Pharmacies are the pillar of the community, providing medicine and support to the most vulnerable. Pharmacies offer a host of NHS services; prescriptions, treatment, advice, emergency support, and more. 72% of us have used a community pharmacy in the last three months.
However, in recent years, the number of pharmacies in the UK has been decreasing. There were 11,500 active community pharmacies in England in 2021/22, which was the lowest number since 2015/16. Many of these closures are happening in rural or deprived areas, and in places where there may not be another pharmacy nearby. The reality is not just a matter of inconvenience; it’s a symptom of a deeper crisis in the UK’s healthcare system and one that disproportionality affects the most vulnerable members of society.
Pharmacy closures: the facts.
Since 2015, the UK has lost over 1000 pharmacies. Chains like Boots have closed hundreds of branches up and down the country, including Lloyds who closed all 237 of their outlets inside a Sainsbury’s supermarket in 2023. Other supermarkets such as Tesco and Asda collectively closed 15 pharmacies in 2023, also.
Lloyds blamed changing market conditions and gaps in NHS funding for closing branches. Analysis of General Pharmaceutical Council (GPhC) data by the Pharmaceutical Journal revealed that the company had closed or sold over 90% of its outlets in the last five years.
Speaking at The Pharmacy Show on 15 October 2023, Janet Morrison, chief executive of Community Pharmacy England, commented: “I’d like to reassure people, my whole committee are business owners and work in pharmacy businesses, so we’re fully aware of the crisis and it is unprecedented.
“I think even when I arrived in my job last March, and we would talk to governmental ministers or whomever, and we’d say there’s a crisis, I think they were still a bit sceptical. Like ‘well, you know, we haven’t seen the closures’.
“Certainly, when Lloyds exited the market. I was at a meeting with the minister where it was splurged, not by me, but it was splurged, and I saw the alarm on his face. And I know that that caused a lot of concern.”
Not all areas are affected equally by these closures. According to the Company Chemist’s Association (CCA), between 2015 and June 2023, 37.5% of closures occurred in the 20% most deprived areas in the country. For residents of deprived areas, who often lack reliable transport, even a short journey to the pharmacy can be a significant obstacle. This can lead to delays in accessing medication, impacting their health and well-being.
As more pharmacies close, greater pressure is placed on already stretched services, such as other local pharmacies, GPs, hospitals, and remote services like NHS 111. This increases waiting times and overcrowds facilities that were designed decades ago.
In the last six months, Boots has closed, or are planning to close, six pharmacy branches in Plymouth alone. Three of these are in the bottom 20% of most deprived areas in the UK, further marooning the most vulnerable people from healthcare facilities they desperately need.
One Boots branch earmarked for closure is North Road West Medical Centre in Plymouth. In a comment to the Pharmaceutical Journal, Andrew Potter, a GP partner at the branch, said: “Our patients are in an area of deprivation in Plymouth so everything that makes their lives harder is more keenly felt.”
Potter told The Pharmaceutical Journal that around 4,000–4,500 of the surgery’s 9,300 patients will need to change pharmacy because of the closure. Boots did not reply when asked for a comment by The Doughnut.
In a statement to The Doughnut, Malcolm Harrison, Chief Executive of the Company Chemists’ Association, said:
Since 2015, there has been a net loss of 1,000+ pharmacies in England. Our analysis shows that these net closures are occurring disproportionately in the areas of highest deprivation, where healthcare need is typically greater.
This year alone there has been a net loss of 300 pharmacies. Worryingly the rate of net closures is increasing – currently there is an average net loss of 8 pharmacies per week.
Closures mean that patients may have to travel further to receive the care, medicines, or advice that they need.
Why pharmacies are closing.
As with many areas of the NHS, pharmacy funding has not risen with inflation, causing a large deficit as operating costs continue to rise. Industry bodies estimate that pharmacies have taken a real-term funding cut of 30% over the last 7 years, with the CCA estimating an annual funding blackhole of more than £67,000 per pharmacy in England. The total cost of prescription medicines to the NHS in England reached a new high of £17.2 billion in the financial year 2021 –2022, according to a new independent report by LSE, the London School of Hygiene & Tropical Medicine (LSHTM) and the University of York. With inflation on healthcare products standing at over 10% in the last two years, and funding remaining stagnant, many community and independent pharmacies can no longer afford to operate efficiently. Pharmacies are also affected by the rising cost of energy and rising staffing costs.
Staff shortages are also putting strain on pharmacies. In March 2021, the Home Office added pharmacists to the shortage occupations list due to “a decline in the number of pharmacy graduates and increasing demand for their services”. In 2019, NHS England announced the Additional Roles Reimbursement Scheme (ARRS), whereby primary care networks could recruit pharmacists and other healthcare professionals working outside of primary care, in exchange for funding from the NHS. It’s thought that over 5,200 FTE pharmacists are now working in primary care networks, and the CCA estimates that this has led to almost 4,000 community pharmacists leaving the sector to work in primary care networks or general practice.
Between 2017 and 2023 the workload demand across the pharmacy network increased by 1.7 million hours. The Government plans for pharmacies to do more, without immediate funding.
In recent years, virtual, and online, pharmacies have taken a large section of the market. These pharmacies don’t operate physical branches, instead, use the Electronic Prescription Service (EPS) to process prescriptions from a central warehouse and send them to customers in the post. This cuts down on operating costs and allows the company to centralise its assets. This is also a benefit for patients, as their medication gets delivered straight to their door, cutting out time-consuming journeys. The largest online pharmacy, Pharmacy2U, processed over 1.5m prescriptions in November 2023.
Pharmacies and the NHS as a whole.
Pharmacies are many people’s first port of call when they have a minor medical condition, or when they need advice on their health or lifestyle. Most towns and villages have at least a small pharmacy, which makes them very accessible to people who need them the most, such as elderly people, and people with reduced mobility. However, as small community pharmacies continue to close, people are forced to turn to other streams of advice.
GPs are already overstretched, and more people are forced to book appointments if they can’t access easy advice from a pharmacist. In the last 5 years, the average amount of weekday GP appointments has risen by over 20% (see bottom left). The average wait time for a routine GP appointment in 2023 was 19 days. Channelling more patients into an already stretched service will only degrade its quality for all patients.
Another stream of information is NHS 111, a free telephone service open 24/7, 365 days a year. Calls to the service have increased nearly 40% since its introduction in 2014. The service aims to answer calls within 20 seconds, however waiting times regularly reach up to 10 minutes, and up to 40% of calls were abandoned by patients before they were answered. Services are being overstretched by the additional demands from ex-pharmacy users.
Finding a solution.
The solution to this issue is multi-faceted. All pharmacy industry groups point to the desperate need for more funding. The real-terms funding decrease of 30% needs to be addressed by the NHS, as well as more support for pharmacists and patients.
Community pharmacies in England have been subject to a 30% real-terms cut in core funding since 2015. Our latest analysis shows that pharmacies are underfunded by at least £67,000 per pharmacy. Pharmacies are being asked to take on more and more NHS workload but they urgently need additional investment. Without this, we are concerned that patients may not be able to access the medicines they need.
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