Community pharmacies closing at a rapid rate with deprived areas worst affected
As the government asks pharmacies to do more to ease pressure on GPs, Sky News analysis has revealed those in England are closing at a rapid rate – with nearly 1,000 lost since 2017, a third of them in the last year alone.
Between July 2017 and July 2023, the number of operating pharmacies in England fell by 914 from 11,723 to 10,809.
Deprived communities, where the need is greatest, have seen the biggest decline. More than one in ten pharmacies have been lost in the poorest 20% of areas in the last six years.
That accounts for 40% of losses in that period.
Dr Leyla Hannbeck CEO of the Association of Independent Multiple Pharmacies says the situation is “awful, terrible” and “the worst it has been in years and years”.
It’s been caused by a combination of government funding cuts, rising rents and costs, staff shortages and supply problems, as well as increased patient demand.
The result is that pharmacists like Reena Barai in Sutton are wondering how long they can stay open.
“Currently, we’re in what I describe as a survival of the fittest,” she says. “Within community pharmacy, the majority of my colleagues really do feel like we’re on a sinking ship.”
“We want to be that front door to the NHS because we know that people go to the GPs or A&E unnecessarily for minor illnesses and they should be coming to the pharmacy. We really want to be that first port of call, but we’re struggling.”
Impact of big chain closures
The bulk of closures so far has been driven by big companies like LloydsPharmacy and Boots. LloydsPharmacy has lost three quarters of its branches (1,087 out of 1442) since 2017 and around two thirds (629 out of 984) in the past year.
Boots, which lost 40 branches in the last year, has also just announced a further 300 closures over the next 12 months.
The loss of these bigger pharmacies has increased the burden on those that remain, many of them smaller, independent businesses, which must pick up the workload without extra funding.
An analysis by The Pharmaceutical Journal in February suggested the impact of this year’s closures could displace nearly one million prescriptions each month to surrounding pharmacies.
Dr Hannbeck says: “Pharmacies are drowning because the workload from those other pharmacies (that have closed) is landing on them.”
Deprived areas are the worst affected
Sky News analysis suggests the increased burden is being felt most acutely in England’s poorest neighbourhoods where people are more likely to depend on their services.
Richard Murray, CEO of the Kings Fund says in deprived areas “there are higher levels of ill health. They’ll probably be a lot more walk ins going into the pharmacy asking for advice, more people going in to collect their medicines, and probably more people struggling with their medicines too”.
Pharmacies in the most deprived 20% of areas are now serving a 13% more people than a decade ago, compared to just 3% more in the least deprived.
On average all pharmacies are dispensing more items, with the number of items dispensed per pharmacy up 17% since 2017.
And poorer areas have seen the greatest increase, dispensing a sixth more than those in the least deprived areas.
“The job can be harder in deprived areas,” says Richard Murray.
“The workforce crises that we see across the profession are often localised, deprived areas may suffer a bit on that front,” he added.
“Pharmacists do generate money from selling other things but at a time of cost-of-living crisis, it just might be harder for other parts of the business to prop up community pharmacy and rather easier in areas that are richer, where people have got more money to spend.”
Pharmacy First and funding cuts
It’s in this context that NHS England recently said it would invest £645 million into a Pharmacy First scheme, allowing pharmacists to prescribe medicines for seven common conditions including sinusitis and shingles. The aim is to reduce the footfall at GP surgeries, saving a potential 10 million appointments each year.
But Leyla Hannbeck and Reena Barai both believe the funding gap that already exists needs to be addressed before pharmacists can take on new responsibilities.
“The funding is absolutely not fit for purpose,” says Hannbeck. “If government really cares about patient care, accessibility to care, and people not landing in GP surgeries or A&E then they have to take pharmacy seriously. And we need an immediate cash injection.”
Cuts introduced in 2016, followed by a five-year funding deal in 2019, that didn’t take account of inflation has shrunk the value of the pharmacy contract in real terms by 30% from £2.8bn to £2.15bn since 2015.
The figures were revealed in a written parliamentary answer in January and amount to an annual shortfall of around £67,000 per pharmacy in England.
A recent National Pharmacy Association report – authored by Professor David Taylor of University College London and Dr Panos Kanavos from the London School of Economics and Political Science – found in England in 2022, community pharmacy accounted for a lower percentage of total health spending than at any point since 1948.
It means Reena Barai is questioning whether she can afford to be involved in Pharmacy First.
“I really want to take part in it (Pharmacy First) because I’ve got the skills, the training, the clinical confidence to do these things. But to do that, I also need to improve my infrastructure to expand the premises.”
