Policy paper

Managing a robust and resilient supply of medicines

Published 11 August 2025

Applies to England

Ministerial foreword

Across the world, medicines play a vital role in protecting public health. They not only treat illnesses, but they can also empower patients to manage long-term conditions and live comfortable, fulfilling lives. However, the reality is that medicine shortages continue to present challenges to patient care at the global scale. We must do more to ensure the medicines supply chain functions better so that patients experience less interruption and anxiety as to when, where and how they can access their medicines.

On 3 July 2025, the 10 Year Health Plan for England was published as part of this government’s health mission to build a health service fit for the future. Our efforts to improve the management of medicines shortages and strengthen supply chain resilience are crucial to reinventing the NHS and enhancing patient care - from increasing access to shortage information at the point of prescribing, to the role of pharmacists, exploring where an alternative product could be supplied without needing to return to the prescriber.

I am incredibly grateful for the continuous dedication of everyone working tirelessly behind the scenes to get medicines to patients every day. While we cannot avoid all supply issues, this government is committed to building on the important actions already underway across the system to minimise disruption for patients.

Publishing this document marks the beginning of a new phase of work we have planned. Timely and clear communication to those affected by medicines shortages remains critical. That’s why, later this summer, we will publish information guides for patients, pharmacists and GPs on medicines shortages.

I want to thank everyone who has contributed, helping us understand the root causes of medicines shortages and offering clear, forward-thinking recommendations. We will continue to embrace new opportunities, learn from each other, work with our international allies and adapt to ever changing challenges. I am positive that, together, we can continue delivering lasting improvements for patients.

Karin Smyth MP
Minister of State for Health

Executive summary

All NHS patients have a right to access treatment - whether prescribed or available over the counter - to meet their needs. Where those medicines are in shortage, we recognise the implications this can have on the health and wellbeing of patients, as well as the significant challenges it presents to dedicated healthcare professionals.

In the UK there are over 14,000 licensed medicines. These rely on complex, global supply chains that are highly regulated in their manufacture and distribution to ensure patient safety. While at any one time the vast majority of medicines are in good supply, we accept that we cannot prevent all shortages from occurring. Medicine shortages can arise from a wide range of multifaceted causes not specific to the UK and with far-reaching impact across the world. Our role, working closely with all our partners across the medicines supply chain, is to help reduce the frequency of shortages and minimise patient impact when they occur.

The UK is not alone in facing challenges with medicines shortages, with many other nations experiencing disruption. In the UK, there is no single, reliable measure that can comprehensively reflect an increase or decrease in the frequency of reported supply issues over the past 3 years. However, we have seen supply issues increase in complexity in recent years. The most common cause, as reported by suppliers, is manufacturing disruption, often linked to raw material availability. Other causes reported include demand surges, and transport and logistical issues (see section 2: ‘Trends of UK medicines supply issues’).

To that end, increasing resilience of UK medicines supply chains remains a priority for the government. This spans activity within the Department of Health and Social Care (DHSC) and NHS England but also areas of trade, international co-operation and industrial strategy. Robust supply chains are an important underpinning of the government’s growth and health missions.

A wide range of people and organisations are impacted by the stability and reliability of the supply of medicines. Therefore, this document is aimed at a broad audience, including all those operating across the supply chain and in the provision of care to patients and patient groups.

This document has 3 main objectives:

Transparency

To provide greater transparency of the supply chains we rely on and the action we take to protect patients from medicines shortages when they occur.

To support the availability of medicines that patients rely on, we monitor and manage medicines supply at a national level and have a range of well-established systems and processes to proactively prevent disruptions where possible and effectively mitigate their impact on patients when they do occur (see section 3: ‘UK medicines supply management’).

Resilience

To outline the steps we plan to take to further enhance processes for mitigating medicine shortages and to strengthen long-term resilience. These include:

• tangible measures around earlier identification of potential disruption
• enhanced reliability and timeliness of supply across the whole supply chain
• improving communication and guidance to different sectors
• strong international partnerships

(See section 4: ‘Strengthening our approach to shortages and resilience of medicines supply chains’).

Partnership

To invite all partners across the health system and medicines supply chain to continue to work with us and the NHS to co-design and provide the changes needed to ensure a consistent and reliable supply of medicines to patients.

The approaches we have set out are not intended to provide a complete and definitive solution to the complex issues facing medicines supply around the world. However, they are steps we can take forward together, to better predict and withstand medicine shortages and protect patients from disruption.

1. The UK medicines supply chain

This section sets out how the medicines that UK patients rely on are supplied by a complex global supply chain, which in turn rests on the actions of critical partners to manufacture, regulate, distribute and dispense to patients.

Part of a complex and global supply chain

Medicines play a critical part in our nation’s health, from self-care - allowing people to manage their own conditions - to treatment in the NHS through primary or secondary care. Our priority is to help ensure patients can reliably access the medicines that are clinically appropriate for their treatment.

The medicines that patients rely on are sourced from a complex, highly regulated and global supply chain. Disruption at any point in the end-to-end supply chain, from raw materials and packaging production (upstream) to regulatory compliance testing and certification and ‘last mile’ delivery to patients (downstream) can impact the timely availability of products for patients when and where they are needed.

Our supply chains depend on imports from other countries. Many active pharmaceutical ingredients (APIs) - the biologically active components that produce the intended therapeutic effect - have a license for manufacturing in India, Germany, China, Italy and the US. Similarly, many of our finished products - that is, the products we use - have a license for manufacturing in India, the UK (domestically produced) and Germany (Medicines and Healthcare products Regulatory Agency (MHRA) licensing data, 2022).

These deeply connected global supply chain networks provide significant benefits of:

• enhanced operational efficiencies
• greater agility to respond to changing market dynamics
• wider access to a wide range of high-quality medicines
• cost-effectiveness

Drawing on a global network of expertise and capabilities means countries can benefit from one another so that medicines are made available more consistently and reliably to patients who need them around the world.

As with other supply chains, the medicines sector is also vulnerable to increased global supply chain volatility resulting from a range of geopolitical, environmental, societal and cyber shocks which are increasing in frequency, highlighting the need to foster strong international co-operation to continue building globally resilient and agile systems.

The medicines supply chain operates in a highly regulated and carefully controlled environment to ensure patient safety. Unlike other commercial products and sectors, even minor deviations in pharmaceutical products can have serious consequences for patients. Regulations control every aspect of manufacturing, testing, storage and distribution and are essential in safeguarding public health. That is why every step of the medicines supply chain, from API production through to finished product delivery, must meet the necessary safety and quality standards. While regulations can present challenges to respond with speed and flexibility to sudden changes in demand compared with other sectors, these measures also reflect the high degree of precision and care being dedicated to protecting patients from any potential harm. It can take months, in some cases years, to increase production and deliver a medicine to meet increased demand.

Despite this, of the approximately 14,000 medicines licensed for supply in the UK, the vast majority are in good supply at any given time. Unfortunately, medicines supply issues do arise, and we recognise the mental and physical strain they can cause for patients if they are unable to access their usual medicine, including the anxiety and frustration the possibility of delayed treatment can cause. The issue of medicine shortages also has an inevitable impact on dedicated healthcare professionals who spend time sourcing supplies, directly engaging patient concerns and managing individual clinical treatment plans. This is why we are committed to continually strengthening the resilience of our supply chains.

