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.
A woman who is under police investigation after assisting the suicide of her husband at Dignitas in Switzerland has told Sky News she has no regrets.
Louise Shackleton has spoken publicly for the first time since her husband’s death in December, as parliament prepares to vote again on legislation to introduce assisted dying in England and Wales.
Mrs Shackleton surrendered herself to police after returning from Switzerland having seen her husband Anthony die. He had been suffering with motor neurone disease for six years.
“I have committed a crime, which I have admitted to, of assisting him by simply pushing him on to a plane and being with him, which I don’t regret for one moment. He was my husband and I loved him,” she said.
“We talked at length over two years about this. What he said to me on many occasions is ‘look at my options, look at what my options are. I can either go there and I can die peacefully, with grace, without pain, without suffering or I could be laid in a bed not being able to move, not even being able to look at anything unless you move my head’.
“He didn’t have options. What he wanted was nothing more than a good death.”
The law in the UK prohibits people from assisting in the suicide of others, but prosecutions have been rare.
Louise Shackleton has spoken publicly for the first time since her husband Anthony’s death
In a statement, a North Yorkshire Police spokesman told Sky News: “The investigation is ongoing. There is nothing further to add at this stage.”
The next vote on the assisted dying bill for England and Wales has been delayed by three weeks to give MPs time to consider amendments.
The legislation would permit a person who is terminally ill with less than six months to live to legally end their life after approval by two doctors and an expert panel.
‘He was at total peace with his decision’
Mrs Shackleton says she saw her husband “physically and mentally” relax once on the flight to Switzerland.
She said: “We had the most wonderful four days.
“He was laughing. He was at total peace with his decision.
“It was in those four days that I realised that he wanted the peaceful death more than he wanted to suffer and stay with me, which was hard, but that’s how resolute he was in having this peace.
“I was his wife, we’d been together 25 years, we’d known each other since we were 18. I couldn’t do anything else but help him.”
‘We need to safeguard people’
She said the hardest part of the journey came after her husband’s death.
“There was this panic and this fear that I was leaving him,” she said. “That was a horrific experience.
“If the law had changed in this country, I would have been with family, family would have been with us, family would’ve been with him. But as it was, that couldn’t happen.”
Opponents to the assisted dying bill have raised concerns about the safety of vulnerable people and the risk of coercion and a change in attitudes toward the elderly, seriously ill and disabled.
They say improvements to palliative care should be a priority.
“I think that we need to safeguard people,” said Mrs Shackleton. “I think that sometimes we need to suffer other people’s choices, and when I mean suffer I mean we have to acknowledge that whilst we’re not comfortable with those, that we need to respect other people, other people wishes.”
Read more:
Assisted dying: What is in the legislation?
Debate over assisted dying delayed
Anthony, who died aged 59, was a furniture restorer who had earned worldwide recognition for making rocking horses.
“I think the measure of the man is that nobody has ever said a bad word about him in the whole of his life because he was just so caring and giving,” his widow said.
‘This is about a dying person’s choice’
She said she had chosen to speak publicly because of a promise she had made him.
“I felt that my husband’s journey shouldn’t be in vain. We discussed this on our last day and my husband made me promise to tell his story.
“He told me to fight and the simple thing that I’m fighting for is people to have the choice.
“This is about a dying person’s choice to either follow their journey through with disease or to die peacefully when they want to, on their terms, and have a good death. It’s that simple.”
UK
Feminists ‘feel braver about speaking out’ after gender ruling – but critics say it ‘stokes culture war’
A former Labour MP who quit the party over Sir Keir Starmer’s leadership has welcomed the landmark Supreme Court ruling on the definition of a woman as a “victory for feminists”.
Rosie Duffield, now the independent MP for Canterbury, said the judgment helped resolve the “lack of clarity” that has existed in the politics around the issue “for years”.
She was speaking to Ali Fortescue on the Politics Hub on the same day the UK’s highest court delivered its verdict on one of the most contentious debates in politics.
Politics latest: MPs respond to Supreme Court ruling on gender
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How do you define a woman in law?
The judges were asked to rule on how “sex” is defined in the 2010 Equality Act – whether that means biological sex or “certificated” sex, as legally defined by the 2004 Gender Recognition Act.
Their unanimous decision was that the definition of a “woman” and “sex” in the Equality Act 2010 refers to “a biological woman and biological sex”.
Asked what she made about comments by fellow independent MP John McDonnell – who said the court “failed to hear the voice of a single trans person” and that the decision “lacked humanity and fairness” as a result, she said: “This ruling doesn’t affect trans people in the slightest.
“It’s about women’s rights – women’s rights to single sex spaces, women’s rights, not to be discriminated against.
“It literally doesn’t change a single thing for trans rights and that lack of understanding from a senior politician about the law is a bit worrying, actually.”
However, Maggie Chapman, a Scottish Green MSP, disagreed with Ms Duffield and said she was “concerned” about the impact the ruling would have on trans people “and for the services and facilities they have been using and have had access to for decades now”.
