UK patients are being “denied the opportunity to participate in cutting-edge clinical research”, according to the Association of the British Pharmaceutical Industry (ABPI).

The organisation that represents pharmaceutical companies in the UK commented that low patient recruitment and slow set-up times are raising costs and lowering the efficiency of industry clinical trials in the UK.

According to the ABPI’s annual clinical trials report, released on 2 December 2025, 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.

The report highlights that, despite participation increasing since the pandemic, just 3.4% of participants in 2024 were recruited into industry trials in the NHS.

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.

As other countries are recruiting faster than the UK, this means that recruitment is often closed before any UK patients have been enrolled onto trials.

This issue has been acknowledged previously by the UK Government, with Prime Minister Keir Starmer and Minister of Health Wes Streeting having committed to reducing clinical trial set-up times. While regulatory decisions were within their new target timeframes, 27% of UK trial sites opened to recruitment within the 60-day target, and 41% recruited their first participant within 30 days.

The government stepped in to improve clinical trials in the UK following a 2023 report by Lord James O’Shaughnessy, which showed that the country had dropped from fourth to tenth as global contributors to clinical trials.

Tracey Loftis, deputy director of policy and influencing at Blood Cancer UK, said the report should be a “wake-up call” to all those responsible for clinical research in the UK.

Loftis said: “People with blood cancer are missing out on the opportunity to join clinical trials that could save or extend their lives.

“While today’s report shows these systemic problems run far deeper than blood cancer alone, the risk is that unless we act quickly and decisively, even more people will be locked out of innovation they simply cannot afford to wait for. That’s why the rise in the number of trials starting in the UK means very little unless patients can actually take part in them, and why government, industry and the NHS must work together to speed up set-up times, raise recruitment targets and remove the barriers faced by underrepresented groups.”

Trial initiations on the up

Despite patient recruitment issues, the number of new industry trials initiated in the UK in 2024 rose by 36% compared to 2023, with the UK climbing to sixth place globally for Phase III trial starts last year. This is up from eighth place in 2023.

Other countries are showing increasing competition, notably China and Spain, with the latter now the leading country for placing clinical trials in Europe.

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.”

Based on the findings, the ABPI is calling for research delivery sites to set and meet higher recruitment targets, the acceleration of set-up times, executive-level accountability for clinical trials across the NHS, and maximised opportunity with the Voluntary Scheme for Branded Medicines Pricing, Access and Growth (VPAG) clinical trials investment programme, which received a significant cash injection in August 2024.

The VPAG programme is facing even more scrutiny than ever, however, especially following the UK and US reaching a deal on 1 December. The deal, which means the UK will be relieved of any tariff payments on imported pharmaceuticals, does include changes to the VPAG programme. It is currently unclear whether this will impact the clinical trials investment programme.