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A winter NHS crisis is inevitable unless the government acts now to reverse the worrying decline in community pharmacies. Years of government underfunding could see 3,000 pharmacies in England - around a third of the network - having no option but to shut their doors to patients in the next few years. That figure is based on independent assessments from Ernst & Young and UCL/LSE healthcare professors: it is not scaremongering - it is the reality the country faces. Fifty per cent of pharmacies are already in financial distress because government funding has been falling in real terms since 2019 and that figure is predicted to rise to 75 per cent within the next two years. The government needs to act now and invest in pharmacy or sleepwalk into a healthcare disaster as we have seen with access to dentistry care. Prescription volumes have risen consistently year-on-year by roughly 2 per cent which means fewer pharmacies doing more work and under greater pressure than a decade ago. Ten years ago around 11,200 pharmacies in England were dispensing roughly 79,000 prescriptions; nowadays around 11,500 are dispensing roughly 89,000 prescriptions. The secretary of state recently asked pharmacy to do more to avoid a winter NHS crisis and at the same time said there will be no new money to pay for those additional services. This at a time when the network is in decline with random unplanned pharmacy closures - 640 closures since 2016 - and pharmacy staff face huge workload pressures as prescription demand is increasing year-on-year. The government's approach to pharmacy literally does not add up: the pharmacy contract is not fit-for-purpose now let alone dealing with a NHS winter crisis.

National pharmacy bodies have called on the government and NHS leaders to take appropriate action to keep pharmacy teams safe from violence and abuse. The Pharmaceutical Services Negotiating Committee (PSNC) - in collaboration with the Association of Independent Multiple Pharmacies (AIMp), the Company Chemists' Association (CCA), the National Pharmacy Association (NPA), and the Royal Pharmaceutical Society (RPS) - is supporting an important petition started by Mike Hewitson, a community pharmacy contractor, who has been threatened with stabbing and robbed in his own pharmacy. The PSNC and the other national pharmacy bodies strongly believe that no healthcare professional should have to deal with this, that and pharmacists and their teams should be better protected. It said: "Community pharmacies play an integral role in the delivery of primary care and most patients are highly appreciative of the hard work of local pharmacists and pharmacy teams from dispensing medicines and administering vaccines to providing medical advice and health monitoring services.

The Pharmaceutical Services Negotiating Committee (PSNC)'s 2022 Pharmacy Advice Audit revealed that more than 1.2 million consultations a week - or 65 million a year - are now being carried out by community pharmacy teams in England. This is an increase from 2021, when the audit results suggested that in total pharmacies were providing 58 million consultations per year. PSNC has published the findings of the audit of over 4,000 community pharmacies carried out earlier this year. During the audit, 82,872 informal patient consultations were recorded, with the average pharmacy completing 19 consultations per day. This suggests that more than 1.2 million informal consultations are taking place in community pharmacies in England every week. The audit helped to quantify the number of informal referrals being made to pharmacies by GPs and NHS 111, with 7,774 informal patient referrals into pharmacy coming from these routes; grossed up to a national level that means 117,000 cases per week. These are all referrals that could and should have been made by the NHS Community Pharmacist Consultation Service (CPCS).

The Association of Independent Multiple Pharmacies (AIMp) and senior official of NHS Property Services (NHSPS) had a meeting on August 18 to review the rent policy for health centre pharmacies. Earlier, the association had sent a letter to NHSPS that was signed by pharmacies from across the sector, including single independents, pharmacy groups and members of the Company Chemists' Association. The letter outlined concerns about rent reviews and the impact of it on the co-located health centre pharmacies. Dr Leyla Hannbeck, CEO of AIMp, said: "We outlined that whilst in the past, the norm established by the industry, was to base rents for co-located pharmacies primarily based on patient list size, (and taking account of a few other factors), the industry now needs to revise the basis on which rents are determined for co-located pharmacies." The association, on behalf of the pharmacy sector, met the CEO of NHSPS and two of their senior directors (director or property management and their finance director).