Partners in the medicines supply chain

The UK benefits from a well-established, efficient and wide-ranging supply of medicines, supported by a variety of effective distribution and regulatory practises. This is underpinned by the UK’s thriving life sciences sector, with world-leading research and innovation driving forward critical medical advancements in collaboration with the UK government, NHS and other partners.

Many patients access medicines either in a primary care setting (for example, a community pharmacy) or a secondary care setting (for example, a hospital). Some medicines can also be accessed through online pharmacies and other retailers (for example, supermarkets). MHRA licensing data for 2022 shows that around 80% of licensed medicine products on the UK market are prescription only medicines (POMs), so require a prescription and must be dispensed by an appropriate practitioner. The remaining approximately 20% of licensed medicine products on the UK market can either be pharmacy (P) medicines (for example, purchased over the pharmacy counter) or a general sales list (GSL) medicine (for example, purchased at a supermarket). Given that P and GSL products are often used by patients to self-treat conditions, the volume of these manufactured and consumed is likely to be higher.

DHSC has overall policy, strategic and operational responsibility for helping to ensure the continuity of the supply of medicines for all NHS services in England. NHS England has specific responsibilities for managing the continuity of supply for some secondary care medicines and certain homecare services awarded on medicines procurement and supply chain (MPSC) NHS frameworks.

Marketing authorisation holders

Medicines are supplied by companies which hold licences for the demonstration of their quality, safety and efficacy. This ranges from large pharmaceutical companies making a range of medicines, to small or even single-product pharmaceutical companies. The NHS also plays a role in manufacturing some specialised and individualised medicines in the UK.

Individual licence holders for medicines are responsible for the manufacture and distribution of their products within the UK. As part of their obligations (see The Human Medicines Regulations 2012), they must take all reasonable steps to provide appropriate and continued supplies of medicines to ensure the needs of UK patients are met. They play a critical part in complementing our efforts to identify threats to supply, strengthen supply chain resilience and manage disruptions when they occur, including effective management of stock levels for individual products lines.

We recognise the important role that different categories of medicine play in helping to ensure patients across the UK have access to the treatments they need and at a price that provides value for money. These include:

• originator (branded) product (a medicine that is sold and marketed under a trade name by the pharmaceutical company that developed and patented it)
• off patent (a medicine whose original patent protection has expired), including:
  • generic (a medicine that is named after the international non-proprietary name (INN) or active ingredient and is sold under this name)
  • branded generic (a generic medicine given a brand name)
  • biosimilar (a biological medicine that is highly similar to another already approved biological medicine)

Generic medicines and their associated lower development costs are playing an increasing role in providing better value for the NHS. Branded medicines are subject to the 2024 voluntary scheme for branded medicines pricing, access and growth (VPAG) or the statutory scheme, which aim to promote better patient outcomes and a healthier population, support UK economic growth and contribute to a financially sustainable NHS.

Regulators and other public bodies

Licence holders must ensure their medicines comply with all relevant standards, regulations and legislations set out by the government. Various bodies are involved in the regulation and licensing of medicines supplied in the UK, including:

• MHRA: responsible for regulating medicines for their quality safety and efficacy, ensuring that they are monitored for their ongoing impact on patient safety. MHRA contributes through active engagement with system partners to support managing supply disruptions
• National Institute for Health and Care Excellence (NICE): responsible for evaluating new health technologies for NHS use, considering clinical effectiveness and value for money. NICE also produces guidance to help health and care practitioners provide the best care
• Home Office: the competent authority issuing licences for controlled drugs and drug precursor chemicals. There is a process for requesting the expedition of applications if needed

Wholesalers

Pharmaceutical wholesalers (or healthcare distributors) and pre-wholesalers also play a vital role in facilitating smooth distribution and delivery of medicines into the NHS, acting as an important link between the pharmaceutical industry and healthcare providers by managing inventory, monitoring fluctuations in demand and ensuring regulatory compliance.

Wholesalers must ensure the quality of products is maintained before arriving at hospitals and pharmacies. Larger pharmaceutical wholesalers can quickly distribute medicines to all UK pharmacies in hospitals and community settings with twice daily deliveries as common practice, and most commonly used medicines can usually be obtained within 24 hours.

Pharmacies

In the UK, pharmacies in the community and online are largely private businesses which are contracted by the NHS to provide certain services. They are responsible for the management of their own stock and have their own buying arrangements. Not all manufacturers supply to all wholesalers and not all pharmacies use the same wholesalers, so there may be some specific medicines that a given pharmacy cannot easily source. Pharmacies aim to ensure that they have sufficient stock available at any one time for their typical patient demand.

The National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 require that pharmacies must dispense prescriptions presented and do so with reasonable promptness. Where a supply issue occurs, pharmacy professionals must comply with guidance issued by the government. This includes providing patients with prompt advice if their usual medicine is temporarily unavailable.

It is important to note that pharmacies may not have every medicine available at all times. However, this does not necessarily indicate a shortage involving a sustained lack of supply. Some pharmacies may, instead, experience a localised or temporary lack of supply - for example, if a medicine needs to be ordered in for later collection. If a healthcare professional is uncertain about whether a disruption in the supply of a medicine is the result of a national shortage or is because of a temporary, localised issue, they should refer to the Medicines Supply Tool hosted on the NHS Specialist Pharmacy Service website, which highlights the latest information on national supply issues, including when products are likely to be back in stock.

Retailers

Medicines are also purchased from retailers, such as supermarkets, who manage their own supply chains and often source directly from manufacturers. These offer easy access to the 96% of the UK population that experiences at least one self-treatable illness every year (see The economic impact of over-the-counter medicines - Frontier Economics).

Collaborative working across the UK

The supply of medicines - including procurement, storage, allocation and distribution - is a devolved matter. However, we regularly engage with the devolved governments to discuss potential supply issues. Where agreed, we take the necessary actions to mitigate supply disruptions for the whole UK in collaboration with all UK countries to help ensure all UK patients have equitable access to medicines (see case study 1 below: ‘October 2024 shortage of radioisotopes’).

These arrangements were formalised from 2022 to 2025 through agency agreements between DHSC and the Northern Ireland Executive, Scottish Government and Welsh Government. The agency agreements are ongoing and give the Secretary of State for Health and Social Care powers to take medicines supply decisions on behalf of the whole UK in the event of any emergencies where there is agreement by Northern Ireland, Wales and Scotland.

Case study 1: October 2024 shortage of radioisotopes

In October 2024, the UK faced a severe shortage of a radioisotope molybdenum-99. This is used for diagnosing cancers, including prostate and breast cancer. The shortage of molybdenum-99 was caused by a sudden global disruption of manufacturing capacity, with several nuclear reactors used to produce these being out of service. This issue impacted not only the UK, but countries globally.

Management plan

The clinical criticality of the radioisotope means disruption to its supply can have a high patient impact. To manage the issue, an incident management group was established, and a comprehensive management plan developed and escalated to the Medicine Shortages Response Group (MSRG). This is a clinically led cross-organisational group of senior clinicians, regulators and professionals to assist with the management of more disruptive issues.

