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Anyone who has studied the finances of an independent pharmacy business knows that money is tight. In many cases, they are perilously close to failure. It's easy to assume they are retail businesses, cashing in on the higher public profile the sector has enjoyed during the pandemic years. But those have been mere words. Certainly, the pandemic represented a halcyon period for the profession. We engendered a feeling of normality, dependable and accessible to society. We played a substantive role in keeping people out of hospitals and giving the vulnerable the ability to live independently from their own homes for longer. We mobilised to smash flu vaccination records and deliver covid jabs. But despite the warm words of a new service based future and the incessant expressions of gratitude contractors desperately need the headroom to prepare, plan and invest. Platitudes, press releases and assurances of a bright clinical future are small comfort to what is needed and that's cash on the table. As the adage goes: "Talk is cheap, money buys houses." Cashflow crisis Since 2016, we have witnessed almost 650 pharmacies fall by the wayside. Some may have merged; the majority, however, have perished due to the relentless need for an increasing cashflow. It is cash, or rather the lack of it, which is killing independent pharmacies.

"Not improving our funding is not an option, if they want to continue to deliver anything like the level of patient care we have done in recent years," he emphasised as he prepares for the NPA'S Save Our Pharmacies Day of Action (June 20). Over the past two years, McElrea has navigated crises stemming from NHS Scotland policies, particularly concerning medicines price inflation and delayed payments. "The cost of medicines increased rapidly compared to inflation," McElrea stated, noting NHS Scotland's slow response in adjusting tariff prices. "This wiped out £50,000 of cash reserves and forced us into £30,000 of additional borrowings." Delayed payments further strained operations, with McElrea highlighting the impact of payments based on outdated pricing.

The Pharmacists' Defence Association (PDA) has written to the National Pharmacy Association (NPA) to highlight several important points regarding their proposed "day of action" on 20 June 2024. The NPA describes this initiative as a response to the "emergency across the community pharmacy sector." In a letter addressed to NPA Chair Nick Kaye and Chief Executive Paul Rees, the PDA's director of pharmacy, Jay Badenhorst stressed the need for NPA members to consider their obligations to staff and patients before participating in the planned actions. He stated, "We are supportive of a new contractual framework for the community pharmacy sector." "However, any actions taken must ensure the safety of patients and the operational integrity of pharmacies." The PDA's letter also expressed concerns over the safety and operational impact of the proposed symbolic gestures, including turning off lights and blacking out windows.

The National Pharmacy Association (NPA) has welcomed the Chancellor's commitment to increase the NHS budget, hoping that 'community pharmacies benefit from this investment'. The association is urging the government to address years of underfunding so that community pharmacies can avoid staff lay-offs to cover the increasing costs of the national living wage. The government's uplift of the National Living Wage was confirmed in its latest budget announcement to tackle the cost of living crisis. The NHS budget will also be increased in each of the next two years by £3.3bn. A recent NPA commissioned report by Professor David Taylor from University College London predicted that wage inflation and other cost pressures could combine with funding cuts to lead to cut-backs and pharmacy closures.

National pharmacy bodies have welcomed two VAT changes related to community pharmacy services announced in the Spring budget on Wednesday (15 March) but were disappointed that the budget brought no further relief for the sector in a crippling funding crisis. It was announced that from 1 May 2023, VAT exemption on healthcare would be extended to include medical services carried out by staff directly supervised by registered pharmacists. The government will also extend zero rate on prescriptions to medicines supplied through Patient Group Directions. This measure will be introduced in autumn 2023. HM Treasury said these measures were being introduced to ensure that the VAT system keeps up with changes to how the NHS operates and how healthcare is delivered across the country. More widely, Chancellor Jeremy Hunt promised to halve inflation and said that the NHS would soon publish its long-term workforce plan.

Boots is reportedly closing another branch in Watton, Norfolk from January, after shutting its High Street branch in Gorleston last month. The Boots store would be one of the four pharmacies expected to be closed next year in the county, which saw closures of six pharmacies in recent months, according to a BBC report. However, the retailer hasn't made any announcement regarding the Watton closure or commented on its decision to shut its Gorleston branch. If the Boots' branch in Watton is closed, the town will be left with only one pharmacy to cater to the healthcare needs of a population of about 12,000, and this is the concern people in the area have expressed. Conservative councillor Tina Kiddell told BBC: "I do worry how they are going to cope, they're already incredibly overwhelmed now."

The Pharmaceutical Services Negotiating Committee (PSNC) has refused to accept the Department of Health and Social Care (DHSC)'s decision to get rid of 'transitional payments' from February 2023. The pharmacy negotiator said that 'any reductions in payments at this point will be impossible for community pharmacy contractors to manage financially.' "We are also continuing to be clear with officials and ministers that CPCF funding needs an urgent uplift to help businesses to cope with soaring costs being driven by inflation and the workforce crisis. We put a comprehensive business case to the government for this uplift in the last CPCF negotiations." The latest 'transitional payments decision' by the Department follows the announcement last year that the value of the these payments would be phased down over the second half of 2022/23 and will be based on the latest monitoring and analysis of funding delivery. PSNC says it submitted a fully-costed bid for a 'Pharmacy First' service in its last round of negotiations alongside the case for an uplift to core CPCF funding. Both of these were refused.

