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Pharmacies across Northern Ireland are in financial turmoil, reporting that they are dispensing prescription medicines at a loss due to inadequate reimbursement from the Department of Health (DoH). This crisis has led to the closure of almost a dozen pharmacies over the past 18 months, with many others struggling to stay open. Siobhan McNulty, who runs Melvin Pharmacy in Garrison, County Fermanagh, described the dire situation. "We're dispensing medicines at a loss," she said. "The reimbursement rates don't match the cost of the drugs, and we're left to cover the gap." McNulty relies on sales of non-pharmaceutical products to keep her business running.

The National Pharmacy Association (NPA) survey revealed that 93 per cent of respondents experienced 'at least one month' of negative cash flow across their pharmacy business in 2022. Nine out of 10 pharmacy owners responding to NPA survey said they made a net loss dispensing medicines for the NHS during 2022, for at least one month of the year. According to the poll, 48 per cent of them lost money on this core NHS service for six months or more. 45 per cent said their overall outgoings had exceeded overall income in at least six months of the year. NPA Chair Andrew Lane said: "This survey shows the bleak financial reality facing many independent pharmacies after years of underfunding. Dispensing at a loss and negative cashflow is clearly unsustainable." "This funding crisis must be addressed urgently or pharmacies will fall into a spiral of declining services and ultimately widespread closures, he added. "Tragically, the story is playing out very much in line with independent research commissioned by the NPA last year, which warned of a nationwide financial emergency in our sector."

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.

The Pharmacists Defence Association (PDA) has expressed its interest to support pharmacists impacted with the latest announcement of the closure of Tesco pharmacies. "Tesco have followed ASDA and LloydsPharmacy (at Sainsbury's) to announce cost cutting changes to their stores, impacting hundreds of jobs," the association said. The PDA's interests in the announcement relate to the planned closure of eight in-store Tesco pharmacies and the impact of those closures upon pharmacists, however the union is of course concerned for all those impacted. The PDA Union will support individual PDA members impacted by the decision so that they are aware of, and can exercise, their rights at work in relation to this situation. Paul Day, PDA Union Director said, "In addition to the immediate impact on pharmacists employed at the stores marked for closure, this is the third instance in just twelve days of reductions in the overall access to a pharmacy for NHS patients. We expect those who represent communities to be concerned about the loss of a key part of their local NHS service."

The Department of Health and Social Care (DHSC) in recent response to the questions asked by members of the House of Lords addressed the concerning trend of pharmacy closures in rural areas across the UK. Led by The Bishop of St Albans, inquiries focused on the number of community pharmacies that had ceased operations over the past five years and the ongoing financial challenges faced by those remaining in rural regions. Lord Markham, the Parliamentary Under-Secretary for Health and Social Care, provided insights into the stark reality confronting rural communities. Highlighting data as per Guide to applying the Rural Urban Classification to data (2019-2023) Markham illustrated the significant closure rates of rural pharmacies compared to the limited number of new openings between 2019 and 2023. The figures revealed a fluctuating trend over the past five years, indicating a dynamic landscape within rural pharmacy provision.

The current funding and contractual framework for community pharmacy is not fit for purpose, the Health and Social Care Committee report has concluded, recommending a complete overhaul to reduce its complexity. Published today, the report highlighted the necessity for a new framework to ensure adequate funding and to prevent damaging cross-subsidy between clinical services and prescription dispensing, as is presently observed. The report revealed that community pharmacy funding has fallen by over 30 per cent in real terms since 2015, resulting in an annual shortfall of at least £67,000 per pharmacy for individual owners. More than 1,100 community pharmacies have closed since 2015, of which were serving the most deprived areas, it said. MPs on the committee have urged the government to address medicine shortages, warning that they could undermine flagship initiatives such as 'Pharmacy First' by eroding public confidence in pharmacists. "People living with type 2 diabetes, ADHD, epilepsy and cystic fibrosis, and those experiencing the menopause, have faced challenges accessing the vital medication they need. Many others are facing similar experiences.

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.

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.