While supplies were significantly constrained, DHSC worked closely with suppliers, the British Nuclear Medicine Society, UK Radiopharmacy Group, NHS England, MHRA and the devolved governments. This was to support the allocation of deliveries to help ensure there was equitable and fair distribution of the product across the UK. DHSC also worked with NHS England and specialist clinicians to develop guidance to provide advice to ensure patients with the most critical needs were given priority.

Once the disruption resolved, DHSC engaged with industry to influence improved procedures for maintenance planning where possible. In parallel, DHSC engaged with the NHS and devolved governments to develop procedures to better prepare for future disruptions, including agreements to allow quicker movement between suppliers.

Communications

A National Patient Safety Alert was issued to the NHS and other organisations, including independent providers of health and social care, which provided comprehensive management advice for clinicians across the UK on how to manage and prioritise patients affected by these shortages. The guidance covered actions for health boards in the devolved nations, including on the co-ordination of mutual aid arrangements and escalation routes between hospitals where issues were identified to ensure that those patients with the most urgent needs were given priority.

A written ministerial statement on the supply of radioisotopes was also laid in Parliament during the shortage period to provide an update on the disruption.

2. Trends of UK medicines supply issues

In this section we assess the trends in UK medicines supply based on a number of metrics and the root causes of disruption, as reported by suppliers.

Global context

The UK is not alone in experiencing supply chain challenges. Nations across the globe are facing increased shortages of medicines, with the 2025 EU ‘Strategic Report of the Critical Medicines Alliance’ report (available on the European Commission’s Critical Medicines Alliance webpage) affirming that shortages of critical medicines have been rising for many years, in Europe and globally.

For example, the following countries have all reported an increase in shortages of medicines or have noted the challenges of medicine shortages and their growing significant impact in recent years:

• Switzerland (see Security in the supply of medicines - the Swiss Federal Office of Public Health)
• the USA (see ‘2023 Drug shortages report’, available on the US Food and Drug Administration’s drug shortages page)
• Australia (see the Australian Government’s Medicine shortages report 2024)
• Canada (see the Government of Canada’s Drug shortages in Canada: fiscal year 2023 to 2024 in review)

These shortages include across common product types such as anti-infectives (see the Organisation for Economic Co-operation and Development (OECD) report Securing medical supply chains in a post-pandemic world).

Additionally, an OECD report in 2022, Shortages of medicines in OECD countries, highlighted that medicines shortages were increasing before the COVID-19 pandemic, citing manufacturing and quality issues as the most significant cause of these shortages.

The frequency of supply disruption notifications in the UK

Each country measures supply disruption in a different way, so it is hard to make a reliable comparison with other nations. It also depends what time period you look at. For the UK, it is hard to rely on a single, reliable measure to assess if medicines supply issues are increasing or decreasing in frequency.

While there are obligations on suppliers to report supply issues, adherence to these requirements and the point of notification can vary. Further, many supply issues can be successfully managed by industry business continuity plans, or by local NHS action. Each individual supply issue is different with vastly different risks to patients, and some of the tools used to mitigate issues are measurable but only relevant to specific cases. As a result, we look at a number of indicators.

Number of Discontinuations and Shortages (DaSH) portal notifications

The primary route for DHSC becoming aware of a medicines supply issue or discontinuation is a formal notification from pharmaceutical suppliers on the department’s online reporting tool, known as the Discontinuations and Shortages (DaSH) portal, which was launched in October 2020.^{[footnote 1]} This formal reporting mechanism allows suppliers of medicines supplied to the NHS to fulfil their statutory requirement to inform DHSC of any supply disruptions (including supply issues or discontinuations).

There have been almost 10,300 potential medicines supply disruption notifications reported to DHSC from when the DaSH portal was operationalised in late 2020 to the end of June 2025 (this includes over 7,400 supply issue notifications and over 2,800 discontinuation notifications).

As seen in figure 1, the number of supply issue notifications increased in 2024 to over 1,900, which is approximately 20% higher compared with 2022 and 2023 when the rate of notifications remained relatively stable, at around 1,600 notifications per year.

However, to date in 2025 the number of notifications has been lower than in 2024, closer to 2023 levels. These numbers are subject to varying factors over time, including increased familiarity with the DaSH portal across suppliers and behavioural differences in when suppliers report issues to DHSC.

Figure 1: number of supply issue notifications reported to DHSC through DaSH, cumulative total by month

Text description for figure 1: a line chart showing the number of medicine supply issue notifications by month. Each line represents a year (2022 to 2025). The number of supply issue notifications increased in 2024 to over 1,900, which is approximately 20% higher compared with 2022 and 2023 when the rate of notifications remained relatively stable, at around 1,600 notifications per year.

Since 2022 and as seen in figure 2, discontinuation notifications have remained stable at around 400 per year - though it should be noted that the total number of medicines licensed in the UK has remained stable as new medicines are launched.

Companies may decide to stop manufacturing a medicine for several reasons. Availability of newer and more effective medicines entering the market can result in a lack of demand for other existing medicines. Other reasons such as manufacturing capacity constraints and production problems may also play a part. Companies are free to review their portfolios, and DHSC has no powers to insist that a company continues to keep a product on the market.

Figure 2: number of discontinuation notifications reported to DHSC through DaSH, cumulative total by month

Text description for figure 2: a line chart showing the number of medicine discontinuation notifications by month. Each line represents a year (2022 to 2025). Since 2022, discontinuation notifications have remained stable at around 400 per year.

Risk ‘tiering’ of DaSH notifications

All medicines supply disruption notifications reported to DHSC through the DaSH portal are assigned a tier from 1 to 4, dependent on patient and system impact. (For more information on the classification of the 4 tiers, see NHS England’s guide to the systems and processes for managing medicines supply issues in England).

When notifications are reported for medicines in the same therapeutic class, they can be managed as a group of notifications (for example, multiple supply issue notifications for products used to treat attention deficit hyperactivity disorder (ADHD) would be managed as one supply disruption).

Most medicines supply disruption notifications are assessed as tier 1 (low impact on the system and population) and means there is assessed to be little to no impact to patients or the healthcare system. This is likely due to our work with alternative manufacturers of the same medicine (formulation or strength) to secure supply that covers demand and meets the supply gap in full. As a result, no medication switching, clinical monitoring or review or amendment to prescriptions is required.

Figure 3 (below) illustrates that when comparing December 2023 and December 2024, almost 80% of open medicines supply disruption notifications were classified as tier 1 (low impact to the system and population).

Across both years, approximately 20% of notifications were classified as tier 2 (medium impact and likely to carry moderate to high patient safety risk) or tier 3 (high impact and likely to carry high patient safety risk), although the proportion (and overall number) of more serious tier 3 issues has reduced. These notifications require more intense management - for example, use of therapeutic alternatives.

No medicines supply disruption notifications were classified as tier 4 (high impact and very high patient safety risk) in December 2023 or December 2024.