“The government will say ‘we’ve just announced x million for Pharmacy First’, but that will be to provide a service. We will also have to train our team, make sure we’ve got the adequate numbers of staff. We’ll need new IT systems.”
Reena Barai, a pharmacist in Sutton, says pharmacies are on a ‘sinking ship’
Fluctuating medication costs
Increased medication costs have added to the funding gap, with some leading pharmacists saying they aren’t fully reimbursed by the NHS.
Ms Barai said: “It gets really difficult when suddenly the price of a bread-and-butter drug that was say 50p goes up to £5 and you’re having to buy the same volume of the drug but an increased cost, that’s what really affects pharmacies a lot, their cash flow.”
“We’re not even guaranteed that we’ll be reimbursed, for example one of the drugs that I’m buying, Atorvastatin, I’m buying it above the cost that the government said that they’ll reimburse us. So, we’re actually out of pocket,” she added.
Staff shortages and burnout
The cash flow crisis and overwhelming workload have made it tougher for community pharmacies to recruit and retain their staff.
Half of pharmacies responding to the Community Pharmacy Workforce Survey 2022 said they were finding it “very difficult” to fill vacancies. The survey also suggested 16% of pharmacist and 20% of technician roles were unfilled.
Mr Murray explains that many have opted to work in GP pharmacies instead: “NHS England has run a big recruitment campaign to take pharmacists into general practice to work alongside the GP teams and that’s ratcheted up the shortages.”
Being short-staffed whilst dealing with increased demand and coping with rising costs makes Reena worry for her own wellbeing.
“It’s exhausting. It’s never-ending,” she says. “Even if you take time off, you can’t put on your out of office and say sorry, you’ve always got to find staff to cover. So, it’s a really all-consuming job. I think I just have to be careful that I don’t burn out and that my team don’t burn out.”
A spokesperson for the Department of Health and Social Care said: “We are carefully monitoring access to pharmaceutical services, but good access remains.
“We have announced £645 million in additional funding in the Primary Care Recovery Plan and thousands more training places for pharmacists as part of the Long-Term Workforce Plan, on top of the £2.6 billion we provide every year to the sector.”
Methodology: To get the number of active pharmacies we looked at the number active on a given date, in this case, the last day of July for every year since 2017. We looked at each pharmacy’s open and close dates to determine if it’s open on the given date. If a pharmacy’s open date is on or before the specified date and it doesn’t have a close date or its close date is after the specified date it’s counted as active.
The Data and Forensics team is a multi-skilled unit dedicated to providing transparent journalism from Sky News. We gather, analyse and visualise data to tell data-driven stories. We combine traditional reporting skills with advanced analysis of satellite images, social media and other open source information. Through multimedia storytelling we aim to better explain the world while also showing how our journalism is done.
UK
No 10 backs Chancellor Rachel Reeves and says she ‘is going nowhere’ after tearful appearance in Commons
Rachel Reeves has not offered her resignation and is “going nowhere”, Downing Street has said, following her tearful appearance in the House of Commons.
A Number 10 spokesperson said the chancellor had the “full backing” of Sir Keir Starmer, despite Ms Reeves looking visibly upset during Prime Minister’s Questions.
Politics latest: ‘A moment of intense peril’ for PM
A spokesperson for the chancellor later clarified that Ms Reeves had been affected by a “personal matter” and would be working out of Downing Street this afternoon.
Politics latest: Reeves looks visibly upset in Commons
UK government bond prices fell by the most since October 2022, and the pound tumbled after Ms Reeves’s Commons appearance, while the yield on the 10-year government bond, or gilt, rose as much as 22 basis points at one point to around 4.68%.
Downing Street’s insistence came despite Sir Keir refusing to guarantee that Ms Reeves would stay as chancellor until the next election following the fallout from the government’s recent welfare U-turn.
Tory leader Kemi Badenoch branded the chancellor the “human shield” for the prime minister’s “incompetence” just hours after he was forced to perform a humiliating U-turn over his controversial welfare bill.
Speaking at Prime Minister’s Questions, Ms Badenoch said: “This man has forgotten that his welfare bill was there to plug a black hole created by the chancellor. Instead they’re creating new ones.”
Turning to the chancellor, the Tory leader added: “[She] is pointing at me – she looks absolutely miserable.
“Labour MPs are going on the record saying that the chancellor is toast, and the reality is that she is a human shield for his incompetence. In January, he said that she would be in post until the next election. Will she really?”
Not fully answering the question, the prime minister replied: “[Ms Badenoch] certainly won’t.
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Welfare vote ‘a blow to the prime minister’
“I have to say, I’m always cheered up when she asks me questions or responds to a statement because she always makes a complete mess of it and shows just how unserious and irrelevant they are.”
