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A worrying rise in pharmacy closures across England is disproportionately affecting older people and rural communities, according to a new report by Healthwatch England. Findings obtained through Freedom of Information (FoI) requests have exposed the scale of the issue, with over 436 permanent pharmacy closures recorded in 2023 and more than 13,800 temporary closures resulting in nearly 47,000 hours lost. The report, published on Thursday, paints a bleak picture of access to vital healthcare services, particularly in rural areas where pharmacy closures have hit hardest. The report found that Integrated Care Boards (ICBs) in rural areas recorded a higher level of temporary pharmacy closures compared to ICBs in predominantly urban areas. Additionally, ICBs with a higher proportion of people over 60 years of age recorded a higher number of hours lost per pharmacy. Healthwatch chief executive Louise Ansari expressed concern about the impact on elderly populations, noting that the closures were undermining the government's flagship Pharmacy First programme, designed to relieve pressure on GP practices by allowing patients to seek care for common conditions at local pharmacies.

Lloyds Pharmacy's closure of all its 1,300 branches will wake-up the ministers and NHS officials to the reality of community pharmacy sector in England has reached crisis point, expressed Nigel Swift Managing Director of Rowlands pharmacy and Deputy Managing Director of PHOENIX UK. On Friday, The SUN reported that the UK's second largest pharmacy provider - is allegedly in the process of selling its entire estate of 1300 branches. Lloyds Pharmacy will no longer be a High Street presence following its decision to put all its pharmacy branches at the risk of closure. In January it has announced to close its 237 Sainsbury-based pharmacies. Nigel highlighted the fact that community pharmacy is struggling due to insufficient government funding and immense pressures on GPs and A&E departments - an ongoing issue which poses a very real threat to the sector. Commenting on the announcement, he said: "It's not just Lloyds - an independent analysis by Ernst & Young estimated that 75% of community pharmacies will be in financial distress in the coming years. £750 million has been taken out of the English contract due to inflation since it began."

This year has been another turbulent year for the UK pharmacy sector. The sector continues to undergo significant transformations, driven by evolving healthcare needs, regulatory shifts, and economic pressures. For pharmacy owners, staying abreast of these trends is crucial to navigating the challenges and seizing opportunities. IQVIA, a leading global provider of clinical research services, commercial insights and healthcare intelligence, delves into the key issues, challenges, and developments shaping the sector, drawing insights from the latest industry data and reports, supported with data released by NHS England (NHSE). The community pharmacy landscape remains unsettled, with disruptive market dynamics at play. The decline in the number of pharmacies, particularly within the Managed Chains channel, underscores the volatility of the market. The number of active pharmacy contractors in England has dropped significantly, with more closures than openings each month, exacerbated by the exit of Lloyds Pharmacy from the UK market which completed at the end of 2023. In the year ending June 2024, there was a net closure of 440 sites within NHSE which equates to a 4% decline in available pharmacies1. The increase in closures from June 2023 was driven by the closures of Lloyds in Sainsburys and the ongoing divestment of the Boots estate.

In its response to a Freedom of Information Request (FOI), the NHS Business Services Authority (NHSBSA) has confirmed a net decrease of 101 pharmacies in England - with 371 closures and 270 new contracts. Meanwhile, the General Pharmaceutical Council data projected a drop of 43 registered pharmacies in England, Wales, and Scotland for the year ending March 31, 2023, compared to the preceding period. The data, released by business advisor Christie & Co in its annual pharmacy market review on Sept. 5, revealed a total of 14,328 pharmacies across all four UK country regions as of March 31, 2023, indicating a 0.3 per cent decrease from the previous year. Corporate operators experienced a net reduction of 249 pharmacies, while the total number of independent operators remained consistent with 2022. According to the study, the corporate sector saw the most substantial shift, with a 13.7 per cent reduction in businesses operating 300 or more pharmacies. Following closely, groups managing 11 to 15 pharmacies experienced a 5.6 per cent decrease. Christie & Co attributed this shift in group size to operators acquiring additional pharmacies through corporate disposal opportunities throughout the year.

The UK has witnessed a nearly 50 percent increase in pharmacy closures this year compared to the same period in 2023, which was already considered the worst year in recent memory. A new analysis by the National Pharmacy Association (NPA) revealed that 177 pharmacies closed their doors between January and April 2024, compared to 116 in the same period last year. This is the equivalent of 10 local pharmacies shutting down every week. Analysis of NHS figures by the NPA showed that 403 pharmacies closed their doors last year, nearly five times higher than the number that closed in 2022. Since 2017, over 1,400 pharmacies have shut down across the UK. Rising costs and declining real terms funding have led to the fastest rate of closures in decades, said the NPA, highlighting that "real terms funding has decreased by 40 per cent over the last decade."