From over-the-counter flu tablets to crucial antibiotics and antidepressants, medicines are running scarce in UK pharmacies this year, causing concerns among patients, the government, and the wider pharma industry. Drug shortages have accelerated over the past year due to a clutch of problems including the after-effects of the pandemic on supply chains, the war in Ukraine, and soaring input costs weighing on manufacturers. More recently, a sudden spike in respiratory infections - another by-product of Covid-19 that neither pharma companies nor the government were able to predict - has deepened the crisis, with 70 commonly taken drugs out of stock in Britain as of February. The problem is not unique to the UK. In a recent survey of groups representing pharmacies in 29 European countries, three quarters said shortages were worse this winter than a year ago, with a quarter reporting more than 600 drugs in short supply. The US is also facing significant shortages of popular prescription drugs like amoxicillin and Adderall, an ADHD medication. To some extent, the current disruption is laying bare wider challenges facing the industry for several years that were only exacerbated by the pandemic. The over-reliance on foreign suppliers for most active pharmaceutical ingredients (APIs) is one of them. This model has left companies more susceptible to supply shocks, which have in turn increased in frequency and severity due to pandemic lockdowns, the war in Ukraine and other issues such as the shortage of shipping containers. Pharma's long and opaque supply chains, alongside regulatory complexities, also mean it is taking longer for drugmakers to reconfigure manufacturing and distribution in times of additional need.

The lessons from Covid crisis applied in the future through collaboration can create a better integration between GP practices, hospitals and community pharmacies, Pharmacists Defence Association (PDA) has proposed. Stating that a more integrated healthcare system could enable pharmacists to provide effective and more efficient care to patients, the PDA proposed a model where at least two pharmacists would be working in each community pharmacy, empowered, and enabled with two-way referral pathways, having more clinical input and full access to patient records. "Such an environment could not only help to improve communications between health professionals and increase access to services for patients, but would support the NHS to operate more effectively."

A new study has revealed that public trust in services provided by local pharmacies ranks highest in the UK, although confidence in the NHS has nosedived following the pandemic. The 2022 Edelman Trust Barometer report published on Wednesday (April 21) found that around 78 per cent of respondents trust their local pharmacies, the highest for any provider cited in the survey. Besides, 72 per cent said pharmacists are among the most trusted to tell the truth about health matters and protect public health, almost similar to 'my doctor' (75%) and health experts (74%). Just under half of them said the pandemic has decreased their confidence that the NHS is well-equipped in handling major health crisis. The survey also revealed that 60 per cent think they lack access to high-quality healthcare.

The PSNC on Friday said it has warned the DHSC about the "very serious impact" of the limited supply of certain antibiotics on pharmacies who are "having to chase stock, purchase without sight of any concession prices, and cope with increasing patient questions and abuse." With higher than usual number of cases of scarlet fever, caused by invasive Group A Streptococci (iGAS) infections, being reported in children across the country, supplies of antibiotics for Group A Strep treatment have seen a surge in demand, leading to limited supply at certain wholesalers and pharmacies. PSNC has urged the DHSC to adopt measures that could help to manage the current crisis, such as allowing pharmacists more freedom to change strengths or formulations without prescriber approval, outside of Serious Shortage Protocols. It has also raised concerns on the significant rise in wholesale prices of many oral antibiotics as a result of the surge in demand and the ongoing supply disruptions. PSNC also said they have received reports of some suppliers putting up their prices for any oral antibiotics they do have in stock.

Britain on Tuesday (January 4) faced warnings of an impending hospital crisis due to staff shortages caused by a wave of Omicron infections, as the country returned to work after Christmas. However, Britain's vaccine minister said hospitalised Covid-19 patients were showing less severe symptoms than before, adding that there was no need for further restrictions at this stage. Prime minister Boris Johnson resisted imposing stringent lockdown measures in England ahead of New Year as Omicron fuelled a spike in cases to record highs. While hospitalisations are rising they have not tracked the trajectory of daily cases, possibly reflecting the impact of vaccines and booster shots, the likely lower severity of Omicron and the time lag in people going into hospital. "At the moment, if you look at the people who have been hospitalised, they are going in with less severe conditions than before," minister for Vaccines and Public Health Maggie Throup told Sky News, adding that the "Plan B" Johnson brought in in December was working. "The numbers that are in hospital beds is about half what it was a year ago - and that just shows the power of the vaccine."

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.

Almost nine in ten community pharmacists in England say they have patients who sometimes go without prescription medicines because they cannot afford the prescription charge levied by the government. Sixty-eight per cent of pharmacists in a National Pharmacy Association (NPA) survey, conducted via email in June 2022, said this has become more frequent in the past year - suggesting that the rising cost of living could be leading more people to miss out on vital medicines. While prescription charge does not apply in Scotland, Wales and Northern Ireland, in England an NHS patients needs to pay £9.35 per item. For patients who need multiples medicines the cost could be exponential and virtually unaffordable amid rising inflation and higher cost of living. The survey found that 89 per cent of pharmacies in England have patients who sometimes go without prescription medicines due to cost. For most pharmacists (74 per cent) this happens one to five times a week. Fifteen per cent said they see such patients from six to 20 times a week.

