Medicine shortages in the UK are now, in the words of pharmacy and GP leaders, the most severe on record, and they are consuming a large amount of clinical time in every practice and pharmacy. In June 2026 the National Pharmacy Association and the Royal College of General Practitioners jointly warned that shortages pose a serious risk to patient safety, with the longest-running individual-medicine shortages in NHS history. This is a practical guide for GPs and pharmacists: what is short and why, how Serious Shortage Protocols work, the substitution rules that slow everything down, and how to manage shortages safely. Always check the current supply position, because it changes week to week.
Key takeaways
- Shortages are the most severe on record, and a majority of pharmacies report a serious patient-safety risk.
- Creon and the HRT patch Estradot have the longest-running Serious Shortage Protocols in NHS history.
- A Serious Shortage Protocol lets pharmacists supply a specified alternative without returning to the prescriber.
- Without a protocol, pharmacists cannot substitute, even tablet to capsule, and must send the patient back to the GP.
- Antiepileptic drugs are the key exception: brand switching can be unsafe, so do not switch category 1 AEDs.
The scale of the problem
The numbers are stark. The National Pharmacy Association, representing around 6,000 independent community pharmacies, reported that 96 per cent of pharmacies felt the current situation posed a serious risk to patient safety, 89 per cent were unable to dispense a medicine at least once a day, and 98 per cent had seen patients visiting several pharmacies in a day to find a prescription, with 83 per cent of teams facing abuse or anger over unavailable medicines. Two shortages are now the longest-running for individual medicines in NHS history: the Serious Shortage Protocol for Creon, a pancreatic enzyme replacement therapy used in cystic fibrosis and pancreatic cancer, has been in force since May 2024, and the protocol for Estradot, a common HRT patch, since December 2024, both recently extended to 10 July 2026. Pharmacies have reported patients rationing medication and even skipping meals when they could not obtain Creon.
What is short, and why
The shortages extend well beyond those headline medicines. Commonly dispensed drugs affected in recent months include ramipril, prescription co-codamol, some strengths of low-dose aspirin, and medicines used to manage epilepsy. The causes are structural rather than local: a volatile global medicines market, manufacturing and supply-chain disruption, pricing pressures that make some markets unattractive to suppliers, and international factors including conflict affecting supply routes. The scale of the cost is significant too, with a parliamentary group previously estimating that shortages cost the NHS around £220 million in a single year. The practical point for clinicians is that these are system-level problems outside any practice's control, so the task is safe management, not prevention.
How Serious Shortage Protocols work
A Serious Shortage Protocol is the main mechanism that helps. When the Department of Health and Social Care issues one for a specific medicine, it allows community pharmacists to supply a specified alternative, whether a different quantity, strength, formulation, or a therapeutic equivalent, in line with the protocol and without going back to the prescriber. This keeps patients supplied and reduces the back-and-forth that shortages otherwise generate. Protocols are time-limited and specific, so pharmacists must follow the exact terms of the current protocol for that medicine, and GPs should be aware that a protocol may mean a patient receives a different product than prescribed, appropriately and safely.
The substitution rule that slows everything down
Here is the friction that both professions are asking to change. Outside of a Serious Shortage Protocol, a pharmacist cannot make even a minor substitution, such as switching a tablet to a capsule or a cream to an ointment, when the prescribed item is out of stock and a clinically appropriate alternative is available. Instead, the patient must be sent back to the GP for a new prescription, delaying treatment and adding avoidable workload to both the pharmacy and the practice. The National Pharmacy Association has called for this legislation to be amended, and the Royal College of General Practitioners supports allowing pharmacists to make limited, safeguarded changes when a safe, clinically appropriate alternative exists within agreed prescribing guidance. Until that changes, the return-to-GP step remains a legal requirement, not a choice.
Managing shortages safely: the epilepsy trap and general principles
Safe substitution is not the same as any substitution, and antiepileptic drugs are the clearest example. The MHRA categorises AEDs by the risk of switching between manufacturers' products: category 1 drugs, such as phenytoin, carbamazepine, phenobarbital and primidone, should be maintained on a specific manufacturer's product, because switching can affect seizure control. During a shortage, an AED must not be switched brand or formulation on convenience grounds, and category 1 drugs in particular should be kept consistent. More generally, before any switch, confirm the alternative is licensed and clinically appropriate, check the relevant product information for dose equivalence and monitoring, consider interactions and the specific patient, and communicate the change clearly so the patient understands what they are receiving and why. Advising patients to order repeat prescriptions early, rather than on the day they run out, also reduces the risk of a gap.
Where to check, and where iatroX fits
For the current supply position, the authoritative feeds are the Community Pharmacy England Medicine Supply Notifications and Serious Shortage Protocol register, and the NHS Specialist Pharmacy Service supply information, which pharmacies use directly. When you need to check a licensed alternative, its dosing, monitoring or interactions before substituting, Ask iatroX provides UK medicines information grounded in the electronic medicines compendium and SmPCs, with the source attached, so you can verify a substitution quickly rather than searching manually mid-consultation. You can try iatroX with free sample questions at iatroX, and for choosing medicines-focused AI tools, see what to look for in AI tools for pharmacists. The clinician remains responsible for the final decision, as always.
Frequently asked questions
How bad are UK medicine shortages in 2026? Pharmacy and GP leaders describe them as the most severe on record. A June 2026 National Pharmacy Association survey found 96 per cent of pharmacies felt there was a serious patient-safety risk and 89 per cent were unable to dispense a medicine at least once a day.
Which medicines are affected? The longest-running shortages are Creon, a pancreatic enzyme replacement therapy, and Estradot, an HRT patch, both under record-length Serious Shortage Protocols. Others in recent months include ramipril, co-codamol, low-dose aspirin, and epilepsy medicines.
What is a Serious Shortage Protocol? A Department of Health and Social Care mechanism that lets community pharmacists supply a specified alternative, such as a different quantity, strength or formulation, without returning to the prescriber, in line with the protocol's exact terms. Protocols are time-limited and medicine-specific.
Can a pharmacist swap my medicine if it is out of stock? Only under a Serious Shortage Protocol, or with a new prescription. Outside a protocol, pharmacists cannot substitute, even tablet to capsule, and must send the patient back to the GP. Both professions are asking for this rule to be relaxed with safeguards.
Is it safe to switch epilepsy medicines during a shortage? Not routinely. The MHRA categorises antiepileptic drugs by switching risk, and category 1 drugs such as phenytoin and carbamazepine should be kept on a specific manufacturer's product, because switching can affect seizure control. Do not switch these on convenience grounds.