21.04.2024

Ministers are fiddling while pharmacies burn

Lord Grade of Yarmouth is an eloquent practitioner of tact and diplomacy, as you would expect of a former chief of both the BBC and Channel 4. But it is clear he is utterly seething at how government ministers are, as he puts it, ‘insultingly’ ignoring the plight of independent community pharmacies — the chemists’ shops upon which we all rely — as they face mass extinction.

Thousands more could follow suit: one in three pharmacies is no longer financially viable, according to an analysis by Ernst & Young, the London School of Economics and University College London, with fears that thousands of community pharmacies in England might close by next year.

In fact, the pace of pharmacy closures across the country is already accelerating. In January, the LloydsPharmacy chain announced it will withdraw all 237 of its pharmacy services from Sainsbury’s stores in 2023.

Tesco, meanwhile, has said it plans to close eight in-store pharmacies, and Asda — which cut the operating hours in 80 of its 254 pharmacies across England and Wales last year — last month announced it will close seven pharmacies completely.

Damning words from ex-BBC chief Lord Grade — as 49 MPs and peers back the campaign to save the thousands of community chemists that face having to close for good

In January, the LloydsPharmacy chain announced it will withdraw all 237 of its pharmacy services from Sainsbury’s stores in 2023 (stock image)

In January, the LloydsPharmacy chain announced it will withdraw all 237 of its pharmacy services from Sainsbury’s stores in 2023 (stock image)

In all, an unprecedented 252 community pharmacies based in Sainsbury’s, Asda and Tesco are potentially to close this year, according to an analysis published last week by The Pharmaceutical Journal, based on data from the NHS Business Services Authority. These closures mean that nearly one million patient prescriptions each month in England will have to be dispensed elsewhere.

An NHS spokesperson said: ‘A dedicated search facility on the NHS website and app can help people find, and easily switch to, another pharmacy that is convenient to them.’

But people’s ability to switch chemists will depend on local community pharmacies surviving to take on this extra load and then coping with it.

For if the big chains are finding the business isn’t viable, what hope is there for the thousands of small, family-run independents that form the backbone of our community pharmacies?

And it’s the vulnerable and frail who are ultimately going to pay the price.

‘There are millions of people across the country who rely on local pharmacies for medication and advice, and are suffering as pharmacies are forced to reduce their hours because they can’t afford full staffing or are closing altogether,’ says Lord Grade.

He is a prime and highly active supporter of the Mail’s campaign to save these vital lifelines — and like so many of those, including leading industry bodies, who are now actively calling on the Government to take action, he cannot understand why nothing has been done to halt the crisis endangering community pharmacies — not least as the Government is relying on these very same businesses to reduce the pressure on GPs and the NHS.

The peer told Good Health: ‘At every opportunity, I’ve been posing questions in the House of Lords for nearly two years about the crisis to government spokespeople. But all I get back is a few bland sentences that seem to have come from an automated word-processor.’

Over the past four months, he has also written repeatedly to government ministers, contacting both the Health Minister Neil O’Brien and Health Secretary Steve Barclay, spelling out the rising costs driving the crisis in community pharmacies. In response to his detailed warnings, Lord Grade has repeatedly received short-shrift replies, such as this from a parliamentary aide this month which said (in full): ‘Many thanks for your letter addressed to Minister O’Brien about community pharmacies and the invitation to meet. Unfortunately, due to existing diary pressures, the Minister is unable to meet at this time.’

‘It’s insulting to say the least,’ says Lord Grade. ‘They don’t acknowledge the crisis; they refuse meetings; they refuse to answer any questions.

Independent community pharmacists report that for every NHS prescription they dispense, they lose about 73p because, while the NHS pays them £1.27 per prescription, dispensing it can cost about £2, because the 2015 contract has not been adjusted to account for spiralling inflation and costs (stock image)

‘Just when the NHS needs the pharmacies to ease their load, the Government is fiddling and the sector is burning.’

The Government may have its head in the sand but a growing number of MPs and peers are now directly calling for it to tackle the crisis.

Good Health can reveal that 49 MPs and peers from across the political divide have, in the past month, joined a campaign of signing letters to the Health Secretary, asking for an urgent injection of at least £400 million, along with long-term support, to enable community pharmacies to keep their doors open.

Among those who signed letters — composed under the auspices of the community pharmacists’ representative, the Pharmaceutical Services Negotiating Committee (PSNC) — are some 19 Tory MPs disturbed at their own government’s stance, as well as 21 Labour MPs, two Lib Dems and seven peers from all three parties and crossbenchers, including the former Conservative Health Minister Baroness Cumberlege.

One of the signatories, Karl McCartney, the Conservative MP for Lincoln, told Good Health: ‘England’s community pharmacies are now more vital than ever to the health of local communities. I was concerned to learn about the huge pressures that pharmacies face.

‘I urge the Government to work with sector representatives to take immediate steps to ensure the long-term sustainability of community pharmacies.’