Figure 3: tier breakdown for all active open notifications on DaSH for December 2023 and December 2024

Text description for figure 3: a stacked column chart showing the tier breakdown of active open notifications on DaSH in December 2023 and December 2024. Almost 80% of open medicine supply disruption notifications were classified as tier 1 and 20% classified as tier 2 or 3. No medicine supply disruption notifications were classified as tier 4 in December 2023 or December 2024.

Medicine Supply Notifications (MSNs)

A Medicine Supply Notification (MSN) is a routinely used form of communication DHSC and NHS England can use to notify the system of potential supply issues. They are issued to healthcare professionals to provide guidance, informed by advice from clinical experts, on how to manage patients while there is a supply disruption. They include a summary of the issue and management advice.

This measure provides another illustration of the trends in frequency of supply issues. As seen in figure 4, the number of MSNs has been consistent at around 130 issued annually for the last 3 years, despite supply issue notifications increasing in 2024.

Figure 4: MSNs issued by DHSC and NHS England, cumulative total by month

Text description for figure 4: a line chart showing the number of MSNs by month. Each line represents a year (2022 to 2024). The number of MSNs has been consistent at around 130 issued annually for the last 3 years, despite supply issue notifications increasing in 2024.

Causes of reported supply issues in the UK

As part of the DaSH reporting, suppliers report on the root causes of supply issues. While there can be a singular cause for a supply issue, it is often the combination and accumulation of several factors at once, which are often global in nature and impact. Figure 5 highlights the root causes of supply issues reported to DHSC through the DaSH portal in 2024. This analysis does not consider discontinuations.

Figure 5: root causes (sub-categories) of DaSH supply issues as a percentage of total supply issue notifications - data from 1 January to 31 December 2024

Text description for figure 5: a column chart showing the root causes (sub-categories) of DaSH supply issues as a percentage of total supply issue notifications in 2024. Manufacturing problems were the most common root cause of supply issue notifications, with raw material or packaging material shortages (20%) and manufacturing failure or relocation (approximately 15%) as the most reported sub-categories. Within the legal, regulatory, market and demand category, customer demand and demand surges accounted for approximately 20% of total notifications and licensing and regulatory issues accounted for approximately 10% of notifications in 2024. Logistics accounted for 5% of notifications in 2024.

Manufacturing

Manufacturing has been the most dominant root cause since DaSH was introduced. In 2024, manufacturing problems were the most common root cause of supply issue notifications, accounting for approximately 60% of notifications. Manufacturing problems are wide-ranging - however, the most reported sub-categories are:

• raw material or packaging material (for example, foil and plastic used in packaging for tablets) shortages (20%)
• manufacturing failure or relocation (approximately 15%)

We have seen instances where manufacturing problems with a single medicine have led to wider-scale disruption because multiple suppliers depend on the same manufacturer. This leads to multiple suppliers facing supply issues in parallel for the same reason, and greater impact on patients who may face limited treatment options.

Legal, regulatory, market and demand

Legal, regulatory, market and demand factors are the second most reported root cause category, accounting for approximately 35% of all reported supply issues. Within this, customer demand and demand surges were the most common sub-category overall in 2024, accounting for 20% of total notifications.

Demand surges can be caused by one supplier experiencing an issue and other suppliers, sometimes with a smaller market share, needing to increase supply (referred to as a ‘domino effect’). Sudden spikes in demand which are unforeseen or not forecast can also cause significant issues - for example, the global shortage of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) (see case study 2 below).

Behavioural changes and greater public awareness of medicines, partially through the media, have also resulted in unforeseen demand surges. While this can reflect positive trends of more people accessing effective treatments, unforeseen demand surges are difficult for industry to respond to at speed, leading to a shortfall in supply. An example of this were the supply issues that affected hormone replacement therapy (HRT) products between 2022 and 2023 (see case study 3 below).

Licensing and regulatory issues accounted for approximately 10% of notifications in 2024. Regulations are essential to protect patient safety. If any part of the supply chain fails a regulatory inspection or experiences delays in meeting compliance requirements, it can cause significant disruption to production and overall supply of that medicine.

Logistics

Logistics (for example, storage and transportation) continue to be a relatively minor root cause of supply issues, accounting for approximately 5% of notifications in 2024. These primarily cite delays in logistics or shipping, with many referencing geopolitical events - for example, disruption in the Red Sea resulting in ships re-routing around the Cape of Good Hope, which added over 12 hours to shipping times. Delays can also occur due to port congestion (caused by a range of factors) and disruption to warehouse facilities.

Case study 2: shortage of glucagon-like peptide-1 receptor agonists (GLP-1 RAs)

Between 2023 and 2024, supply issues were experienced with GLP-1 RAs. These are predominantly licensed for type 2 diabetes but some are also licensed for the management of obesity. The issues were largely driven by off-label prescribing for weight loss which caused a large global increase in demand.

Management plan

While supplies were constrained, DHSC engaged closely with suppliers, NHS England, MHRA and the devolved governments to expedite deliveries and boost supplies. Through this work, an oral version of semaglutide was made available in large quantities to allow new patients to commence treatment with a GLP-1 RA.

In parallel, DHSC routinely captured supply data and modelled demand to identify times where stock may become constrained in future weeks. To reduce demand pressures, we worked with the pharmaceutical industry to support newly licensed products for weight loss and/or diabetes to be launched into the UK market - for example, Wegovy (semaglutide), Mounjaro (tirzepatide) and new biosimilar liraglutide (Victoza) presentations.

GLP-1 RAs were also added to the list of medicines that cannot be exported from, or hoarded in, the UK.

Communications

Guidance was issued to healthcare professionals in the form of National Patient Safety Alerts and multiple MSNs stating that the medicines licensed for type 2 diabetes should not be routinely prescribed for weight loss​. Clinicians and prescribers were directed not to initiate new patients on these medicines and only to use them to treat their licensed indication, protecting supplies for diabetes patients.

Guidance was supported in a statement issued by the professional regulators (The General Pharmaceutical Council, General Medical Council, Health and Care Professions Council, Nursing and Midwifery Council, and Pharmaceutical Society of Northern Ireland) stressing the importance of healthcare professionals meeting regulatory standards. This was alongside additional advice issued in Scotland, Wales and Northern Ireland which critically reinforced the messaging provided through the National Patient Safety Alerts.

Case study 3: shortage of HRT products in 2022 to 2023

Between 2022 and 2023, the UK faced supply issues with a limited number of HRT products, primarily driven by large increases in demand.

Management plan

DHSC maintained regular close engagement with individual suppliers to:

• secure frequent stock updates
• monitor progress against plans
• horizon scan for potential issues
• actively secure additional deliveries
• expedite resupply dates to mitigate shortages

To support rapid resolution, DHSC established the HRT Taskforce and began regular roundtables with suppliers, wholesalers and community pharmacists to share:

• live supply and demand data
• updates on stock levels
• actions being taken to address shortages
• relevant policy developments from across DHSC and NHS England which may have a future impact on supply

In parallel, DHSC collaborated closely with MHRA to expedite regulatory procedures to support quicker resolution of issues.

Communications

DHSC regularly shared communications to healthcare professionals, providing advice to the NHS on the management of current supply issues, including direction on use of alternative HRT products.