Mrs Badenoch interjected: “How awful for the chancellor that he couldn’t confirm that she would stay in place.”
The prime minister’s watered-down Universal Credit and Personal Independent Payment Bill, aimed at saving £5bn, was backed by a majority of 75 in a tense vote on Tuesday evening.
A total of 49 Labour MPs voted against the bill – the largest rebellion in a prime minister’s first year in office since 47 MPs voted against Tony Blair’s Lone Parent benefit in 1997, according to Professor Phil Cowley from Queen Mary University.
After multiple concessions made due to threats of a Labour rebellion, many MPs questioned what they were voting for as the bill had been severely stripped down.
They ended up voting for only one part of the plan: a cut to Universal Credit (UC) sickness benefits for new claimants from £97 a week to £50 from 2026/7.
Ms Badenoch said the climbdown was proof that Sir Keir was “too weak to get anything done”.
Read more:
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Ms Reeves has also borne a lot of the criticism over the handling of the vote, with some MPs believing that her strict approach to fiscal rules has meant she has approached the ballooning welfare bill from the standpoint of trying to make savings, rather than getting people into work.
Experts have now warned that the welfare U-turn, on top of reversing the cut to winter fuel, means that tax rises in the autumn are more likely – with Ms Reeves now needing to find £5bn to make up for the policy U-turns.
Asked by Ms Badenoch whether he could rule out further tax rises – something Labour promised it would not do on working people in its manifesto – Sir Keir said: “She knows that no prime minister or chancellor ever stands at the despatch box and writes budgets in the future.
“But she talks about growth, for 14 years we had stagnation, and that is what caused the problem.”
Prosecutors are considering whether to bring further criminal charges against Lucy Letby over the deaths of babies at two hospitals where she worked
The Crown Prosecution Service said it had received “a full file of evidence from Cheshire Constabulary asking us to consider further allegations in relation to deaths and non-fatal collapses of babies at the Countess of Chester Hospital and Liverpool Women’s Hospital”.
“We will now carefully consider the evidence to determine whether any further criminal charges should be brought,” it added.
“As always, we will make that decision independently, based on the evidence and in line with our legal test.”
Letby, 35, was found guilty of murdering seven children and attempting to murder seven more between June 2015 and June 2016 while working in the neonatal unit of the Countess of Chester Hospital and is currently serving 15 whole-life orders.
Letby worked at the Countess of Chester Hospital and Liverpool Women’s Hospital
She is understood to have carried out two work placements at Liverpool Women’s Hospital, where she trained as a student, between October and December 2012, and January and February 2015.
Police said in December that Letby was interviewed in prison as part of an investigation into more baby deaths and non-fatal collapses.
A Cheshire Constabulary spokesperson said: “We can confirm that Cheshire Constabulary has submitted a full file of evidence to the CPS for charging advice regarding the ongoing investigation into deaths and non-fatal collapses of babies at the neo-natal units of both the Countess of Chester Hospital and the Liverpool Women’s Hospital as part of Operation Hummingbird.”
Detectives previously said the investigation was looking into the full period of time that Letby worked as a nurse, covering the period from 2012 to 2016 and including a review of 4,000 admissions of babies.
Letby’s lawyer Mark McDonald said: “The evidence of the innocence of Lucy Letby is overwhelming,” adding: “We will cross every bridge when we get to it but if Lucy is charged I know we have a whole army of internationally renowned medical experts who will totally undermine the prosecution’s unfounded allegations.”
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Three managers at the hospital where Lucy Letby worked have been arrested on suspicion of gross negligence manslaughter.
On Tuesday, it was confirmed that three managers at the Countess of Chester hospital had been arrested on suspicion of gross negligence manslaughter in a separate investigation.
Read more from Sky News:
‘Catastrophic failure’ that led to Heathrow power outage revealed
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Police said the suspects, who occupied senior positions at the hospital between 2015 and 2016, have all been bailed pending further inquiries.
There is also an investigation into corporate manslaughter at the hospital, which began in October 2023.
A public inquiry has also been examining the hospital’s response to concerns raised about Letby before her arrest.
In May, it was announced the inquiry’s final report into how the former nurse was able to commit her crimes will now be published early next year.
Earlier this year, Letby’s lawyers called for the suspension of the inquiry, claiming there was “overwhelming and compelling evidence” that her convictions were unsafe.
In February, an international panel of neonatologists and paediatric specialists told reporters that poor medical care and natural causes were the reasons for the collapses and deaths.
Their evidence has been passed to the Criminal Cases Review Commission (CCRC), which investigates potential miscarriages of justice, and Letby’s legal team hopes her case will be referred back to the Court of Appeal.
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