Why Are Medicines Running Out?

Medicine shortage notifications from the DHSC to community pharmacies doubled between 2019 and 2024, reaching 126 per month.^[1] The notifications cover a wide range of medicines but the most publicised shortages — HRT, ADHD medication, antibiotics, GLP-1 diabetes drugs — share a common feature: demand has grown substantially faster than manufacturers have been able to scale production. The pharmaceutical supply chain is long, concentrated, and fragile: many active pharmaceutical ingredients are manufactured by a small number of plants, often in India or China, and supply disruption at any point can take months to resolve.

The HRT shortage of 2022-23 affected the most widely prescribed oestrogen and progesterone preparations for up to 14 months.^[2] Women were advised to switch brands, split patches or go without — with significant consequences for symptoms and quality of life for hundreds of thousands of menopausal women. The ADHD medication shortage, affecting methylphenidate and lisdexamfetamine, has been more prolonged^[3]: the rapid growth in adult ADHD diagnoses was not anticipated by manufacturers, and some supply disruptions continued into 2024. Children and adults dependent on these medications faced gaps that their prescribers could not reliably fill.

Brexit has added a layer of complexity without being the primary cause. The UK is now outside EU medicines supply chain frameworks, which affects how shortages are managed, and the additional regulatory burden has deterred some parallel importers who might otherwise have sourced shortfall quantities from European markets. The DHSC’s early-warning systems have improved since 2022 but the underlying concentration of global pharmaceutical manufacturing — and the UK’s relatively small share of global demand — means shortages are likely to recur.