This included issuing 23 serious shortage protocols (SSPs). Some allowed pharmacists to supply alternatives to prescribed HRT medications where there were no stocks, and others limited the amount prescribed to one month’s supply to support equitable distribution of the limited available stocks among patients.

3. UK medicines supply management

In this section, we explain how DHSC and NHS England identify potential disruption and manage medicines supply across England to help ensure that stocks remain available to meet regional and local demand.

Identifying potential disruption

Cross-cutting disruption

Medicine supply chains are global and can be vulnerable to a wide range of international and domestic threats. These factors often pose a risk to sectors across the economy. In recent years, we have seen growing geopolitical tensions impacting supply chains, such as Russia’s illegal invasion of Ukraine, extreme weather events (such as Hurricane Helene in the US) and global cyber-attacks. Alongside, we have seen country level export restrictions and industrial action at home and abroad.

Our identification of cross-cutting disruption across the end-to-end supply chain (raw materials to ‘last mile’ delivery) comes from a variety of sources. It is partly from relationships with other government departments and our UK embassies overseas. It also comes from industry partners including through trusted advisory groups. An additional channel is bilateral and multilateral engagement including DHSC and MHRA participation in the Global Regulatory Working Group,^{[footnote 2]} where information is shared about shortages of medicines with a global impact and actions are taken to prevent, monitor and mitigate their impact.

Information regulations

New regulations introduced in January 2019 placed a legal requirement on medicine licence holders to provide information to DHSC about the availability of UK licensed medicines supplied to the NHS and about discontinuation or anticipated supply shortages (see The Health Service Products (Provision and Disclosure of Information) Regulations 2018). Information must be provided at least 6 months before the shortage or discontinuation happens. Alternatively, where this information is not available 6 months in advance, it must be provided as soon as reasonably practicable after the producer makes the decision to discontinue or becomes aware that there may be a supply shortage. The mechanism to report is through notification by the affected manufacturer on DHSC’s DaSH portal.

The introduction of regulations and the DaSH portal has increased both the quality and quantity of information provided on shortages and discontinuations. Early notification means we can complete a thorough risk assessment of the severity of the issue, and engage with suppliers and other agencies ahead of an anticipated disruption becoming an actual shortage. Details on our plans to strengthen information regulations can be found in section 4 (‘Strengthening our approach to shortages and resilience of medicines supply chains’).

Global risk register, including identification of criticality and vulnerability

In 2020, DHSC developed a global risk register which draws on information on medicines licensed in the UK to map manufacturing touchpoints within the supply chain. It is used to help understand medicines supply chains vulnerability and risk. We have since identified medicines which are deemed both clinically critical and - using information from the global risk register - have potentially vulnerable supply chains. This is not a static list but a process that is used to target the most impactful resilience activities and is regularly updated to take account of the ever-changing supply situation. In respect to clinical criticality, we have considered elements reflecting both the impact on patients and the health system, such as availability of alternatives and ease of switching medications. Supply chain vulnerability was assessed by considering previous supply issue data and the complexity of the supply chain at the active pharmaceutical ingredient touchpoint and finished product touchpoint. This information is used to inform which product areas may require additional resilience measures, and to support our work, such as targeted seasonal supply monitoring (see below for further information).

Targeted seasonal supply monitoring

Potential disruption can also be identified early through targeted monitoring around specific events or risks. For example, growing demand and challenges in forecasting disease rates during winter, combined with broader strains on healthcare, can put extra pressure on already stressed supply chains.

For the past 2 winters, DHSC and NHS England set up a winter monitoring group to proactively monitor, analyse and assess demand trends for a specified subset of medicines most likely to be needed. These medicines were identified by analysing historical demand data, together with known supply constraints and clinical criticality.

Through a collaborative approach with the UK Health Security Agency and industry (which has supplied active stock level data for these products), we were able to improve oversight of potential issues based on analysis of the demand and supply level data and clinical insights on areas of potential concern. This reduced the need to investigate increases in demand that had been anticipated by industry planning, freeing up resources to concentrate on confirmed issues.

Risk assessment and management

Cross-cutting disruption

As described, the majority of cross-cutting disruption poses a risk to multiple sectors beyond medical products. Examples include logistics through the Red Sea, cyber-attacks or threats to energy disruption. For these risks, we work with a range of internal and external partners to understand the scale of risk posed to medicines (and other medical products). We feed this intelligence into cross-government activity, often co-ordinated by the responsible department or the Cabinet Office and communicated to industry as required.

To help us rapidly assess the risk to medicines, we have developed a global dependencies tool to instantly identify where products are sourced from and so might be at risk from an event that impacts a particular region or country. Another common tool is the utilisation of preparedness exercises, often considering a ‘reasonable worst-case scenario’ to test the extent that our existing response mechanisms would mitigate the risk and identify gaps to strengthen our response plans.

Risk assessment

For specific risks posed to individual medicines, the ‘guide to the systems and processes for managing medicines supply issues in England’, updated in March 2025 (and linked above), details the national, regional and local management and escalation processes and communication routes. Its purpose is to support NHS teams and professionals who have a responsibility for reporting a medicines supply issue, and teams and professionals who need to act when a shortage arises.

When investigating potential supply issues, we use medicine usage data to evaluate how the issue will affect the wider UK supply, and if it will create a medicine shortage.

The teams also regularly engage with the affected suppliers as part of a risk assessment to understand:

• issues, barriers and timelines for re-supply
• whether alternative suppliers can address gaps in supply - and, if so, how quickly
• confirm current stockholdings, which may include looking at global supply and future volume forecasts
• the ability to expedite deliveries and establish if production can be increased

For supply issues that cover multiple medicines affecting a particular treatment, we gather information from suppliers on the future supply of these medicines to identify times where supply will be constrained. This work enables us to work with other suppliers to meet any gap in supply or prepare management advice, with input from clinical experts, that can be shared with the NHS to help ensure patients can continue to access the medicines they need.

For high-impact supply issues facing significant fluctuations in demand, we incorporate additional demand data from a wider variety of sources to support more timely and holistic modelling when faced with sudden demand spikes.

Risk management

The scale of a medicines supply issue impacts the speed and type of national intervention needed. High and critical impact issues are overseen by the MSRG - a clinically led cross-organisational group of senior clinicians, regulators and professionals to assist with the management of more disruptive issues.

