Drug Shortages UK: Why They Happen and How Hospitals Can Respond

The Royal Pharmaceutical Society's 2026 report, Medicines Shortages: One Year On, confirmed what hospital pharmacists and procurement teams across the UK already know from experience: the number of medicine shortages remains high, and pharmacy teams are managing supply problems every single day.

This is not a temporary disruption. It is a structural problem in how medicines are manufactured, distributed, and procured globally. Understanding why shortages happen is the first step to managing them effectively, and knowing what procurement options exist when licensed supply fails is essential for any hospital or health institution operating today.

Why Drug Shortages Happen in the UK

Medicine shortages are rarely caused by a single factor. They typically result from a combination of global and domestic pressures converging at the same time. The most common causes include:

Global manufacturing concentration

The vast majority of active pharmaceutical ingredients (APIs), the core chemical compounds in most medicines, are manufactured in a small number of countries, primarily India and China. When production at a single facility is disrupted by a quality issue, a regulatory inspection failure, or a natural disaster, the ripple effects are felt across dozens of markets simultaneously. The UK, which imports a significant proportion of its medicines, is directly exposed to this risk.

Supply chain complexity

A medicine that reaches a UK hospital pharmacy typically passes through four to six supply chain stages: API manufacturing, formulation, packaging, national distribution, wholesaler, and dispensing. A problem at any point in that chain can result in stockouts at the end, and the length of the chain means that problems are often identified late, leaving very little time to source alternatives.

Currency and pricing pressures

Many medicines are manufactured overseas and imported into the UK. Sterling fluctuations affect the landed cost of these products. When currency movements make UK supply unprofitable for manufacturers, some redirect their output to higher-margin markets, reducing the volume available to UK distributors and wholesalers. This is particularly acute for generic medicines where margins are already tight.

Demand spikes

Sudden increases in demand, driven by a disease outbreak, a change in clinical guidelines, or a widely-reported study, can exhaust existing stock before the supply chain has time to respond. The ADHD medication shortage of recent years is a well-documented example of demand-driven shortage creating sustained supply disruption.

Regulatory and quality events

MHRA inspections, product recalls, and quality control failures can remove products from the market at short notice. When a recall affects one of only two or three licensed suppliers of a given product, shortages follow quickly.

Brexit and regulatory divergence

Since the UK's departure from the EU, the country operates its own regulatory framework independently of the European Medicines Agency. While MHRA regulation is robust, the separation has created additional friction in European supply routes and reduced the UK's access to parallel import channels that previously provided a buffer during shortage events.

The Real Impact on Hospitals

For hospital pharmacy teams, the practical consequences of medicine shortages go far beyond inconvenience. When a critical medicine is unavailable, the consequences can include:

• Treatment delays for patients already admitted
• Forced switches to therapeutic alternatives that may carry different side effect profiles or require different monitoring
• Increased pharmacist workload managing shortage communications, alternative sourcing, and prescriber liaison
• Cost pressure from higher prices for shortage products or alternative formulations
• In the most serious cases, clinical risk if no adequate alternative exists and supply cannot be secured quickly

The burden falls disproportionately on hospital pharmacy teams, who must manage these situations in real time while maintaining all other aspects of their clinical and operational role. This is the "day in, day out" reality that the RPS report highlighted, and it is why having a reliable, pre-established supply route for shortage situations is not a nice-to-have, it is operationally essential.

What Hospitals Can Do When a Medicine Is Out of Stock

When a licensed medicine is unavailable through normal channels, hospitals have several options. The appropriate response depends on the product, the clinical urgency, and the availability of alternatives.

Step 1: Confirm the shortage scope

Before exploring alternative supply, confirm whether the shortage is limited to your primary supplier or is market-wide. Contact your usual wholesaler for an ETA. Check the MHRA's medicines supply tool and any manufacturer communications. In some cases, a short wait is all that is required.

Step 2: Explore licensed UK alternatives

If the same product is available from a different licensed UK manufacturer or wholesaler, this is the simplest route. Your pharmacy team should maintain a list of secondary suppliers for high-risk or critical medicines. Licensed wholesalers with broad supplier networks can often access stock that is not visible through standard procurement routes.

Step 3: Consider therapeutic alternatives

If the specific product is unavailable across the market, the clinical team may need to consider a therapeutically equivalent alternative. This requires clinician involvement and, in some cases, patient consent. The pharmacist plays a central role in advising on the suitability of alternatives and monitoring requirements.

