Pharmacists say they are struggling to obtain many common medicines and paying “vastly increased” prices for them.
This is leaving patients complaining of delays in getting hold of drugs such as painkillers, anti-depressants and blood pressure medication.
The BBC has found there has been a big rise in the number of drugs on the “shortage of supply” list for England.
There are now 80 medicine in such short supply, that the Department of Health has agreed to pay a premium for them.
This is up from 45 in October.
There are a number of reasons why this has happened, but there are now concerns that uncertainty over Brexit will only make that worse.
The Royal Pharmaceutical Society said there was “a massive shortage and price spikes”.
What does this mean for patients?
Most people should be able to get their prescriptions filled as normal.
But if they need one of the drugs that is running short, they might not be so lucky.
Some pharmacists are sending patients back to their GPs to ask for a different medicine or dosage.
Others are giving as much of a drug as they can spare and sending people away with IOU notes for the rest.
The best advice is to make sure you get prescriptions to your pharmacist in good time.
It is almost always possible to come up with an alternative.
However, that can be more difficult with conditions like epilepsy, where patients need to be on specific drugs.
What is the scale of the problem?
It is hard to get a definitive tally of which medicines are running short.
But the industry in England uses a list from the Pharmaceutical Services Negotiating Committee (PSNC).
It shows which drugs are in such short supply and for which ones the NHS has agreed to temporarily pay a higher price.
The PSNC publishes monthly lists of these so-called concession prices.
The BBC has analysed this data and found that the number of medications on the list has grown sixfold in three years.
During this time period the peak was in November 2017, but there has been a recent surge and figures for December show it is approaching that level again.
What drugs are affected?
This is about prescriptions for generic medicines, rather than specific brand names.
For example, Nurofen is a common painkiller, but you can buy the same generic drug, ibuprofen.
Ash Soni, president of the Royal Pharmaceutical Society, says he has never seen so many common drugs affected by shortages.
He explains: “The items are out of stock and unavailable. Patients are having to wait.
“We’re having to send some patients back to the GP to get a different prescription, because we just can’t fill them.”
On December 2018’s concession list, 28 drugs, or about a third, were among the 500 most commonly prescribed.
For example, furosemide is used to treat high blood pressure and other cardiovascular problems.
It comes in various dosages, but one type, 40mg tablets, is the 23rd most commonly prescribed drug in England.
Other drugs on the list include fluoxetine, which treats depression, and naproxen, which is an anti-inflammatory.
Mr Soni says naproxen went “completely out of stock” recently.
“I didn’t have any on my shelf last week. I’ve got patients who are waiting for it.”
He did manage to track some down now, but it cost £6.49 a box. That is more than £2 more than the NHS last agreed to pay for it.
He says: “I’ve ordered 20 boxes today and that will last me about two or three days.
“We’re dispensing at a loss. We’re paying for patients to get their meds on behalf of the NHS.”
What do drug companies say?
Warwick Smith, director general of the British Generic Manufacturers Association, says stock levels can fluctuate.
He prefers to call it a “tightening of supply” rather than a shortage.
“It’s normal for levels of availability to increase and decrease, which impacts prices,” he adds.
The government stresses that two million prescription items are dispensed in England every day, and the vast majority of medicines are not in short supply.
A Department of Health and Social Care spokesperson said: “We continue to work closely with industry and partners to ensure patients receive the medicines they need and pharmacies are reimbursed fairly.”
Why is this happening?
Industry figures all stress that there is no single, neat answer to explain such a complicated situation.
Suggestions for reasons behind the shortage include:
- increased global demand
- cost of raw materials
- new regulatory requirements driving up costs
- fluctuations in exchange rates
- generic companies being unwilling to carry on selling unprofitable products.
Another possible explanation is that the NHS has done too good a job of driving down the prices it will pay for drugs.
The PSNC says this makes the UK a less attractive market for manufacturers.
Has Brexit had an impact?
The government has told manufacturers of both branded and generic drugs to stockpile six weeks’ worth of supplies, so that people would still get their medications if we have a no-deal Brexit.
Hospitals, distributors and patients have been told not to stockpile their own supplies.
Generic shortages started peaking in 2017, so it is not possible to say that this issue has arisen because we are so close to Brexit.
But Gareth Jones, from the National Pharmacy Association, says: “Uncertainty over Brexit appears to be a significant factor.”
He says patients do not seem to be panicking about getting their medicines after a possible no-deal Brexit, but thinks there could be an element of “unconscious stockpiling”.
In other words, if people at every step of the supply chain hold on to extra medicines, it could have a significant impact on supplies.
Martin Sawer is executive director of the Healthcare Distribution Association, which circulates 92% of the medicines in the UK.
He says: “You can bet your bottom dollar people might be stockpiling.
“Some businesses could be speculating on Brexit. That’s the nature of the market.”