular wholesalers.
Two weeks ago Leyla Hannbeck wrote to Wes Streeting, the Secretary of State for Health, highlighting ‘the impact of the ongoing war in the Middle East and [asking] if the government had a clear plan to protect our medicines market.’ However she said there had been no reply: ‘When you think about how serious this is we expected that we would have heard back.
‘Right now we are experiencing a lot of problems with medicine supply and if this war continues, we will enter a crisis situation.’
It’s not just empty spots in pharmacy shelves for over-the-counter drugs such as aspirin. Confirmation, if needed, of worrying shortages is the increase in so-called UK Medicine Supply Issue Notifications, which signal actual or potential medicine supply problems sent by manufacturers to the Department of Health and Social Care (DHSC).
In 2021, the first full year this was recorded, there were 989 notifications. But in February (SUBS 2026) alone there were 283 notifications – the highest ever in a single month.
Another barometer of shortages is a significant rise in price concessions – this is a system where pharmacists apply to the DHSC to cover the increased cost of drugs, as suppliers raise prices in a competitive market. Every three months the DHSC publishes a ‘drug tariff’, a list telling pharmacies how much it is prepared to refund pharmacists for medicines they supply to the NHS. Shortages means the DHSC has to increase the amount it will pay for a drug.
In 2020 there were 641 price concessions during the whole year, in 2022 they had increased to 1,496. In February this year the CPE said the number of price concessions already stood at 174 and experts are concerned.
‘Given the current trend, we are likely heading towards a record number of price concessions for the year,’ Dr Davies warned.
The reasons behind the shortages are multiple.
Sourcing raw materials and even packaging have become a mounting problem since supply chains were badly hit by the pandemic, and since then it has been compounded by manufacturers shutting down and shipping being severely delayed.
There is a solution: if the supply of a medicine is greatly disrupted, the Department of Health can issue a Serious Shortage Protocol, which lets pharmacists supply an alternative medicine
Malcolm Harrison, chief executive of the Company Chemists Association, which includes big chains like Boots, uses the example of the drug Creon, which is prescribed to those who lack digestive enzymes for examples as a result of pancreatis, an inflamed pancreas or cystic fibrosis.
‘There were three manufacturers supplying the European market but one of them withdrew and the other two could not scale up,’ he told the Mail.
But a major problem is the fact that generic medicines provide the bulk of prescription drugs.
These mass-produced copies are a fraction of the cost of branded drugs and account for around 80 per cent of all NHS prescribed drugs.
Britain only produced about a quarter of these generic medicines it consumes – with the rest imported, primarily from India and China. This makes us particularly vulnerable because we cannot fall back on our own manufacturers and, instead, rely on fluctuating global supply chains.
When shortages occur and demand outstrips supply and there’s a spike in prices; the Government can choose to apply a price concession so pharmacies can pay more to wholesalers to secure medicines for patients – but the pharmacists say this doesn’t happen enough.
There is a quick-fix solution: if the supply of a medicine is significantly disrupted the Department of Health can issue a Serious Shortage Protocol (SSP), which allows pharmacists to supply an alternative medicine. For instance, an SSP was issued with Fixapost eye drops, in December last year. Pharmacists were told they could use Vizilatan Duo as an alternative.
However, the problem is introducing swaps can cause patients problems particularly when there are significant differences in doses and patients may be less likely to use their medication.
And switching from tablets to capsules for example can alter the effectiveness.
And for medicines used to treat a variety of different conditions there are often no standard alternatives.
One example would be amitriptyline, which is prescribed for both depression and chronic pain.
‘Patients should be aware that their pharmacist will do all they can within their sphere of influence to ensure they supply a substitute if their regular medicine is not available,’ says Leyla Hannbeck, ‘but it is becoming increasingly difficult’.
‘The Government needs to listen because this is going to become critical if nothing is done – it is becoming less affordable for manufacturers to supply these medicines at such cheap prices.’
Leyla Hannbeck added that the UK’s medicines budget is ‘one of the lowest of any developed country which makes the UK market unattractive to manufacturers’ and combine that with the war in the Middle East ‘driving up costs, constraining raw ingredients delaying supply, and you have a perfect storm exacerbating medicine shortages’.
A DHSC spokesperson told the Mail that the ‘vast majority of the UK’s licensed medicines are in good supply’.
They added: ‘We’re strengthening the resilience of our medicine supply by offering financial incentives for the manufacturing of more medicines – and have well-established processes in place to mitigate risks, including using alternative medicines when available.
‘We are also actively engaging with partner countries to bolster supply chains – protecting NHS services and patients.’
Pharmacy bodies recommend that patients shop around when their designated pharmacy cannot supply the required prescription.