Susan Smith and Marion Calder, directors of For Women Scotland celebrate after the ruling. Pic: Reuters
“One of the grave concerns that we have with this ruling is that it will embolden people to challenge trans people who have every right to access services,” she said.
“We know that over the last few years… their [trans people’s] lives have become increasingly difficult, they have been blocked from accessing services they need.”
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‘Today’s ruling only stokes the culture war further’
Delivering the ruling at the London court on Wednesday, Lord Hodge said: “But we counsel against reading this judgment as a triumph of one or more groups in our society at the expense of another. It is not.
Campaigners celebrate outside the Supreme Court. Pic: PA
“The Equality Act 2010 gives transgender people protection, not only against discrimination through the protected characteristic of gender reassignment, but also against direct discrimination, indirect discrimination and harassment in substance in their acquired gender.
“This is the application of the principle of discrimination by association. Those statutory protections are available to transgender people, whether or not they possess a gender recognition certificate.”
Read more:
Supreme Court decision has immediate real-world consequences
Prisons across England and Wales now 98.9% full
Asked whether she believed the judgment could “draw a line” under the culture war, Ms Chapman told Fortescue: “Today’s judgment only stokes that culture war further.”
And she said that while Lord Hodge was correct to say there were protections in law for trans people in the 2020 Equality Act, the judgment “doesn’t prevent things happening”.
“It may offer protections once bad things have happened, once harassment, once discrimination, once bigotry, once assaults have happened,” she said.
She also warned some groups “aren’t going to be satisfied with today’s ruling”.
“We know that there are individuals and there are groups who actually want to roll back even further – they want to get rid of the Gender Recognition Act from 2004,” she said.
“I think today’s ruling just emboldens those views.”
Arsenal have reached the semi-finals of the Champions League after a dramatic victory over holders Real Madrid in Spain.
The north London side, who became the first English team to win twice at the Bernabeu following their triumph there 19 years ago, will face Paris Saint-Germain in the last four after the French side beat Aston Villa on Tuesday.
It is the third time the Gunners have made it through to the semis of the top club football tournament in Europe, and the first since 2009.
Arsenal went into the second leg of their quarter-final clash on Wednesday with a 3-0 lead.
Backed by a raucous home crowd, Madrid tried to get off to a strong start and Kylian Mbappe scored after two minutes. However, the goal was disallowed for a clear offside.
Arsenal had the chance to go ahead in the 13th minute but winger Bukayo Saka missed a penalty.
The Spanish hosts were awarded a penalty of their own about 10 minutes later when Mbappe stumbled under pressure from Declan Rice in the box – but the decision was overturned by VAR.
Saka atoned for his tepid penalty as he chipped the ball past Madrid’s keeper Thibaut Courtois when put through on goal by auxiliary striker Mikel Merino in the 65th minute.
But Arsenal were pegged back just two minutes later as Vinicius Junior caught William Saliba dawdling on the ball and fired Real Madrid level.
Arsenal’s resolute defending kept the home side at bay until Gabriel Martinelli made a late break through the home side’s defence to put his side 2-1 ahead three minutes into injury time, as the Gunners made it 5-1 on aggregate.
(L-R) Arsenal’s Declan Rice and Mikel Merino celebrate after the defeat against Real Madrid. Pic: AP
‘We knew we were going to win’, says Rice
Arsenal midfielder Declan Rice has insisted his team are intent on winning the Champions League after their victory in Madrid.
Speaking to TNT Sport, Rice, who was named player of the match, said: “It’s such a special night, a historic one for the club. We have the objective of playing the best and winning the competition.
“We had so much belief and confidence from that first leg and came here to win the game. We knew we were going to suffer but we knew we were going to win. We had it in our minds, then we did it [in] real life. What a night.
“I knew when I signed, this club was on an upward trajectory. It’s been tough in the Premier League but in this competition we’ve done amazingly well.
“It’s PSG next, who are an amazing team.”
‘We have to be very proud of ourselves’, says Arteta
Arsenal boss Mikel Arteta told TNT Sport: “One of the best nights in my football career.
“We played against a team with the biggest history.
“To be able to win the tie in the manner we have done, I think we have to be very proud of ourselves.”
He added: “The history we have in this competition is so short. The third time in our history of what we have just done and we have to build on that. All this experience is going to help us, for sure.”
Real Madrid were seeking their third Champions League title in four seasons.
Mbappe twisted ankle
Their forward Mbappe twisted his right ankle during the game and was jeered by part of the crowd when his substitution was announced after a lacklustre performance.
The French star, who is still looking for his first Champions League title, was replaced by Brahim Diaz in the 75th minute following his injury. He was able to walk off the pitch by himself, but was limping slightly.
The other semi-final will be between Barcelona and Inter Milan.
The first legs are set to be played on 29 and 30 April, with the second legs on 6 and 7 May.
The final will be on 31 May.
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