YouGov polling commissioned by the Pharmaceutical Services Negotiating Committee (PSNC) has revealed that majority of the people responding to the poll said that they would be concern by the pharmacy closure in their locality. The results show the extent of the public backing for a Pharmacy First approach - PSNC has been arguing that a fully-funded service would be beneficial for pharmacies, patients and the wider NHS. The poll witnessed 1,774 adults' participation from England. It showed 68 per cent of people agree that they would find it easier to seek health advice for common conditions, such as skin conditions or indigestion, at a community pharmacy rather than a GP surgery. Only 11 per cent disagreed that this would be easier. While 75 per cent of people agree that they would like to see community pharmacies offering more healthcare services such as treating urinary tract infections or sore throats. Only 6 per cent strongly disagreed with this. When asked how important, if at all, are the services provided by community pharmacies to them, their family, or community, 78 per cent indicted this was very important. Only 14 per cent said this wasn't important. 77 per cent said they would be very concerned if the pharmacy they use most often were to close permanently. Only 19 per cent said they would not be very concerned.

NHS England has mandated a business continuity plan for pharmacies dealing with temporary closures from the end of this month. Community Pharmacy England (CPE) has put together a briefing and a template plan to help guide pharmacy owners through the process. It explains what is required in the plan, describes how and when to implement it, and outlines some additional considerations. "This could be added as an annex to your pharmacy's existing business continuity plan. A checklist has also been added, which may be used in the event of a temporary suspension," said CPE. "NHS England will be publishing the approved particulars shortly. NHS England is also still to publish guidance on the amendments to the Pharmaceutical Regulations that came into force on 25th May, which will include guidance on these requirements.

The Company Chemists Association (CCA)'s 'Prospectus for community pharmacy' has revealed that community pharmacies can release over 42 million appointments from general practice every year. In its prospect, the association calculated that community pharmacies could reduce hospital readmissions by 65,000 and administer an additional 10m routine vaccines annually. The prospectus sets out bold ideas and proposals regarding the future of community pharmacy. The association said: "Community pharmacies already work collaboratively with the NHS to ensure that patients can access care easily and safely. Whilst the sector has evolved considerably in recent years, the CCA proposes that pharmacies could do even more to directly tackle key problems for patients." CCA is concerned that without immediate action pharmacy closures will become increasingly common. "Fewer pharmacies will considerably diminish access to vital medicines and services, with the greatest impact on those in deprived communities."

In an oral parliamentary debate on community pharmacy held on Monday (20 March), the government was asked for an indication of 'how much it would cost to make the best use of community pharmacies'. A number of Peers at the House of Lords spoke out in support of pharmacies, while others asked when would the government address the current crisis in the sector. Kicking off the session, Baroness Hodgson asked the responding minister, Lord Evans, about recent pharmacy closures as well as underfunding. She asked whether the government would 'enter into discussions with PSNC to look at introducing a fairly funded pharmacy first service as soon as possible which will help relieve the work load on GPs'. The minister responded: "We have already introduced and funded a range of service in community pharmacy that make use of the clinical skills of pharmacy teams… we continue to discuss with PSNC how the government can best support the sector to provide support to patients." The House of Lords oral questions session was opened by Baroness Hodgson on behalf of Baroness Cumberlege as follows: "To ask His Majesty's Government what plans they have for making the best use of community pharmacies".

The health secretary, Steve Barclay was asked over the delay of 'Pharmacy First' model in England that was proposed by the Pharmaceutical Services Negotiating Committee (PSNC) last year, at the Health Committee evidence session held on Tuesday (31 January). Taiwo Owatemi MP (Chair of the Pharmacy APPG) asked whether he was adhering to his statutory responsibility to ensure continued access to medicines and cited the CCA's closures in areas of deprivation research. Barclay replied that the government is 'investing more'. He said, "We put an extra 100 million on top of the 2.6 billion a year we commit to community pharmacy to expand the range of clinical services. We've got over 2 million patients that have been referred to community pharmacy from NHS." He further added: "One of the issues I'm very keen on is to explore what more we can do in pharmacy not least given the pressures on GP and the opportunity to look at what it is currently people go to GPS for where potentially the risk to do more at the pharmacy and we're already doing that."

Amid media speculations that a large pharmacy multiple was putting all its stores at risk of closure, PSNC supremo Janet Morrison said the sector was in crisis and in danger of a significant collapse. Addressing delegates via a video link at Sigma Pharmaceutical's 13th Annual Community Pharmacy Conference held last week (March 4 -9) in Punta Cana, Dominican Republic, she said while "a lot of consolidation or sales" would continue, a lot of the smaller, independently-owned community pharmacies - which had to work harder and harder to make ends meet - were just "hanging on in there". "But I don't know how much longer people can go on," she said, adding that the risk of actual closure was rendering the remaining pharmacies so fragile that "they may not be able to pick up the slack of many thousands of patients" who would need repeat prescriptions. "The disruption is frightful and awful. We have got 53 per cent of the population on repeat prescriptions, so that matters." Her comment on the opening day of the conference was a sober reminder that the sector - which relies heavily on income from prescriptions - couldn't afford to "carry on with the current format of a contract and the current amount of money" it was paid to deliver numerous tasks which have been heaped on it to share the burden of a crippling NHS.