Another signatory, Peter Aldous, the Conservative MP for Waveney, says: ‘During the pandemic, pharmacy teams remained open throughout, ensuring critical patient access to their services. It is concerning that a large number of pharmacies are struggling. I urge the Government to take steps now to prevent the deterioration of our pharmacy network.’

Lord Grade, a crossbench peer, laments: ‘While there is a groundswell of concern in both the Commons and the House of Lords, we have yet to see any evidence that either the Government or the Department of Health & Social Care (DHSC) plans to do something about it.’

Lord Grade’s concern was originally sparked during the pandemic, when he and his wife Francesca spent lockdown in Yarmouth, Isle of Wight.

The couple realised during frequent visits to collect prescriptions from their local independent community pharmacist Tim Gibbs — who remained open throughout lockdown — that his business, having been run successfully for 17 years, was on the edge of financial disaster.

It has been calculated that the NHS service payments on which independent pharmacies rely have, as a result of spiralling costs and growing demand, effectively shrunk by 30 per cent since they were set in 2015.

As well as inflation for overheads such as electricity, community pharmacies’ staffing costs have jumped by 70 per cent since 2015. Rates for locum pharmacists have gone up by 80 per cent in the past year, too, Lord Grade points out, saying that many community pharmacists now cannot afford temporary locum pharmacists to cover for sickness or absence.

‘They can’t open the shop if a qualified pharmacist is not on the premises,’ he says. ‘This is causing increasing numbers of community pharmacies either to close temporarily or cut their hours.’

Worsening the problem is the fact that independent pharmacists increasingly find that the wholesale prices for common drugs such as antibiotics can rise by more than 100 per cent owing to supply shortages

Worsening the problem is the fact that independent pharmacists increasingly find that the wholesale prices for common drugs such as antibiotics can rise by more than 100 per cent owing to supply shortages

And it is not as if taking on the million more prescriptions from supermarket pharmacy closures will bring in any additional money into independent pharmacies. Quite the opposite, in fact. Independent community pharmacists report that for every NHS prescription they dispense, they lose about 73p because, while the NHS pays them £1.27 per prescription, dispensing it can cost about £2, because the 2015 contract has not been adjusted to account for spiralling inflation and costs.

Worsening the problem is the fact that independent pharmacists increasingly find that the wholesale prices for common drugs such as antibiotics can rise by more than 100 per cent owing to supply shortages, but the Government will often not reimburse them for the increased price: according to the PSNC, it only gives them, at best, the normal market price.

Indeed, the Government’s Drug Tariff system is increasingly imposing unsustainably low prices for drugs on community pharmacists because it believes they should somehow be getting discounts from wholesalers.

This problem has gone from affecting dozens of drugs to hundreds over the past five years, according to a study published last week in The Pharmaceutical Journal, leaving pharmacists even further out of pocket.

‘Tim’s still just managing to keep going,’ says Lord Grade, ‘but he is on his knees through working round the clock seven days a week, both to serve often vulnerable people in the local community and to stay financially afloat. He has not been able to take a holiday in the past six years because he can’t afford to pay another pharmacist to cover for him.’

Lord Grade points out that the supermarket pharmacy closures could be the straw that breaks the camel’s back for independent community pharmacies, significantly increasing demand for loss-making prescriptions as well as increasing the demand from people seeking advice on health problems because they can’t see their doctors.

‘While the GPs are funded to advise patients, pharmacists aren’t paid a penny for all the precious time that they spend giving people such vital guidance,’ he says.

Indeed, PSNC figures show how patient demand for advice and support from pharmacies has risen sharply since the pandemic, with customers requesting more than 65 million informal consultations in pharmacies in the past year.

Janet Morrison, chief executive of the PSNC, told Good Health: ‘The pharmacy network is in such a fragile state that we could soon see a domino effect. As patients of one wave of closures find themselves being directed to alternative pharmacies for access to medicines and pharmaceutical services, the pressures on those refuge pharmacies will increase, putting them at higher risk of closure.

‘Without urgent action, we will see increasing numbers closing their doors, which could have disastrous consequences for patients and the public.

‘We need the Health Secretary to listen to the worries of his fellow MPs and to step in to help save pharmacies.’

Meanwhile, the Government expects independent pharmacists to keep taking on more work.

A spokesperson for the DHSC told Good Health: ‘Pharmacies already provide a range of clinical services, and over the next 18 months we will be increasing the support pharmacists can provide, including taking referrals from A&E, managing oral contraception needs and supporting patients who have been newly prescribed antidepressants.’

The spokesperson added: ‘Community pharmacies play a vital role in our healthcare system and we back them with £2.6 billion a year.’

As for the MPs’ letters, the spokesperson said that the Health Secretary ‘will respond in due course’. Lord Grade argues passionately that the Government must act urgently to forestall a devastating collapse among independent community pharmacies.

‘No government will do anything until it absolutely has to. But here the Government is miscalculating dreadfully and is putting an entire and vital part of our national health system at risk,’ he says.

