Medicine shortages are an ever increasing problem for the UK primary care system, with the Department of Health and Social Care (DHSC) logging an average of 137 shortage notifications per month from medication manufacturers in 2023, an increase of 67% from 2021.1 With shortages becoming more common, community pharmacies are spending more time attempting to source alternatives and on the phone to GP practices, with practice staff subsequently burdened with prescribing alternatives on an ad hoc basis.2 Patients may question the reason for or, more worryingly, be confused by changes, and medication regimens may be disrupted while waiting for a suitable alternative to be sourced. Supply shortages affect a wide range of therapies, including type 2 diabetes, hormone replacement therapy (HRT), epilepsy, and attention deficit hyperactivity disorder (ADHD) medications in recent years.3

The medicines supply network is a complex system, encompassing raw materials suppliers, manufacturers, wholesalers, prescribers, pharmacies, and, ultimately, patients. Different parts of this network are exposed to a variety of external factors beyond their immediate control, including market forces, regulatory policy, changes in guidelines or product licensing, and operational challenges. The system’s many moving parts and different vulnerabilities means there can be numerous reasons for shortages of a particular drug. Medicine shortages can be broadly grouped under three causes: demand surge, capacity reduction, and coordination failure.4

The first of these, ‘demand surge’, is when the capacity to manufacture or supply a medicine can’t keep up with an increase in prescribing. This can be caused by pandemics, disasters, changes in guidance, and …