Patient enrolment in clinical trials in the UK has fallen for the fifth year in a row, a report from the Association of the British Pharmaceutical Industry (ABPI) has found.
While the speed of trial initiations has improved, data from ABPI’s latest annual clinical trials report, released on 5 November, raises concerns about the continued drop in recruitment as well as a drop in trial initiations, saying that “urgent action is needed”.
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On the global stage compared to other countries, the UK is faltering when it comes to trial initiations. It ranked seventh for Phase I trials in 2025/26, down from sixth in 2024/25. For Phase II trials, it dropped one place to fifth. Phase III trials remain unchanged, with the UK ranking seventh, as it did last year.
Phase I trials have traditionally been a UK strength, but a global move to China has meant the latter has become the top-performing nation for clinical trial initiations across all phases. This is predominantly driven by single-country studies led by companies based in China, but multi-country studies are increasing, with China rising up the rankings for multi-country Phase I trials. The ABPI writes that this could be a leading indicator for future trends across subsequent trial phases.
The report shows that just 17,618 people took part in industry clinical trials in the NHS in 2025/26, down from 19,507 the year before. This is 31% fewer than in 2022/23.
Only 3.8% of interventional clinical trial participants were recruited to industry-sponsored studies, a proportion that was consistently higher than 10% pre-pandemic.
The government has pledged to double the number of people taking part in industry trials by 2026, and to double it again by 2029, an ambition supported by the ABPI. There have been signals to support this – in August 2026, every study got an approval decision within 60 days. This does not translate further down the clinical development process, however, as the time it takes for studies to open to recruitment remains a concern, as is the time taken to recruit the first patient and to open all sites in a trial.
In 2025/26, an average of 35% of studies opened to patients within 60 days of approval, against a target of 90%. Of the studies, 53% recruited their first patient within 30 days of opening.
Despite the falling numbers, the report showed a positive trend. The UK’s Commercial Research Delivery Centres (CRDCs), which are funded as part of the VPAG Investment Programme, are outperforming the wider UK ecosystem on set-up and delivery measures of clinical trials. In 2025/26, 75% of CRDC studies were open to recruitment within 60 days of approval, compared to 58% of all UK sites.
The ABPI report also highlights initiatives which show early signs of driving further efficiencies in study setup, including an improved National Contract Value Review process, which has reduced the time it takes to finalise contracts and costing for participating trial sites from 65 days to 25 days.
Joe Edwards, executive director of UK competitiveness at the ABPI, said:“Industry clinical trials give patients the opportunity to take part in research into the latest innovative treatments, sometimes when there are no other options available. The fact that UK recruitment continues to fall is worrying.
“The government, regulators and the NHS have made real progress on speed of set-up, but the full benefit is only realised by patients, the NHS and the economy when speed is followed by recruitment. Companies invest in clinical trials where every site can open quickly and recruit reliably. The UK must now deliver that across the whole trial, not just at the first site,” he added.
Recommendations for growth
Based on the report findings, APBI has made five recommendations to governments across the UK, the NHS and industry.
Firstly, it calls for expanding UK Clinical Research Delivery metrics and research delivery funding to support study delivery across all sites and incentivise more ambitious and predictable recruitment.
It also calls for setting up a UK-wide service that uses NHS data to help find and enrol suitable patients for trials, as well as measuring and reporting on the diversity of clinical trial participants to make research more inclusive and representative.
ABPI also wants to see the UK’s viability strengthened as a trial location by ensuring the medicines access and adoption environment gives patients globally competitive care, delivered through the commitment to double innovative medicines spend by 2036.
Finally, it calls for reinvesting income from industry trials in research staff and facilities, so the UK’s trial system can pay for itself in the long term.
Reforms to the UK clinical trial space came into effect in April 2026, marking the first major change for this sector in 20 years. These developments, which were passed in Parliament, include faster assessment of first-in-human trials and the introduction of notifiable trials, a fast-track route to allow lower-risk trials to start sooner, and modifications to be approved more quickly, while maintaining the highest safety standards.
The reforms will make it simpler to start lower-risk studies, strengthen support for early-stage research and embrace new approaches, including the use of early safety data from overseas studies that meet UK standards and computer model simulations, which can help to predict how new medicines may behave before they are tested in patients.
While these reforms will make the UK a more attractive place to run clinical trials, experts question whether the regulation on its own is significant enough.
