England's medicine shortages set to worsen, with heart and mental-health patients hit hardest
A report published Friday by the Royal Pharmaceutical Society (RPS) finds England's pharmacies in the deepest medicine-supply crunch of the past three years. The report draws on a survey of 1,742 pharmacists; 86 percent said that in the past six months they had been unable to fill a prescription, and 47 percent said they received calls from patients about supply issues at least weekly. The crisis centres on cardiac drugs, anticoagulants, antidepressants and insulin formulations.
The report finds that the average duration of out-of-stock periods for critical drugs has lengthened from 18 to 31 days. Disruption to anticoagulants used by atrial fibrillation patients, such as apixaban (Eliquis) and clopidogrel (Plavix), is the most worrying category for cardiologists. A gap of more than two weeks in these drugs can double or triple stroke risk for those patients. According to the Royal College of Physicians, in just the past month 14 new cases admitted to stroke units have been linked to interruptions in anticoagulant treatment.
The "Medicines Supply Strategy 2026," published by the UK Department of Health in March, was designed to address medicine-supply issues seen since Brexit. But RPS president Professor Claire Anderson said the strategy was missing the financial support needed for supply: "Of the 47 recommendations listed in the strategy, none establishes a fiscal incentive mechanism to lower the cost of producing medicines in England. Total medicine-import costs have risen by £1.4bn a year post-customs; that cost directly drives the supply crisis."
The picture is more complicated for mental-health drugs. The supply of SSRIs (selective serotonin reuptake inhibitors) and atypical antipsychotics has dropped 38 percent over the past six months. Common antidepressants such as sertraline (Zoloft) and fluoxetine (Prozac) are out of stock in 71 percent of pharmacies; pharmacists are seeking prescription changes from doctors as an alternative. The situation is seriously undermining the continuity of treatment for patients with depression and anxiety disorders.
Manchester pharmacist Dr Sarah Akram, speaking to BBC Health, described a recent scene at her counter: "A patient could not get his apixaban for atrial fibrillation. He tried three pharmacies, all out of stock. He went three days without it. I contacted his doctor urgently, and a substitute, rivaroxaban, was prescribed. But rivaroxaban stock at my pharmacy has been dwindling for two weeks too." According to Akram, her pharmacy has experienced stock interruptions for 24 different critical medicines since the start of 2026.
The background to the crisis is multifaceted. The first major factor is Brexit; the loss of information-sharing arrangements between the ECDC, EMA (European Medicines Agency) and the UK's Medicines and Healthcare products Regulatory Agency (MHRA) is delaying entry of new generic drugs to the British market by an average of six months. The second factor is global supply-chain pressure; Indian and Chinese raw-material suppliers have over the past three years begun prioritising the European and North American markets, and the UK has lagged with its new customs procedures.
UK Health Secretary Wes Streeting has been called to an emergency debate in the House of Commons on Monday for questions. In earlier remarks, Streeting said that the rollout of the March strategy would take time, and that incremental improvements were expected within the next 6 to 12 months. Following the publication of the RPS report, Streeting's press statement is more cautious: "We are actively working to resolve service disruptions. The NHS is strengthening alternative treatment protocols."
Professor Andrew Hill, a specialist in medicine supply chains, told BBC Health that structural change is required: "For the UK health system to repair its supply chain, it must either reach a new service arrangement with the EU or expand domestic medicine production. The current strategy provides softening, but it does not solve the structural problem." Hill noted that during similar supply crises in the United States and Japan, governments invested directly to take more control over their generic-drug pipelines.
Pharmacy enquiries from patients are increasing fastest in Cardiff, Birmingham and Liverpool. The picture is more complicated in Wales; according to the Welsh Department of Health, 31 percent of pharmacies have had stock interruptions on at least one critical medicine every week for the past three months. Welsh patient association representative Mike Hedges told BBC Wales that recommending patients keep an "unpostponable treatment list" is a practice he never used to need.
The next three months will be decisive for whether the crisis softens. The RPS is calling on the government for five urgent measures: tighten medicine-export licences, incentivise domestic medicine production, establish a real-time stock-sharing system between the NHS and pharmacies, revise the patient-alert protocol, and sign a new mutual-recognition agreement with the EU through the MHRA. The Department of Health's response on 18 May is being seen as the decisive moment for the crisis's near-term direction.