The Royal Pharmaceutical Society (RPS) Director for Scotland Clare Morrison participated in the panel discussion alongside representatives from other health professional organisations on tackling the workforce crisis at the SNP conference in Aberdeen on 8 October. At the conference, the Cabinet Secretary for Health and Social Care committed to achieving protected learning time for health professionals. Morrison welcomed the Cabinet Secretary's statement as fantastic news for pharmacists across Scotland. "RPS Scotland will follow up the discussion by writing to the Cabinet Secretary to request a meeting to discuss achieving protected learning time, the forthcoming results of our workforce wellbeing survey, and positive examples of how pharmacy teams have improved the well-being of their teams," said the society.

The Pharmaceutical Society NI (PSNI)'s Council has decided to freeze the annual registration fee for the current financial year 2023/24. The annual registration fee is considered each year by the PSNI's council. At its meeting in November 2022, Council members in recognition of the effects of the Covid-19 pandemic, the personal and professional impact of the cost of living crisis on pharmacists, and the overall cost of regulation agreed to maintain registration fees at their current level for the next financial year. Pharmaceutical Society NI's Chief Executive Michaela McAleer said: "I am pleased with Council's decision to continue the freeze on registration fees for the 7th successive year. We are acutely aware of the pressures facing the pharmacy profession and hope this can provide some reassurance to the profession as we deal with these financially difficult times.

Many of us know that oral health plays a hugely important role in our general health and wellbeing. We're continuing to see a rise of cosmetic dentistry such as veneers and teeth whitening[1] but fundamentally, it shouldn't be forgotten that oral health encompasses so much more than aesthetics. Our diets, the oral hygiene products we are using, and our brushing techniques are all elements that impact our oral health. It's been hard to miss in the news that there is a dental crisis in the UK, with 'dental deserts' leaving some areas with over 3,000 patients for every NHS dentist[2]. With oral health being of such importance to our overall health[3], it's only reiterated to us at Haleon that we must continue to promote access to dental care and understanding of better dental health. As I've mentioned in previous articles for Pharmacy Business, an understanding of preventative, self-care is hugely beneficial, not just to improve health inclusivity but to help reduce these current burdens on both healthcare and dentistry professionals. We know that at Haleon, we, and the consumer healthcare industry as a whole, have a responsibility to empower people to equip themselves with the tools and information to participate in their own and loved ones' health - and dental health is such an important part of that.

The country as a whole is facing uncertain and challenging times, and for our profession emerging from the second year of the pandemic, the pressures and stresses don't look to be easing up. It is undeniable that the wellbeing of those in our pharmacy family has suffered and many face emotional and psychological challenges in addition to immense workplace pressure. What do we know about the state of wellbeing within the profession? As the profession's independent charity, it is crucial that Pharmacist Support keeps abreast of the changing needs of the profession to enable us to meet the needs of those we are here to help. To do this, each year we collaborate with the Royal Pharmaceutical Society (RPS) to carry out an annual Workforce Wellbeing Survey. The last survey carried out was in the latter part of 2021 but nothing has changed since. And the results provided stark reading. Of the 1,014 responses received, many reported living with 'poor' or 'very poor' mental health and wellbeing. The survey results highlight a continued clear need for mental health and wellbeing support. Within the survey, it was identified that there is a very clear need for independent assistance, with many saying they feel unable to talk to their employers about their mental health issues. The need for our charity has never been clearer.

The UK is lagging behind comparable countries when it comes to cancer survival, Cancer Research UK (CRUK) has said, calling on all political parties to make cancer a top priority in their party manifestos. While cancer survival rates in the UK have doubled over the last 50 years, the charity warned that the hard-won progress is at risk of stalling, with NHS cancer services in "crisis" and around half a million cancer cases a year projected by 2040. The charity has published an ambitious cancer plan which, if adopted by the next UK government, could dramatically improve cancer outcomes and prevent 20,000 cancer deaths a year by 2040. Called "Longer Better Lives: A Manifesto for Cancer Research and Care", the plan has been developed with the insights of cancer patients and experts from across health, life sciences, government and academic sectors, it said.