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The closure of community pharmacies and what this means for the wider health system in 2023
Updated: Sep 13, 2023
At THC Primary Care, we provide resources to support Primary Care Network leaders and managers.
In this blog, we shine a light on our community pharmacy colleagues (who share similar challenges to us in general practice) to aid Primary Care Network managers, administrators, and digital and transformation leads to better understand the system in which they work.
In this blog, we cover:
1. The services provided by community pharmacy teams
2. Some key statistics relating to the number of patients who currently utilise
community pharmacy services each year
3. The market forces contributing to pharmacy closures
4. The impact of pharmacy closures on patients and the healthcare system
Let’s jump in.
An introduction to community pharmacy
Community pharmacies are situated in high street locations, shopping centres, supermarkets, and within the heart of some of our most deprived communities.
The business model is varied, ranging from large chains to general practice-owned pharmacies and small, individually owned pharmacies.
As qualified healthcare professionals, pharmacists have the ability to offer clinical advice and information about over-the-counter medicines covering a range of minor illnesses such as coughs, colds, earaches, skin rashes, cystitis, conjunctivitis, sore throats, gastrointestinal issues, and general aches and pains.
The traditional role of the community pharmacy (dispensing doctor-issued prescriptions and simply existing as the place where we collect our over-the-counter medicines) has changed significantly.
Many community pharmacies provide out-of-hours services and extended opening hours during the evenings and at weekends. Some are open until midnight (or even later) and on public holidays.
Other services which may be available at your local pharmacy:*
🎯 Advice following contact with NHS 111 or a GP
🎯 Emergency contraception
🎯 Asthma inhaler use and advice
🎯 Chlamydia screening and treatment
🎯 Stop smoking services
🎯 Blood pressure, cholesterol, and blood sugar testing
🎯 Substance misuse service, including needle and syringe exchange schemes
🎯 Weight management service
🎯 Flu vaccination
*Source: NHS How your pharmacy can help
The value of community pharmacies
To help paint a more vivid picture of the value of our community pharmacies, the Pharmacy Advice Audit 2022 findings were as follows:
➡️ Each week, pharmacies help over 865,000 patients who require clinical advice about specific symptoms and over 251,000 patients who have questions about an existing medical condition.
➡️ Almost half of the patients said that if they did not have easy access to a pharmacy, they would have visited their GP. As such, we can estimate that pharmacy advice saves an incredible 32.2 million GP appointments over the course of one year.
➡️ Over half a million consultations per week take place in each community pharmacy hub (for clinical advice alone) and where no sale of a medicine is made.
➡️ As many as a quarter of a million people visit England’s community pharmacies each week because they are unable to access other areas of the NHS. The number of patients presenting in pharmacies with urgent medical needs runs into the millions.
But our pharmacies are closing down.
Pharmacy Closures
Research by the Company Chemists’ Association (CCA) has found that, between 2015 and 2022, over 40% of permanent community pharmacy closures took place in the 20% most deprived parts of England.
In January 2023 Lloydspharmacy announced that it was withdrawing pharmacy services from Sainsbury’s supermarkets.
The CCA’s analysis of NHS data found that between 2015 and 2022, 808 pharmacies closed permanently in England. During that period, only 138 new pharmacies opened – a net loss of 670 community pharmacies.
The reason for the closures? Pharmacies have to grapple with a business model that doesn’t quite stack up and also have to contend with the following contributing factors:
➡️ The rising cost of medicines versus the increased cost of living (and working) has directly impacted finances and profitability.
➡️ The current constraints within the labour market and ongoing challenges of recruitment.
➡️ Contractual factors as highlighted by Leyla Hannbeck, Chief Executive of the Association of Independent Multiple Pharmacies; "We've been left with a contract that doesn't take into account any rises in inflation or cost of living”.