Mitigations may include:

• advice on use of alternative strengths or forms of the same medicine where sufficient supply allows switching - for example, supplying 2 125mg solutions in place of a 250mg solution or a tablet instead of a capsule. We engage with suppliers to understand whether there is sufficient supply of those alternatives to allow for switching, and with clinical specialists who advise on the appropriateness of switching to an alternative product for different patient populations
• advice on use of appropriate clinical alternatives based on advice from Specialist Pharmacy Service and clinical expert input if it is required - for example, another medicine that can be used to treat the same clinical indication and provide detailed advice on how to switch patients to a new medicine
• expediting regulatory review, which can, if necessary, speed up the decision on additional supply routes. MHRA continues to assess medicines applications well within statutory timelines and will always prioritise applications according to public health need. Approvals such as Mounjaro KwikPen, which MHRA were the first major regulator to license, demonstrate their commitment to this. In 2024, MHRA launched ‘Track My Case’ on the RegulatoryConnect platform - a new efficient service which provides greater visibility of progress in regulatory procedures to industry
• sourcing parallel imports (this is a medicine authorised in a European Economic Area (EEA) member state and can be marketed in the UK through the MHRA parallel import licensing scheme, as long as the imported product has no therapeutic difference from the equivalent UK licensed product)
• sourcing unlicensed imports (a medicine which may have a marketing authorisation from another country, or in some cases may be unlicensed in their country of manufacture) from abroad through specialist importer companies and expediting MHRA approval for the importation of these products. The medicine must meet standards of manufacturing that are equivalent to those for licensed medicines. This practice is only considered in certain circumstances, as there is potentially no detailed scrutiny of safety, quality or efficacy by any competent authority
• using a UK licensed medicine outside the terms of its licence, in accordance with professional practice guidelines
• proactive monitoring of supply and demand where there are particular concerns or threats to supply and as part of the management of live issues. In limited cases, we will also share demand forecasts with suppliers to help ensure sufficient future supply - for example, as done when DHSC led a series of supplier roundtables held for the HRT and ADHD medicine shortages seen in 2023
• working with wholesalers to help ensure stock is allocated evenly across the country, including in the devolved nations, and to discuss whether further strategies are needed to manage remaining stock or work with Specialist Pharmacy Service regional pharmacy procurement specialists to share stock between trusts or within and between regions (mutual aid)
• adding products to our list of medicines that you cannot export from the UK or hoard to help ensure medicines can remain available for UK patients. We restrict the export and hoarding of some medicines already placed on the UK market where there is evidence of a critical shortage, or a risk of a critical shortage which could adversely impact UK patients. We do not restrict the export of any medicines which are manufactured for overseas markets. We take a proportionate approach regarding the list of medicines that are subject to export restrictions so that restrictions are applied in a targeted, transparent and time-limited manner. We run twice-yearly periodic reviews of the list, removing medicines that no longer meet the criteria for inclusion. We work with the Department for Business and Trade (DBT) to promote transparency at the World Trade Organization (WTO), providing updates about the UK’s regime of medicine export restrictions, achieving a best practice approach to our notification obligations
• enabling the use of SSPs, which allow community pharmacists to supply an alternative product in the event of a shortage, by supplying in accordance with the protocol rather than supplying in accordance with a prescription, with the patient’s consent and without the needing to go back to the prescriber
• DHSC’s National Supply Disruption Response (NSDR) hosts the Express Freight Service (EFS), which helps to ensure the continuity of medicines and medical supplies in the event of significant disruption, or risk of disruption, to medical supply chains. This 24/7 service provides bespoke, global logistics solutions, and can move all and any type of medical product. The user of the EFS is responsible for payment of carriage - however, NSDR provides end-to-end oversight of all EFS solutions, from design to delivery

8-week supplier-held buffer stocks for secondary care medicines

In addition to the above, and to provide a first line of defence in the face of shortages, NHS England introduced an approach to supplier-held buffer stocks in 2022. These are part of mandatory framework terms and conditions to increase medicines supply resilience across the generics, branded and biosimilar medicines categories.

The buffer stock (which is calculated from 8 weeks’ previous purchases) allows for the ‘ebb and flow’ of demand fluctuations and short-term supply chain breaks. This drives better supplier chain performance and helps ensure supply remains available. Where the buffer stocks are in place, tier 1 issues (shortages that are deemed to have a low impact on the system and population) have stabilised and reduced.

The 8-week buffer stock requirement for secondary care medicines is awarded across all suppliers on MPSC frameworks (noting that not all secondary care medicines are on MPSC frameworks). This provides a degree of resilience where multiple suppliers are awarded contracts for a given medicine and there is a plurality of buffer stocks that can be used in the event of a potential supply disruption. We understand that stockpiling, if not implemented strategically, can reduce agility in managing medicines shortages and has the potential to exacerbate global shortages where there is unco-ordinated stockpiling across multiple countries at once.

NHS England’s move to value-based procurement is an important shift from price-based procurement. It introduces an increased level of supplier accountability across a broader base of criteria, which now includes suppliers holding buffer stocks. This holistic, outcomes-driven approach is underpinned by the Procurement Act 2023 (which came into force on 24 February 2025) and means that suppliers are more likely to be selected for contracts if they operate a well-managed buffer stock programme that has sufficient reporting, compliance and utilisation. Resilience is an important part of the tender assessment, and value based procurement rewards strong performing suppliers who provide the most overall value. Non-complying suppliers who do not hold or share data on buffer stocks face penalties and their future contract awards can be impacted. See section 4 (‘Strengthening our approach to shortages and resilience of medicines supply chains’) for more details on increasing compliance.

Communications

When a medicines supply issue arises which requires partners to act, communication is critical. Each medicines supply issue is different, and our communications are developed and predominantly aimed at healthcare professionals who will have sight of an individual patient’s medical history and current health status. They provide information that clinicians need about supply disruption, informed by advice from clinical experts. These communications support clinicians to have bespoke conversations with patients on their personal healthcare needs. More information on the different types of communications issued for medicines supply issues, including MSNs, National Patient Safety Alerts and SSPs can be found in NHS England’s ‘guide to the systems and processes for managing medicines supply issues in England’ (linked above).

To enhance this approach, in 2021, DHSC and NHS England launched the Medicines Supply Tool, a searchable, web-based tool hosted on the NHS Specialist Pharmacy Service website, for use by healthcare professionals. The tool is designed to support providers of care and has been a critical step to providing easily accessible, live information on supply issues, actions to take, alternatives to use and expected resolution dates. The information provided by the tool replicates the advice in MSNs and signposts to any National Patient Safety Alerts issued. All hospital and community pharmacists and prescribers are encouraged to sign up.

We routinely work closely with patient groups for particular shortages that impact specific patient populations (for example, epilepsy medications), to help raise awareness of shortages and so that patients know what to do in times of shortage.

Further information on our ongoing work to improve how guidance on supply issues is communicated to different audience groups can be found in the next section.

4. Strengthening our approach to shortages and resilience of medicines supply chains

Previous sections have described:

• the critical partners and complexity of the global supply chains we rely on (section 1: ‘The UK medicines supply chain’)
• the frequency and root causes of the supply issues reported to us (section 2: ‘Trends of UK medicines supply issues’)
• the current activity implemented to help us identify, manage and communicate to protect patients (section 3: ‘UK medicines supply management’)

In this section, we outline some of the ways we are enhancing our processes to manage acute disruption and strengthen supply chain resilience. These include measures around:

• earlier identification of potential disruption
• enhanced reliability and timeliness of supply
• improved communication and guidance
• stronger international partnerships

These do not claim to entirely fully mitigate risks or guarantee a reduction in disruption (which is subject to global factors) but set out tangible actions that will help us protect patients. This is part of an ongoing priority to continually learn and seek to improve the way we work with our partners to respond to challenges that emerge and achieve a more resilient, sustainable medicines supply chain.