Two dozen parliamentarians from across the political spectrum have called on the prime minister to act as a wave of pharmacy closures in recent years has threatened to spiral out of control. A letter to the prime minister signed by 24 MPs and peers has warned that worse could be yet to come after "spiralling business costs" and "year after year of real terms funding cuts" have led to hundreds of pharmacy closures. New data from the PSNC shows that over 639 local pharmacies have been lost in England since 2016. "This is the equivalent to just short of one pharmacy closure per constituency", the cross-party group warned. The letter comes as MPs came together at a parliamentary summit to call for pharmacies to be embraced as a "game-changer" for tackling healthcare backlogs and taking pressure off other areas of the NHS. A 'Future of Pharmacy' event was attended by 53 parliamentarians on July 5 in the Palace of Westminster. At the event parliamentarians heard directly from frontline pharmacists and representatives of pharmacy bodies where a map of constituency-specific pharmacy numbers was also unveiled, with details of the number of pharmacy closures in MPs' local area.

The full-time equivalent community pharmacy workforce saw a 6 per cent decline in a year, while the overall number of pharmacists remains nearly constant, according to NHS England's Community Pharmacy Workforce Survey 2022. However, vacancy rates among pharmacists rose 16 percent, suggesting an increased reliance on locum pharmacists who, on average, work fewer hours, the data revealed. According to NHSE, the mandated survey released (Aug. 3) achieved a 95 per cent completion rate among pharmacy contractors, marking a substantial increase compared to only 47 per cent in the previous year. The survey results indicate a shift in working patterns within community pharmacy, with locum pharmacists being utilised more frequently as part of the staffing model. The survey revealed a 6 per cent decrease in the community pharmacy workforce across all roles combined. The number of full-time equivalent pharmacists working in community pharmacy decreased by 2,411, from 20,255 in 2021 to 17,844 in 2022, the survey found. The employed pharmacists decreased by 16 per cent from 12,774 in 2021 to 10,943 in 2022, while locum pharmacists increased by 26 per cent from 4,297 in 2021 to 5,477 in 2022, NHSE said.

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 Pharmacists' Defence Association has called on the Scottish government to end unnecessary pharmacy closures and introduce emergency regulations to force companies that operate Scotland's pharmacies to open on the days and hours they have agreed. It is concerned that decisions made by some health boards in Scotland have now allowed pharmacy owners to close their pharmacies on Saturdays. The PDA is worried that a pharmacy closure could have negative impact on patients and other parts of the NHS, including neighbouring pharmacies, addiction and mental health services, and minor injury and A&E units. The association claims that there are record numbers of registered pharmacists who are available to work and therefore a decision to close a pharmacy over staff shortages is misleading. "The business owners may claim there is a shortage of pharmacists, but when they actively cancel agreed hours of work it does not suggest there is a shortfall of workers," said the PDA, adding: "These business decisions often include closing their pharmacies at very short notice, even when pharmacists are available and willing to work."

All pharmacy businesses are reporting that they are struggling to find the registered professionals needed to open their pharmacies, clarified the Company Chemists' Association (CCA) in response to an attack by the Pharmacists' Defence Association. Last week, PDA allegedly accused some large pharmacy chains of 'orchestrating' full or part-time closures of some of their shops due to the staff shortage. In its Open Letter published on Tuesday (July 19), PDA demanded urgent action "to protect patients by ensuring that essential community pharmacy services are provided safely and consistently". "All parts of the healthcare system are struggling to recruit staff and to assume that pharmacies would be immune to such pressures, seems fanciful," said CCA. "CCA members are working extraordinarily hard to prevent temporary closures, but recruitment and retention of pharmacists is becoming increasingly tough. The recent rise in Covid cases and the beginning of the summer holiday season in parts of the UK have only worsened the situation." The Association also showed data from the PSNC Pharmacy Pressures Survey (April 2022) which found that 91 per cent of pharmacies are experiencing staff shortages, clearly demonstrating that these shortages are affecting the entire sector.

The Royal Pharmaceutical Society (RPS) has launched a partnership with the charity Marie Curie to develop professional standards in end of life care for community pharmacy. Available for pharmacy teams across the UK, the standards will provide a free, evidence-based framework to help community pharmacies self-assess and continuously improve their end of life and bereavement care for patients and carers. They will enable community pharmacy teams to work together to develop their own practice. RPS is setting up a professional standard steering group which will have community pharmacy experts, experts within the field of palliative and end of life care, lay members, and healthcare professionals who interact with community pharmacy. Elen Jones, director lead for palliative care work at RPS, said: "RPS has a long-term commitment, striving to ensure that people living with life-limiting conditions who are approaching the end of life have timely access to medicines and clinical support from a skilled pharmacy team. "The development of these standards, in partnership with Marie Curie, is a crucial step to support community pharmacy teams to undertake simple quality improvement measures and build upon the care they already provide to this group of patients and carers."