Step 4: Source via unlicensed import

When a licensed UK alternative is not available or clinically suitable, the same product, manufactured overseas and meeting equivalent quality standards, can be imported under the UK's unlicensed medicines framework. This is a legal, well-established route under Regulation 167 of the Human Medicines Regulations 2012.

This option requires a prescriber to make an unsolicited request for the product for a specific patient, and the supply must be arranged through an MHRA-licensed Wholesale Dealer Authorisation (WDA) holder. The supplying wholesaler is responsible for ensuring the product is sourced from a verified, GMP-compliant manufacturer and is accompanied by the correct documentation.

Building Shortage Resilience Before You Need It

The most effective shortage response is one that is planned before the shortage occurs. Hospitals and procurement teams that have pre-established relationships with specialist wholesalers, including those with international sourcing capability, are significantly better positioned than those who begin searching for alternatives only after a shortage has already hit.

Practical steps to improve shortage resilience include:

• Identify high-risk medicines: Map your formulary for products with limited licensed suppliers, long supply chains, or a history of shortage. These are your most vulnerable products.
• Develop secondary supplier relationships: For your highest-risk products, establish contact with at least one secondary licensed wholesaler before you need them.
• Maintain safety stock: Where clinical and storage requirements allow, carry a buffer stock of critical medicines. The appropriate level depends on the product's shortage risk and your institution's usage rate.
• Know your unlicensed supply route: Identify an MHRA-licensed wholesaler with international sourcing capability that you can contact immediately when a licensed product is unavailable. Have the contact details available and ensure your pharmacy team knows the process for initiating a named patient import request.
• Stay informed: Subscribe to MHRA shortage notifications, pharmaceutical supply bulletins, and relevant trade communications. Early warning of a potential shortage allows more time to secure alternative supply.

The Role of a Specialist Wholesaler in Shortage Management

A pharmaceutical wholesaler that operates specifically in complex and shortage supply scenarios offers capabilities that general distribution networks cannot match. These include:

• Established relationships with overseas manufacturers that hold GMP certification recognised by the MHRA
• Experience navigating the documentation requirements for special import licences and named patient supply
• The operational infrastructure to move quickly, sourcing, documentation, and delivery within 24 to 72 hours in genuine emergencies
• Cold chain logistics for temperature-sensitive products
• A compliance-first approach that protects the hospital from regulatory risk

Euro Biom was built specifically to serve this function. We hold an MHRA Wholesale Dealer Authorisation and our core operation is complex, urgent, and non-routine pharmaceutical supply, including shortage cover, named patient imports, and emergency procurement for hospitals and health institutions in the UK and internationally. You can view our full emergency and shortage supply services here.

If your pharmacy team is managing a shortage situation now, or if you want to establish a relationship before you need it, we are available to discuss your requirements.

How to Source Alternative Supply When Shortages Hit

When a shortage interrupts routine supply, procurement teams typically have five working routes, but only two deliver fast, verifiable stock for urgent clinical need. The first is a licensed wholesale dealer with an active MHRA WDA authorisation who can draw from parallel-imported or brokered EEA stock within existing GDP chains. The second is direct named patient or specials supply through a UK wholesaler experienced in named patient medicine procurement, where the medicine is sourced specifically for one identified patient under Regulation 167 of the Human Medicines Regulations 2012.

Euro Biom operates in both of these channels. Our MHRA WDA licence covers wholesale distribution, brokering, and export, and we hold active supplier relationships across the UK, EEA, and non-EEA markets. For hospitals facing an urgent shortage, we can typically confirm availability within one working day, quote landed cost with full regulatory documentation (batch, expiry, temperature excursion data), and ship under GDP-compliant cold chain or ambient logistics as required. For international procurement teams, including NHS trusts sourcing from outside the UK, or ministries of health in our 40+ export markets, we manage the named patient import workflow end-to-end: Special Import Licence application support, customs clearance, and verified chain of custody.

If you are dealing with a live shortage, the fastest path to supply is usually a direct enquiry with a WDA-licensed wholesaler who already has the product or knows where to get it. Waiting for the MHRA to issue an SSP or for the manufacturer to resolve the shortage at source is rarely an option when a patient needs the medicine this week.