The Department of Health and Social Care (DHSC) is pushing ahead with its plans to implement a new drug tariff from April 2024. However, this move has sparked strong opposition from Community Pharmacy England (CPE), raising concerns about its potential impact on pharmacies and patients. Earlier, it was announced that the April drug tariff will include the new 'Retrospective top-up payment for Concessionary prices, which will be applied automatically for the products listed in Part VIIIE each quarter by the NHS Business Services Authority (NHSBSA), according to the volume the contractor was paid for. However, CPE argued that the government has imposed these "untested" changes without their agreement, and strongly opposed them stating that "no recovery or downward pressure on margin is acceptable given the financial fragility of community pharmacies." Janet Morrison, chief executive of CPE, has voiced strong opposition to these changes, arguing that "any system expecting pharmacies to dispense at a loss" jeopardises the sector's financial stability and compromises patient care.

Released on Monday morning, the election manifesto shared by the Liberal Democrats pledges to "strengthen patients' rights" by tackling public health inequalities and providing early access to community services. The Liberal Democrats Party's manifesto promises to address the issues at both the "front and back doors" of the National Health Service (NHS), which the party claims has been plunged into crisis by the Conservatives. Pledging to invest in public health and early access to community services, the party aims to "work towards a fairer and more sustainable long-term funding model for pharmacies and build on the Pharmacy First approach to give patients more accessible routine services and ease the pressure on GPs." The pledge also includes making prescriptions for people with chronic mental health conditions free on the NHS, as part of a wider commitment to review the entire schedule of exemptions for prescription charges.

Trust leaders involved in the New Hospital Programme (NHP) have warned that further delays in the government scheme will lead to more patient harm, disappointment among staff, and higher costs for taxpayers. According to NHS Providers, delays in the government scheme that promised 40 new hospitals in England by 2030 are draining millions of pounds from scarce NHS funds every month. Some trusts are compelled to spend over £1 million a month from their under-pressure budgets due to spiraling cost pressures, on-hold building projects, and the bill for having to patch up deteriorating sites. While there has been some progress over the past year, trust leaders remain apprehensive that "uncertainty over funding and shifting timetables risks putting their promised buildings further out of reach."

As the countdown to the next UK election begins, the King's Fund has identified three priorities to improve public health. The national action would be taken by the future government to fix the "NHS and social care" in the country. The health policy think tank said it would prioritise "improving access to out-of-hospital care", making "careers in health and social care" more attractive and tackling the biggest risk factors affecting people's health. It highlighted that workforce crisis is one of the biggest challenges faced by the National Health Service (NHS) and social care services in England while citing "years of poor planning and fragmented responsibilities" as the reason for widespread staff shortages. As per the King's Fund's data, there were more than 125,000 vacancies across the NHS workforce in England in October 2023, not including primary care vacancies such as GPs, and 152,000 vacant posts in the adult social care workforce.

Poverty not only takes a significant toll on people's health but also leads to additional costs for the National Health Service (NHS). Rise in deep poverty, cost-of-living crisis, and high pressure on NHS services have worsened the situation, according to a study published by The King's Fund this week. The report underscored that poverty and deprivation contribute to a greater prevalence of diseases, difficulties in accessing health care, late or delayed treatment, and worse health outcomes. These challenges could be seen across various NHS services, spanning from emergency care to dental services Additionally, it revealed that 30 per cent of people living in the most deprived areas have turned to 999, 111, A&E or a walk-in centre because they could not access a GP appointment. In 2016, the Joseph Rowntree Foundation (JRF) estimated the cost of poverty on health care at £29 billion (£34 billion in current prices). As the proportion of people living in deep poverty has risen, the situation has worsened. In 2021/22, six million people were living in very deep poverty, up from 4.5 million two decades ago. Currently, more than one in five people in the UK are estimated to be living in poverty, the report noted. Deprivation is linked to a range of diet-related health problems, including cardiovascular disease and diabetes, as well as mental illness. According to the report, the depression rate is two times higher among people living in the most deprived areas, compared to the least deprived areas.

Challenges in accessing the NHS waiting list are pushing more and more people toward private-funded alternatives for access, diagnosis and treatment, thereby increasing the demand for private health cover. According to a report published by health data provider LaingBuisson, the demand for private health cover, including medical and dental insurance and cash plans, has surged to its highest levels since 2008. The UK's overall health cover market reached £6.7 billion in 2022, an increase of £385 million from the previous year. During the period from 2020 to 2022, the market experienced annual growth rate of 6.1 per cent, a significant increase compared to the average annual growth rate of 1.7 per cent observed between 2008 and 2019, the research found. A total of 4.2 million people were subscribed to medical cover schemes in 2022. When dependents covered by these policies were included, the number reached 7.3 million - the highest count since 2008. LaingBuisson's analysis showed that medical cover volumes were steady through most of the 2010s, but began to increase alongside rises in the NHS waiting list from 2018.