What will it take to get help from the government before an individual or sector breaks? Pharmacists raised questions after the Pharmaceutical Services Negotiating Committee (PSNC)'s 2023 Pharmacy Pressures Survey confirmed the ongoing pressures and health issues faced by the pharmacies. Pharmacists are not all shocked by the PSNC's survey report as they feel the same as what has been reported related to their businesses and health. They hope the government listens and work with them to find resolutions. "We are bullied into a corner," said Salim Jetha Chairman, Avicenna. "Unlike other industries, we can't increase our prices. Most of the daily calls I get from Independents is about financial health of their business and any cost cutting would be detrimental to patient care. Urgent holistic review is required." Bristol pharmacist Ade Williams said: "The report is a dire indictment, and I would also warn, likely an underestimate of the extent and detrimental impact of the ongoings pressures and squeeze on Community pharmacies." "If the closest interface of the NHS to communities and patients is so distressed, what does that mean for those that need and depend on us? We are notoriously very stoic, so this is a warning light, which, taken with workforce pressures, market-exit activity, and other reports raising concern about wellbeing and stress, must beg the question; what will it take to get help before the sector and individuals break?" he questioned. The survey results don't surprise Kent-based community pharmacist Amish Patel. He said, "I have been feeling exactly what has been reported for far too long. I'm burnt out and would say beginning to suffer with my own health because of it. Now it's for PSNC to talk to government, and government to listen and work with us to find resolutions."

Those of us who work in community pharmacy know there is a workforce crisis created in large measure by PCNs actively recruiting pharmacists and pharmacy technicians from our sector. It is welcome, if long overdue, that this has now been officially acknowledged in a report commissioned by the English Health Secretary. PCN hiring 'exacerbates pharmacist shortage' says DH-commissioned report, which states such recruitment has "on occasion exacerbated the problem of a general shortage of pharmacists" which has compounded "the problem of community pharmacy closures." We have been telling the government this for years only to be told "problem? What problem?"- but now that Steve Barclay has his own official report sitting on his desk, he and NHSE cannot continue in denial mode. The facts are there for all to see. Time to act. No more dithering, delay or indifference. You asked if there was a problem and you have been told there is. In the absence of a holistic workforce strategy and cross-sector career pathways, PCNs poaching from community pharmacy is a zero sum game adding nothing to improving patient care.

In the parliamentary drop-in-event hosted by Community Pharmacy England last week, Members of Parliament (MPs) questioned the Health Secretary on the rising issue of medicines supply. "Eighteen community pharmacists in my constituency are reporting challenges on medicine supplies. What more is the Minister going to do to get a grip of this situation?", Mike Amesbury MP for Weaver Vale, who was present at the event last week, asked the Health Secretary. In his response, the Health Secretary, Steve Barclay MP said: "We have a long-standing team in the Department focused on medical supplies, which are a continual issue; as a matter of routine business, there are often challenges in that area." The Shadow Pharmacy Minister, Karin Smyth MP, also asked: "People across the country rely on local, accessible pharmacies, but whether it is high street closures or supply problems leading to the absurd situation where women are phoning or visiting multiple pharmacies for a prescribed dose of hormone replacement therapy and other drugs…They have repeatedly announced plans to expand the role of community pharmacies but have failed to update legislation that could possibly help. … Why will they not do so?

Boots has shut down three more stores, as it moves forward with its plan to close 300 stores across the UK over the next 12 months. On Saturday (18 November), Boots closed its branches in Mudge Way, Plymouth; Mount Pleasant Road, Exeter; and Low Moor Road, Kirkby, Ashfield. The NHS issued a memo to shoppers and patients who use the Plymouth branch, which is located next to Plympton Health Centre, to inform them that "you will need to find and nominate another pharmacy to dispense your prescriptions going forward." Patients can set their nomination by contacting their new pharmacy and requesting "they do this for you." According to DevonLive, a note was attached to the Mount Pleasant pharmacy door that read: "Boots Mount Pleasant Store will close on Saturday, November 18 2023.

A new study published in BMJ Open journal has revealed a significant decline in the number of general practices in England over the past decade, alongside shifts in workforce dynamics and organisational structures. Conducted by researchers from University College London (UCL) and the London School of Hygiene and Tropical Medicine (LSHTM), the study analysed data from NHS England, the Office for Health Improvement and Disparities, and the Care Quality Commission (CQC). They found that, between April 2013 and April 2023, the total number of general practices fell by 20 per cent, dropping from 8,044 to 6,419-an average loss of 178 practices per year. The decline coincided with an 11 per cent increase in the total population registered with a GP practice, which saw average practice list sizes swell by 40 per cent from 6,967 to 9,724 patients. Additionally, the number of unique practice postcodes decreased from 7163 to 5849, representing the loss of 18 per cent practice locations over this period.