Current global context

Increasing global tensions, growing demand worldwide for healthcare and challenging economics mean that risks to our medicines supply chains are increasing. These both amplify and add to the chronic vulnerabilities in our supply chains from high reliance on individual nations, companies or logistic routes, as well as growing risk from technological (for example, cyber), sociological (for example, anti-microbial resistance) and environmental (for example, extreme weather events) factors.

In response, most major governments have prioritised introducing policy aimed at securing their medical supply chains. Each individual country, or group of countries, will take their own approach influenced by their health system design and priorities. For example, the European Union has announced new legislation such as the Critical Medicines Act and the introduction of a European Shortages Monitoring Platform, launched in January 2025.

Germany (see German act to combat and improve the supply of medicines - Federal Institute for Drugs and Medical Devices) has introduced new mandatory stockpiling requirements, meaning certain stocks of specific medicines are held within that country. Increased manufacturing investment has been seen globally - for example, with a focus on critical medicines announced in France (see France Relance recovery plan: building the France of 2030 - France Diplomacy) and greater requirements for industry to demonstrate transparency that have been introduced in Europe and the Americas (see Drug shortages in Canada - Government of Canada).

We have worked with Lancaster University to better understand international practices around supply chain data and information sharing as a tool to manage medicines shortages. We also regularly engage with international partners to understand the measures they are introducing, share best practice from our own experience, and assess the impact of measures taken by other nations on UK resilience.

In addition, we know many in industry have sought to strengthen their own supply chains through stronger business continuity plans, increased inventories and dual sourcing their inputs.

This serves to illustrate that the challenges faced are global and that it is vital that we take a holistic and proportionate approach to boosting the resilience of our supply chains and improve our response plans.

Earlier identification of potential disruption

As outlined in section 3 (‘UK medicines supply management’), it is critical that we identify potential disruption as soon as possible to maximise the time to assess and manage to protect patients. Identification of a potential disruption can come from various sources, including direct from suppliers who are required to report to DHSC through the DaSH portal.

Actions that we will take forward include:

Consulting on better reporting of supply issues

While the majority of suppliers report disruption in a timely manner, not all do so and this can impede our ability to mitigate patient risk. As part of our obligations under the information regulations (the legislation that requires medicine licence holders to provide us with information on anticipated supply shortages and discontinuations for medicines supplied to the NHS), we regularly review and consider the need to amend provisions. To consider options to improve better reporting in supply issues, we will consult on:

• how we can ensure the information provided by suppliers on shortages and discontinuations is sufficient to allow us to put timely measures in place to manage supply and mitigate the impact on patients
• the penalties regime, to ensure they continue to achieve their objectives and that the objectives remain appropriate

Improving our visibility of supply chain data

We will work with suppliers and wholesalers to understand how we can improve the efficiency of our digital tools to support robust, faster and more targeted responses to issue management. This has the potential to reduce the amount of time that industry spends notifying DHSC of shortages or providing essential data on stock levels and ensure we are picking up early warning signals across the supply chains.

Linked to this, we are trialling the Global Supply Chain Intelligence Programme (GSCIP), which combines several large commercial data sets, to identify shortages before they occur and more rapidly assess the impact of a disruption in one area on others.

Improving accuracy of demand forecasting

Current demand forecasting is often issue specific or seasonal - for instance, around winter. We will work with manufacturers and distributors on actions to better anticipate demand fluctuations to help prevent essential medication becoming out of stock. Examples include disease fluctuations or changes to NHS guidelines.

For a subset of products, we want to implement routine broader sharing of our demand forecasting analysis with suppliers (based on the information we hold) to help identify potential trends and ensure we are working together to better understand future demand.

Enhanced reliability and timeliness of supply

Just as it is critical to identify potential disruption in the supply of medicines early, we will take action to promote a secure and resilient supply base. This includes:

• exploring how we can help ensure there are enough finished product suppliers in the UK market
• exploring the role pharmacies can play in facilitating a consistent supply of medicines to patients
• being mindful of unintended incentives from pharmacy buying systems

Simplified processes and reviews have already been put in place by MHRA for the consideration of parallel import licences, which are significantly improving the supply of licensed medicines from other jurisdictions.

Implementing the necessary changes to meet sustainability and carbon reduction goals - essential for reducing the environmental footprint of medicines - will also need to be carefully managed to ensure supply is not inadvertently impacted. Continued collaboration between government and industry is essential to monitor and address vulnerabilities, minimise risks and take advantage of opportunities across the supply chain.

Further areas of action that we will take forward include:

Consulting on pharmacist flexibilities

In primary care, community pharmacists must supply the exact product, quantity, strength and formulation prescribed. There are, however, some exceptions set out in legislation such as original pack dispensing and SSPs. We will consult on enabling pharmacists working in a community pharmacy to have the flexibility to supply an alternative strength (and hence also quantity) or formulation against a prescription written by another prescriber, to improve patient access to medicines and improve patient experience.

As part of this, we will need to give careful consideration to when this might be appropriate, to balance any risks to patient safety and the potential knock-on impact that could unintentionally lead to supply problems with other products.

Increasing compliance with secondary care 8-week buffer stock requirements

As part of secondary care tendering, suppliers are contracted to have an 8-week buffer stock. Most suppliers are compliant, but we are continuously seeking to improve this to a 100% compliance rate. We will issue communications to all relevant suppliers to reinforce the need to oblige and are exploring the potential use of spot audits to drive compliance further.

Reactivating dormant licences

Broadening the supplier base is critical to bringing additional resilience to portfolios of medicines which have only 1 or 2 suppliers in the market. We will continue to work with MHRA and Medicines UK to identify target molecules, and to progress plans for 40 molecules to be reactivated over the next 2 years. Wider engagement with international pharmaceutical companies is planned in sequence to support entry to UK market for these at-risk molecules.

Unlocking UK manufacturing opportunities

We are committed to creating an attractive environment where the UK’s medicine manufacturing capabilities can grow and excel. Clearly it is not viable to produce all medicines domestically, but by investing in domestic manufacturing we can help diversify our supply and reduce our dependency on imports.

Strengthening local production not only shortens lead times but can also help mitigate the risk of disruptions caused by international events such as geopolitical conflicts or environmental crises.

Ongoing work includes:

• Life Sciences Innovative Manufacturing Fund (LSIMF): the UK government has committed up to £520 million in life sciences manufacturing through LSIMF. The fund offers capital grants to support UK-wide investment in human medicines, medical diagnostics and medtech products. LSIMF builds on the success of previous grant funding schemes, which are on track to provide over £410 million in private investment in medicines manufacturing and secure over 1,100 high-skilled jobs. Support was provided across the medicines sector, including to large pharmaceuticals, contract development and manufacturing organisations and generic manufacturers. This has bolstered the UK’s capacity in critical areas such as API manufacture and fill-finish capability (the process of filling and finishing pharmaceutical products into their final containers)
• NHS aseptic and manufacturing units: these act to support medicines supply resilience for medicines that may not be economically viable for the commercial sector. Investment of £9.6 million in equipment and facilities for local hospital pharmacy aseptic and manufacturing units was made during 2022 to 2025 to support improved capability and capacity for clinical trials medicines production. In 2025 to 2026, 4 new NHS aseptic medicines production hubs will open, following prior investment of £75 million. These will produce an additional 2.5 million doses of cancer treatments and other ready-to-administer injectable medicines per year for NHS patients. NHS over-labelling units continue to support efficiency in medicines in emergency departments, ambulance trusts and hospital discharge

Supporting the new DBT Supply Chain Centre

As part of the Industrial Strategy published on 23 June 2025, the government committed to launch a new Supply Chain Centre based in DBT. This will lead the government’s work, in tandem with business, to build the resilience of the supply chains critical to the UK’s security and prosperity, helping to secure our ability to withstand future disruptions.

