Common medicines are in increasingly short supply according to reports from pharmacists who warn they are being forced to pay over the odds to secure drugs for their patients.
While shortages occurred two years ago, some experts warned that preparations for a no-deal Brexit including government directions to key drug manufacturers to stockpile a six week supply may be pushing up prices.
Experts said the chaos in Westminster could mean patients, hospitals and other parts of the supply chain might also be stockpiling medicines something the government has urged against.
Gareth Jones, from the National Pharmacy Association, told the BBC: Uncertainty over Brexit appears to be a significant factor.
There are now 80 medicines, including blood pressure drugs, antidepressants and painkillers which are so scarce in England that they have been added to a government shortage supply list.
This means the Department of Health has agreed a concessionary premium to secure supply, and the number of shortage medicines has risen from 45 in October.
A similar spike in 2017 and saw the number of concessions reach a high of 91 in November with the government rapped by MPs for its lethargic response which ended up costing the NHS an extra £315m.
However the Royal Pharmaceutical Society warned there were massive shortage and price spikes and president Ash Soni said he had never seen so many common drugs affected.
The items are out of stock and unavailable. Patients are having to wait, Mr Soni said.
We’re having to send some patients back to the GP to get a different prescription, because we just can’t fill them.
Health Secretary Matt Hancock said before Christmas pharmacists could be granted emergency powers. Shortages are affecting generic medicines, rather than more costly forms which are still under patent.
The NHS has been working to encourage GPs to switch as many as their patients on to generics in recent years in a bid to cut its prescribing bill.
While some drugs may be in shortage because they are for uncommon conditions or are less profitable, as of December 28 of the 80 medicines in short supply were in the top 500 most commonly prescribed drugs.
Health secretary Matt Hancock said before Christmas that pharmacists could get emergency powers in the event of a no-deal Brexit that allows them to change GPs prescriptions, offering different doses or equivalent products.
But in the face of current shortages pharmacists are already having to go to extreme lengths.