Pharmacy bodies and MPs discussed on support needed to unlock the "full potential" of community pharmacy at the All Pharmacy Party Group (APPG)'s general meeting held in Westminster on Tuesday (01 November). The attendees of the meeting were Janet Morrison OBE, Chief Executive of Pharmaceutical Services Negotiating Committee; Malcolm Harrison, Chief Executive of The Company Chemists' Association; Thorrun Govind, Chair of the Royal Pharmaceutical Society; Sanjeev Panesar, National Pharmacy Association Board Member, and Pharmacist Superintendent and Owner of the Pan Pharmacy Group; and Sandeep Dhami, Association of Independent Multiple Pharmacies member and superintendent at MW Phillips Chemist At the session, 18 parliamentarians were briefed on the myriad of ways pharmacies contribute to the health of the nation. The panel of experts also highlighted that pharmacists are 'running out of fuel' with the growing challenges such as flat funding, workforce shortages and the cost-of-living crisis impacting pharmacies' ability to deliver vital services.

The Royal Pharmaceutical Society (RPS) has urged people across Scotland to be kind to their pharmacy teams this winter through its campaign called 'Be Kind'. The pharmacies are facing lot of pressure and challenges during winter, RPS has heard from its members that abuse towards pharmacy teams, particularly those in community pharmacy, has 'unfortunately' risen. The campaign has been running throughout December, to promote 'be kind' message to the public at a time when pharmacy services are particularly stretched by winter pressures and other factors, including the recent shortages of antibiotics. "Throughout December, leading figures have provided a series of powerful videos, which all encourage the public to be kind to their pharmacy teams. The campaign has highlighted personal video messages from many figures including Jason Leitch, Scotland's National Clinical Director, Maree Todd, Minister for Public Health, Women's Health and Sport, and Andrew Carruthers, RPS Scottish Pharmacy Board Chair," said RPS.

In a recent interview with The Telegraph, health secretary Steve Barclay stated that he has asked his officials within DHSC to look at a "pharmacy first" approach to alleviate pressures on A&E departments in order to avoid the widely predicted NHS winter crisis. On the face of it, this a welcome if long overdue recognition that community pharmacy is an essential part of our national healthcare infrastructure alongside our GP and A&E colleagues. But let's not get carried away - we have had lots of praise from politicians in the past which have not then been backed by firm commitments for a sustainable future for the network. Could this be a turning point? I hope so, but I am not confident it will be. I fear this may turn out to be another emergency stop-gap measure which does nothing to secure the long-term viability of the sector in England. The role of community pharmacy during the recent Covid pandemic demonstrated clearly how important we are to ensure people have easy access to essential healthcare support, advice and services. The NHS winter crisis can only be avoided or at least mitigated if the potential of the community pharmacy network to provide more patient care services is unlocked and that Barclay requires you to end pharmacy funding austerity and start investing. The Treasury will no doubt say there is no more money, but what then the alternative other than a NHS winter crisis? And, of course, treating people in secondary care settings is far more costly than community pharmacy based interventions.

The Conservative Party Prime Ministerial candidate Rishi Sunak visited Bassett Pharmacy in Southampton on Wednesday (Aug 24) - the pharmacy that used to be run by his family. During the visit, Sunak is reported to have said that he intends to reform the NHS and achieve value for money from health spending, should he become prime minister. Giving his reaction to the visit, National Pharmacy Association (NPA) chief executive Mark Lyonette said: "If Rishi Sunak is serious about NHS reform, he would do well to start with a 'pharmacy first' approach to prevention and treatment which has the potential to transform the way people access NHS care. "That can only happen with a sustained increase in funding for our sector, which is facing much harder times now than it ever did when Mr Sunak's parents owned a pharmacy years ago." Earlier in the week, NPA board member Hiten Patel met the former chancellor when he visited West Harrow for a campaign event on August 23. Patel took the opportunity to explain that pharmacies in England are not being properly supported to fulfil their potential within the NHS.

Dispensing activity by community pharmacy in England has witnessed a 4.2 per cent increase across the year 2021 till March 2022, the Pharmacy Market Review 2022 report revealed. The report launched by Christie & Co, said: "All pharmacy settings saw improvements in dispensing numbers, with standard community settings seeing the highest increase of 4.2 per cent, with the average moving to 7,173 items, albeit still below the combined average." "The independent sector fared better than corporate pharmacy, with a combined average increase of 3.5 per cent versus a 1.8 per cent increase in corporate dispensing. Despite some improvement, integrated pharmacies remained the lowest at 1.9 per cent, in part due to the continued restrictions on patient access." Dispensing activity for England across the year to March 2022 increased by 4.5 per cent to an average of 7,765 items per month, reversing the decline witnessed in 2021.