Health supply chains, including medicines, are one of the priority sectors of the government and we will continue to input and work with DBT and other colleagues across government to apply and embed consistent, evidence-based frameworks for assessing supply chain vulnerability.

Enhancing strategic relationships through Health Crown Representatives

A joint programme of work has been launched between DHSC, NHS England and Cabinet Office which aims to use the NHS’s significant scale and influence to strengthen partnerships with the most strategic suppliers to provide additional value and unlock opportunities.

An important part of this work is the appointment of 4 Health Crown Representatives (see DHSC appoints business leaders to manage strategic suppliers). Crown Representatives - individuals with significant senior and executive industry experience - act as a conduit between government and the most strategic suppliers. They support both the supplier and health organisations with challenges, opportunities and risks. We will continue to work with our Crown Representatives to provide more strategic partnerships with those suppliers involved.

Improved communication and guidance

How and when we communicate and what we say publicly is a careful balancing act to ensure that we are best supporting the NHS and patients without exacerbating the supply issue. That includes the role others play in responsibly reporting on supply issues to the public. We must ensure information is timely, easy to access and actionable by the consumer.

To achieve this improvement we will be:

Updating the 2013 medicines supply best practice guidance

Through close engagement with trade associations, we will update the best practice guidance to ensure it supports suppliers with clear information on how to ensure efficient supply of medicines to patients. This will reflect legal requirements and recommendations for manufacturers, wholesalers, NHS provider trusts, pharmacies and dispensing doctors in respect to supply of medicines.

Publishing information guides for patients, community pharmacies and general practices about what to do when faced with supply issues

The aim of the patient information guide is to give patients an understanding of why medicines may be in short supply and where to get advice and support to address some of the concerns patients may have when there is a shortage of their medicine.

The information guide for pharmacists and GPs aims to give guidance on what to do when faced with a shortage of a medicine and where to find the most up to date management advice on national supply issues so that they can best support their patients.

Providing shortage information at the point of prescribing in general practice

At present, GPs do not have visibility of live national shortages at the point of prescribing on their prescribing software. This can result in patients having to go back and forth between pharmacies and GPs if they are prescribed a medicine that is unavailable across the country and consequently require a new prescription.

We will expand and speed up access to information on anticipated resupply dates for out-of-stock medicines and available alternative treatments for GPs through the third parties that operate their prescribing software. This will allow prescribers to take the necessary mitigating steps - for example, prescribing an alternative medicine - and reduce potential pressure on pharmacies, the GP sector and patients.

We have already made changes to the GP terms of service to enable GP software providers to access the Medicines Supply Tool. We are also developing a document, known as an ‘information standard’, that will outline how third party software providers can ensure they are providing medicines supply information which is accurate and up to date.

Improving useability to the Medicines Supply Tool for healthcare professionals and creating an easily accessible landing page for patients

We will improve the Medicines Supply Tool to ensure healthcare professionals can quickly and efficiently find the information they need on a particular supply issue. That includes ensuring the website is user-friendly and easy to navigate.

We also plan to develop a landing page for patients to quickly find the information needed about shortages of medicines and where to seek further support.

Providing regular education and training

To help different sectors understand what resources are available in times of supply disruption, we will conduct webinars with industry partners, so manufacturers are aware of how to report a potential supply issue to DHSC.

Alongside this, working with representative bodies, we will run seminars and events and provide relevant resources, such as the pharmacist and GP information guides, for healthcare professionals to provide an understanding of why supply issues occur and where to access the most up-to-date guidance available in managing supply issues.

Stronger international partnerships

As described, given the inherent globalised nature of medical supply chains, international collaboration is crucial to strengthening supply resilience and helping to ensure continued access to medical products by providing opportunities for mutual support and intelligence sharing on the challenges facing medicines supply chains. Robust global supply chains are in all of our interests and the UK is working with international partners to strengthen resilience, reduce critical dependencies and support stable access to medical goods.

We will achieve this by:

Deepening our collaboration with multi-lateral organisations

The UK regularly engages with various multinational organisations such as the G7, G20, WTO and OECD to champion strong international co-operation and harmonization, as well as the removal or reduction of regulatory and trade barriers.

The UK’s largest trading partner remains the EU. In 2024, the UK imported around £16.6 billion pharmaceuticals products and exported around £9.7 billion pharmaceutical products from the EU (see ‘overseas trade statistics’ (HS30 pharmaceutical products), available on HM Revenue and Customs’ Get trade data page).

On 19 May 2025, the UK secured a new agreement with the EU that:

confirmed our shared principles of maintaining global economic stability and our mutual commitment to free, sustainable, fair and open trade, in line with our shared values, as well as noting the importance of co-operation with all of our trading partners in safeguarding our supply chain resilience and monitoring trade diversion.

We will work to build on this deal to achieve specific benefits to help secure our supply chains and protect patients. This is alongside our ongoing engagement with the EU Critical Medicines Alliance - of which DHSC became a member in spring 2024 - and on targeted measures proposed in the Critical Medicines Act.

Enhancing health security through trade deals and agreements with priority nations

We are committed to maintaining and expanding these relationships to address shared global supply chain challenges collaboratively.

For example, in early 2025, the UK signed a memorandum of understanding (MoU) with the Government of India, a major supplier of pharmaceuticals globally, agreeing collaboration on a range of health and life sciences priorities including medical supply chain resilience.

On 8 May 2025, the general terms for the UK-US Economic Prosperity Deal (EPD) were announced, paving the way for preferential treatment on tariffs for UK produced pharmaceuticals exported to the US - the first country to secure such a deal. We continue to actively work with the US to implement this deal, including working together on supply chain security to serve the health security interests of both nations.

Next steps

Patients are at the heart of everything we do and we are committed to continuing to strengthen the supply of medicines to patients. Our priority is to achieve the commitments in this document, which set out our plan of action and help inform future priorities.

In the coming months, we will be working across government and alongside our partners across the health system and medicines supply chain to draw on their valuable expertise and achieve our ambitions more quickly. This will include our expert working groups with representatives from across the supply chain.

We will also continue engaging with patient representative organisations to integrate the patient perspective into all our work, while also ensuring supply chain partners have a clear voice and role in shaping solutions.

We are committed to transparency and will provide updates on progress - including a published update in 2026.

1. Some secondary care supply issues may or may not be included in overall DaSH notifications as contracted suppliers will notify NHS England of potential disruptions directly as part of their routine contract agreements. ↩

2. The group meets on a quarterly basis and consists of medicine regulatory authorities from the UK alongside Australia, Canada, Japan, the United States and the European Medicines Agency, with the World Health Organization (WHO) as an observer. ↩