UK patients cannot expect to access approved innovative medicines if the country does not adequately contribute to clinical trials, an expert has said.
Speaking on a panel at the NHS Confed Expo, which took place in Manchester on 10 and 11 June, Dr Rebecca Clark, co-clinical lead of the UK Vaccine Innovation Pathway and clinician in the North West of England, said that if the UK wants patients to access innovative medicines, then the country must increase its commercial clinical trial contributions.
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“We are living in a time of increased pressure – I see that day in day out in my NHS practice, but I would counter that with saying that, in my time as a researcher, I have never seen drug developments like we are seeing now and are going to see over the next 10 years. If we want to make sure that the UK continues to be a global leader, and we want to be a global leader in clinical trial development, we need equity of access to clinical trials for the best medicines possible. We can’t expect to fight for that position in the world if we don’t commit to having access to those drugs at the other end of the spectrum,” Clark explained.
According to the Association of the British Pharmaceutical Industry’s (ABPI’s) annual clinical trials report, which analysed studies between 2022/2023 and 2024/2025, the number of patients recruited into UK industry clinical trials fell by 25%, with participation in commercial trials now at its lowest level since 2017/2018.
When questioned, pharma companies attributed slow trial set-up times and significantly reduced recruitment targets set by UK trials sites, compared to other European countries, as key reasons for the decline.
In a statement alongside the report, Dr Janet Valentine, the ABPI’s Executive Director of Research and Innovation Policy, said: “Industry clinical trials bring widespread benefits for patients, the NHS and the economy. While the increase in the number of industry trials initiated in the UK is positive, the low number of patients taking part is selling UK patients short of the opportunity to participate in studies of the latest therapeutic innovations, which is especially vital where there are no other treatment options available.”
Clark said that the industry hopes to double, and double the number of participants in clinical trials, which reached 45,000 participants in 2025.
In the commercial clinical trial space, Clark said that she employs as many people in her research arm as she does in her NHS contract, and all those staff are funded by the pharmaceutical sector.
Despite this, however, much of the research in the UK is in large, central hospitals, making access to research a continuing challenge.
“As a clinician, I feel a responsibility to have access to world-leading research. I make this case often as to why I should have it in Blackpool, and it shouldn’t just be stuck in Addenbrooke’s or somewhere like that. I am so used to fighting that fight, and I feel like it’s really important to make sure that we can do everything we can to keep that industry thriving.”
Clark said that equitable access should start from R&D, all the way through to drug availability, making local access to clinical trials vital to improve access after approval.
UK and US pricing agreement shakes the sector
This discussion comes soon after the US and UK reached a pricing agreement for branded pharmaceuticals. The key element of the agreement, finalised in April 2026, is confirmation that UK pharmaceutical exports to the US will face a preferential tariff rate of 0% for at least three years.
In return, the UK government has committed to increasing net NHS spending on innovative medicines by around 25%. This marks the first major uplift in more than two decades, allowing funding for therapies previously rejected on cost grounds, including breakthrough cancer and rare disease treatments.
To support this, the National Institute for Health and Care Excellence (NICE)’s standard cost-effectiveness threshold is being raised from £20,000–£30,000 ($27,000–$40,000) to £25,000–£35,000 ($34,000–$47,000) per quality-adjusted life year.
Patient and research charities have welcomed the changes as a long-overdue step that better reflects the true value of medicines and should speed access to cutting-edge therapies in oncology, rare disease, respiratory, and other high-need areas.
Others, however, including Clark’s fellow panellist Sally Gainsbury, senior policy analyst for the Nuffield Trust, are more sceptical of this agreement.
Gainsbury said: “The purpose of the NHS is to improve the health of the population, where that is amenable to healthcare, and to do so in the most cost-effective and fair way. When it comes to new branded medicines, these are a much higher cost per quality-adjusted life year (QALY) gain for the patient. Given the finite NHS budget, that roughly means that for every new branded medicine, the NHS has to forego two QALYs that could have been gained had that money been spent just on extending existing services.”