➡️ Issues related to supply chain and distribution**. A shortage of shipping containers is a problem globally, causing delays to the import and export of drugs. The lack of workforce and delays in authorisation by the Medicines and Healthcare products Regulatory Agency (MHRA) have had a knock-on effect on drug supply, along with the rising demand for certain medications. HRT is a good example of this. The demand for Hormone Replacement Therapy (HRT) over the last seven years has risen by 38%, and limited manufacturing capacity has created problems with supply.
➡️ Increasing patient demand. Within the PSNC, Community Pharmacy England’s 2023 Pharmacy Pressures Survey (involving 6,200 pharmacy premises and 2,000 pharmacy team members), the findings confirm the worsening situation for community pharmacies and the very real risk of further closures.
The survey also offers a breakdown of patient requests by type, with all of the following increasing significantly over the last three months:
↗️ Requests for help with symptoms for serious conditions (81%)
↗️ Requests for help with minor conditions (96%)
↗️ Requests for help with long-term conditions (78%)
↗️ Requests for help with prescription ordering (74%)
↗️ Requests for help with diagnostics and monitoring (66%)
↗️ Requests for advice on menopause and HRT (81%)
↗️ Requests for advice about and / or direct requests for antibiotics (91%)
The results of the entire survey can be found here.
The impact of pharmacy closures
The closure of local pharmacies can significantly inconvenience many patients at the same time as placing an overwhelming burden on the remaining nearby pharmacies. This could undoubtedly lead to an increase in waiting times, demand and potentially, overcrowding.
I live in Whitstable and the recent closure of three pharmacies within the local area has resulted in the need for security presence to monitor and manage the queue within the remaining Tesco-based pharmacy.
Closures also mean:
❗️It can take longer for people to access their medication
❗️ Frustrated and annoyed patients
❗️ A stressed and burned-out pharmacy workforce
❗️ Increased risk related to patient safety
❗️ Reduced staff satisfaction and retention rates
❗️ Increasing challenges of recruitment
❗️ Disruption to employment and the family/ community unit
Closures often disproportionately affect those within the most vulnerable sectors of the community, such as the elderly or those on low income, who rely heavily on the proximately of their local pharmacy for fulfilment of their prescriptions and / or general management of their day to day, over-the-counter needs. This could, in turn, lead to potential delays, or interruptions in their treatment plans, and an adverse knock-on effect on the rest of health care system with patients either presenting to A&E or having to contact their GP Practice.
Further Reading
Working collaboratively in an ICS: freeing up opportunities in community pharmacy. Exploring the opportunities for greater collaborative working between community pharmacies, primary care networks and federations within ICSs.
➡️ Read the NHS Confederation article here.
We hope this provides a greater understanding and appreciation of the challenges faced by our pharmacy colleagues. We are all in this together.
Podcast
Have you caught the podcast this week?
Alongside taking on full ownership of a pharmacy, Neil Modha shares how he continues to grow and innovate his general practice, Primary care network and leadership roles.
We also discuss:
🎯 Funding tensions between PCN and practices
🎯 Processing feedback on his performance
🎯 Becoming a Deputy Lieutenant to the King for Cambridgeshire and Peterborough
Honest, entertaining and informative. You can't really ask for more 😀.
Listen here: https://bit.ly/NMKeyingredients
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Find out more about THC Primary Care at www.thcprimarycare.co.uk
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About the Author
I'm Tara; I am the founder of THC Primary Care, an award-winning healthcare consultancy specialising in Primary Care Network Management and the host of the Business of Healthcare Podcast, where we have now published over 260 episodes.
I have over 20 years of project management and business development experience across the private and public sectors, and I have supported over 120 PCNs by providing interim management, training and consultancy.
I have managed teams across multiple sites and countries; I have an MBA in Leadership and Management in Healthcare, I'm published in the London Journal of Primary Care, and I am the author of over 250 blogs.
I have 3 children. My eldest has Asthma, my middle child has a kidney condition called Nephrotic Syndrome, and my youngest daughter has Type 1 Diabetes, so outside of work, healthcare plays a huge role in my life.
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