‘In a sense, the independent pharmacists are victims of their own dedication and resilience, because they are managing selflessly to hang on, delivering a service in circumstances that are actually impossible.’

He adds: ‘I’m hugely encouraged by the Daily Mail’s campaigning interest. It’s a big morale booster for people who are trying to keep this service going. But is the Government just going to wait until all the independent pharmacies close, or what?’

Nine of ten pharmacists say they are at serious risk of burnout as three quarters say they consider QUITTING altogether, research suggests 

BY JOHN NAISH

The pressure on pharmacists is fuelling a nationwide mental health crisis that has reached alarming proportions among community pharmacists, the people running our High Street chemists.

In January, a nationwide survey by the Royal Pharmaceutical Society of some 1,500 pharmacists found that nine in ten say they are at serious risk of burnout, and three quarters say they have considered quitting the profession altogether.

‘I speak to pharmacists every day about their mental health issues — many are in tears and at their wits’ ends,’ pharmacist Harpreet Chana, 41, from Derby, tells Good Health. ‘Some people are suicidal, struggling with anxiety, burnout and despair.’

She is CEO and founder of the Mental Wealth Academy company, working as a certified professional coach who specialises in mental health awareness, most often with fellow pharmacists, training them to ‘self-manage’ through their crises. And she has a unique perspective on what they are going through.

‘Their crises are similar to how I felt in the past.’ Seven years ago, she says she found herself seriously considering ‘just ending it all’. ‘That was the point I realised how bad things were,’ she recalls.

In January, a nationwide survey by the Royal Pharmaceutical Society of some 1,500 pharmacists found that nine in ten say they are at serious risk of burnout, and three quarters say they have considered quitting the profession altogether (stock image)

In January, a nationwide survey by the Royal Pharmaceutical Society of some 1,500 pharmacists found that nine in ten say they are at serious risk of burnout, and three quarters say they have considered quitting the profession altogether (stock image)

The married mother of two children says that the stresses of her pharmacy career were central to her emotional breakdown: ‘The work brings its own unique pressures. These can drive many pharmacists into a spiral of stress, anxiety, burnout and severe depression.’

The mounting stresses impacting community pharmacy — simply prescribing medication can leave pharmacists out of pocket — along with medicine shortages and ever increasing demands, is adding to a unique combination of severe stresses.

As Harpreet explains: ‘Pharmacists in retail can’t leave the premises for a break or if they feel unwell because the rules say that no medication cannot be given to patients without the pharmacist being there,’ she says. ‘There is always guilt associated with taking time away from a pharmacy shop, especially concerning patients who are really ill or taking end-of-life painkilling drugs for conditions such as cancer.

‘How can we take time off for being unwell when we work with people facing life-threatening conditions?’ she asks. ‘We go into healthcare because we care for other people.’

On top of this are the exacting technical and legal demands of the job. ‘It involves checking the accuracy of everyone involved in dispensing drugs, from the prescriber who wrote the prescription to the person dispensing the drug. The buck stops with the pharmacist, it’s their signature on everything that leaves the pharmacy, it’s their neck on the line,’ says Harpreet.

‘That workplace habit leads to severe perfectionism, a huge pressure to be exact all the time,’ she adds. ‘Pharmacists take this home with them, it creates unrelentingly high standards for themselves and others around them. This fosters huge and constant anxiety and self-criticism.’

And when pharmacists descend into burnout crisis, often they feel there’s nowhere to turn for help. ‘There’s a realistic fear that regulatory authorities will react negatively and deem them unfit to work.’

Then add in the additional financial pressures that are currently crippling community pharmacies.

Harpreet Chana knows the problems well: for five years she worked for the body that negotiates with government on behalf of England’s 11,000-plus community pharmacists, the Pharmaceutical Services Negotiating Committee (PSNC).

She says, ‘I know first-hand that ministers want more out of us, but that they also say there’s no money to support this. We’re already doing more for less money and there’s no money for training or employing an adequate workforce.’

The Government hopes that community pharmacies in England will soon assume a key role in easing the burden on GPs and the NHS, by taking on new responsibilities such as prescribing medications for blood pressure and minor ailments such as skin and urinary tract infections.

Indeed last week the Company Chemists’ Association, the membership group for large pharmacy operators, released a report saying that if community pharmacists took on such roles they could free up more than 42 million GP appointments a year and also prevent 65,000 cases of patients having to be re-admitted to hospital due to lack of support in the community.

The stark fact is that many community pharmacists face the very real prospect of closure.

Under the burden of ever-accumulating stresses, Harpreet sees no end to her work. ‘Community pharmacies did not close our doors during the pandemic, unlike thousands of GP surgeries, even though we had inadequate PPE and put our lives at risk every day. Now we are struggling and record numbers of people are leaving community pharmacy. They can’t take the pressures of having to achieve ever more with ever less,’ she says.

‘More and more of pharmacists are coming to me for help. They need to be taught how they can cope with the severe pressures, because sadly those pressures just aren’t going away.’

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