The Company Chemists' Association (CCA)'s analysis on permanent closures of community pharmacies in England showed that there has been a net loss of 670 pharmacies between 2015 and 2022. The analysis highlighted that 37 per cent of permanent closures of pharmacies and GP practices have occurred in the 20 per cent most deprived parts of England. Current trends indicate that primary care 'cold spots' could soon emerge - areas where there is significantly reduced or inadequate access to a pharmacy or a GP. The CCA's analysis shows that some of the most deprived neighbourhoods concentrated in the North West, the West Midlands and Yorkshire have faced the highest losses of local pharmacies and GP practices since 2015. It demonstrates that the trend of permanent closures amongst pharmacies and GP practices is worsening. Moreover, this burden is likely to be felt unevenly with permanent closures occurring disproportionately in areas of high deprivation. Without action, deprived communities, where need is typically greater, may no longer be able to access the GP and pharmacy services they require.

The Royal Pharmaceutical Society (RPS) has called pharmacy employers and pharmacy trade unions to come together to a round table meeting to agree on principles for a way forward that ensures patients benefit consistently from access to high quality, adequately staffed, safe pharmacy services. It has also urged the governments, NHS organisations and individual pharmacy teams to define clear prioritisation plans, which can be embedded in organisational business continuity plans which set out the pharmacy services that are essential and must always be provided and can be de-prioritised at specific levels of pressures. The challenges for pharmacies are compounded by the escalating cost of living crisis. With unprecedented levels of burnout among pharmacists, pharmacy closures and the potential for strike action, RPS has called for three things- 'professionalism, respect and prioritisation.'

The National Pharmacy Association (NPA) has warned of multi-million financial hit for community pharmacies, while the Pharmaceutical Services Negotiating Committee (PSNC) has renewed its calls for urgent financial support amid a looming energy bill crisis. NPA board member, Olivier Picard, this week shared a screenshot of his estimated electricity bill on WhatsApp groups. Upon expiration of his current arrangements, in October, his electricity bill could rise from its current £1,821 for one pharmacy to an estimated £6,914 - a near fourfold increase. Piccard said: "This is an eye-watering rise in costs for my own pharmacies and adds to the intense financial pressure we're already under. My standing charges will multiply by 10 and the overall cost to each pharmacy amounts to about £5,000." His comments come just ahead of an NPA-commissioned report into pharmacy inflation which will provide an analysis of inflationary costs pressing on the community pharmacy sector, from utilities and workforce to medicines purchasing.

The Company Chemists' Association (CCA)'s research has found that between 2015 and 2022 more than 40 per cent of permanent community pharmacy closures took place in the 20 per cent most deprived parts of England. The association has analysed the NHS data and found that between 2015 and 2022, 808 pharmacies closed permanently in England. In that period, only 138 new pharmacies opened - a net loss of 670 community pharmacies. It also examined where permanent closures had taken place. "41% of net permanent closures had taken place in the top 20% most deprived areas in England. Meanwhile, only 9% of net permanent closures took place in the top 20% least deprived areas." Although the latest figures for 2021/22 suggest that the overall rate of closures may be slowing down, the proportion of pharmacies permanently shutting in more deprived areas has only increased. An even larger share of pharmacies that permanently shut in 2021/22 occurred in the most deprived areas compared with the previous fiscal year: 44% of net closures took place within the bottom two IMD deciles.

Pharmacy Minister, Will Quince received flu vaccination and blood pressure check at his visit to a Boots pharmacy in Westminster arranged by the Company Chemists' Association (CCA). The Boots pharmacist, Flavia, explained to the Minister the broad range of services the pharmacy delivers, from the new medicines service to emergency contraception and the community pharmacy consultation service. The Minister witnessed first-hand much of what the community pharmacy sector has to offer patients and the NHS. Malcolm Harrison Chief Executive of the CCA said: "We share the Minister's vision on how community pharmacies and their teams can contribute to the 'Plan for Patients' set out by the Secretary of State. It is great to have the support of the Minister and we are excited for the future of pharmacy.