A steep drop in the number of patients joining commercial clinical trials in the UK is limiting access to pioneering treatments and threatening the country’s global reputation for research, a new report from the ABPI has warned. According to the body, patient participation in industry-sponsored trials has fallen by 25% between 2022/23 and 2024/25, even as overall involvement in clinical research has grown since the pandemic.
Patients losing out on innovation
The ABPI argues that this decline is “selling patients short” by reducing opportunities to try new medicines, especially where few other treatment options exist. Fewer participants could also discourage global pharmaceutical companies from choosing the UK for their studies. As it stands, commercial research brings billions to the wider economy and delivers direct financial benefits to the NHS, meaning any prolonged decline could have tangible consequences for services and investment.
Dr Janet Valentine, Executive Director of Research and Innovation Policy, ABPI, said industry-led trials offer huge advantages for the NHS, patients and the economy, but low enrolment means too many people miss out on cutting-edge drugs. She welcomed a recent rise in the number of trials initiated in the UK, but warned that “improvements in delivery on the ground” are essential if those studies are to translate into real patient access.
Bottlenecks slowing progress
Pharma companies point to slow set-up times and weak or missed recruitment targets as key reasons for fewer patients entering commercial trials. While regulatory approvals are now largely made within agreed timelines, the ABPI report shows that only a minority of NHS sites open to recruitment or enrol their first participant within government targets, leaving sites overseas to fill studies more quickly.
“The government and system partners are working hard to improve the environment for delivering industry trials in the UK,” said Dr Valentine. “Our report highlights where these efforts could have the greatest impact, including fully exploiting the £300m VPAG Clinical Trials Investment Programme, which is funded by industry to improve the country’s commercial trials performance.”
Rebuilding the UK’s competitive edge
To remain globally competitive, the ABPI says the UK must encourage research delivery sites to set and meet higher recruitment goals, accelerate end-to-end set-up, and ensure clear executive-level accountability for clinical research across the NHS. The report also highlights intensifying international competition: China continues to strengthen its position, and Spain has become Europe’s top destination for commercial clinical trials. Despite these pressures, the UK has climbed to sixth worldwide for Phase 3 trial starts, supported by a 36% increase in new industry trials in 2024.
