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Community pharmacy is stuck in a vicious circle. Pharmacies are closing at an alarming rate whilst the government is talking about moving care away from hospitals and into the community to focus on preventative care. While the government talks about this vision for the future, the stark reality is that pharmacies are already struggling to meet the current Pharmacy First thresholds. And now we discover that one of the key components that could create capacity in pharmacy to deliver more clinical services has been put on hold…indefinitely. The recently published Darzi review, which was commissioned after the new government came to power to assess the state of the NHS, praised the value of community pharmacies and preventative services. But it recognised the level of pharmacy closures across the country and warned pharmacy access could be 'at risk'. Community pharmacy is ideally placed to deliver the government's vision of preventative care in the community. But let's all be clear, moving preventative services into community pharmacies has, so far, been nowhere near as successful as it could have been due to the current climate pharmacies find themselves in. The Pharmacy First scheme is a testament to this. Just this week it was announced that consultation thresholds for the Pharmacy First scheme have been reduced from 30 consultations to 20. It's the second time in three months that the thresholds have been reduced and it follows an intervention from Community Pharmacy England who wanted to "save many pharmacies from missing out on a vital payment this month." In June alone, 3,269 participating pharmacies failed to meet the threshold - that's almost a third of all community pharmacies in England.

The pharmacy bodies have expressed a deep concern over Lloyds Pharmacy's announcement on plans to close all pharmacy branches located in Sainsbury's before the end of 2023. Pharmaceutical Services Negotiating Committee (PSNC) Chief Executive Janet Morrison said: "This significant shrinkage by the second largest pharmacy chain is an extremely worrying development and one of the clearest signals yet of just how much all community pharmacies are struggling to make ends meet. We know that many are at breaking point." She added: "We understand that LloydsPharmacy will be in touch directly with affected staff and patients at this difficult time. As these pharmacies close, other pharmacies locally will be braced for even more pressures as they try to cope with increased demand." "The announcement by LloydsPharmacy will be of concern to staff, patients, the public and the community pharmacy sector alike," Malcolm Harrison, Chief Executive of the Company Chemists' Association (CCA). Pharmacists, and other employees, working at pharmacies owned and operated by LloydsPharmacy in Sainsbury's have been told that the group of more than 200 pharmacies will be closed this year as LloydsPharmacy will be ending their relationship with the supermarket chain.

Online pharmacy delivery partner Gophr has released new data showing a further drop in pharmacy numbers in England, resulting in a phenomenon they call 'Pharmacy Deserts'. Gophr highlighted that a significant portion of the population now lives in 'pharmacy deserts,' referring to the situation where an increasing number of urban residents struggle to access a shrinking number of pharmacies. For the second consecutive year, Gophr has analysed the data for its 'Prescription For Pressure' initiative. The analysis showed that in 2023, pharmacists dispensed 1.18 billion prescriptions across England, marking an increase of 137 million compared to 2022. The average number of prescriptions per pharmacy stands at 103,380, which equates to 283 a day. As calculated by Gophr's data experts, pharmacy numbers decreased from 11,522 in 2022 to 11,414 in 2023, reflecting a decline of 108 compared to the previous year's 'Prescription For Pressure'. Gophr's data also showed that pharmacy deserts are most prominent in the South East (6,024 people per pharmacy), the East of England (5,327), the South West (5,284), and the Midlands (4,975). London, which ranked high last year, fell out of the top four, with 4,759 people per pharmacy.

Community Pharmacy England (CPE) has published its latest Pharmacy Pressures Survey report, highlighting the impact of staffing shortages, underfunding, escalating workload pressures, and extreme stress and burnout. These pressures are affecting not only the personal and professional lives of pharmacy staff but also the quality of patient care. The Pressures Survey 2024: Staffing and Morale Report is based on the views of the owners of over 6,100 pharmacy premises in England and 2,000 pharmacy team members. In the survey, 86 per cent of pharmacy team members reported that staffing shortages have resulted in longer waiting times for patients, impacting timely access to medication and advice. Nearly two-thirds (62 per cent) of pharmacy staff indicated that staffing shortages have led to a reduced ability to offer services or advice to patients in need. Almost all pharmacy staff (92 per cent) stated that they were not coping well and were struggling with their workload.

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."

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.

In response to concerns raised by Community Pharmacy England (CPE), ministers have decided to lower the October threshold for the Pharmacy First service to 20. This decision addresses a major worry for pharmacy owners who have struggled to meet the required number of clinical pathways for monthly Pharmacy First payments, especially as the October increase to 30 pathways approached. CPE has been actively engaged in discussions with the Department of Health and Social Care and NHS England over the past few weeks to address this issue. Commenting on the decision, Janet Morrison, CEO of Community Pharmacy England, said: "It is great that ministers have responded to our concerns about another increase to the Pharmacy First payment threshold: this decision will save many community pharmacies from missing out on a vital payment this month." Morrison added that CPE will continue to monitor service data and, if needed, make further representations to ministers about future months. She also emphasised the need to find a long-term solution, which involves "NHS England marketing Pharmacy First effectively and ensuring that GPs are actively referring people to the service."

Pharmacy First has demonstrated the enormous value of community pharmacy in providing accessible front-line care. However, pharmacists continue to face several challenges in delivering the service. "Pharmacy First is a success, but it needs proper support to reach its full potential," said Numark chairman Harry McQuillan. In the first year alone, community pharmacies in England delivered an incredible 2 million consultations, highlighting the vital role pharmacists and their teams play in supporting the NHS. "This significant number shows the high demand for accessible healthcare and the trust patients place in their local pharmacy teams. It's clear that when empowered, community pharmacy delivers," McQuillan told Pharmacy Business. Key challenges in providing the service While Numark members have embraced Pharmacy First, McQuillan pointed out several challenges that persist: "Workforce capacity continues to be a concern, with patient demand sometimes outpacing available resources. "The administrative burden, particularly around IT interoperability, data capture, and reimbursement processes, adds complexity." "Additionally, some geographical areas are still struggling with public awareness, meaning more work is needed to ensure patients understand when and how they can access Pharmacy First."

The Royal Pharmaceutical Society (RPS) has launched a new position paper on 'How pharmacy can do more to tackle health inequalities'. The RPS paper aims to help pharmacists and pharmacy teams to take action against health inequalities. It is designed to provide a reference source for pharmacy teams to use over time to continually improve services. RPS said: "Like all health services, these pharmacy services do not always reach everyone. Often it is people who are suffering the greatest inequalities that find it most difficult to access the services that are currently available. This can be for a large number of reasons including poverty, education, being part of a group vulnerable to exclusion, language and power." Therefore, the RPS paper focuses not on "what" services pharmacy provides but "how" they are provided, with an aim of making them more accessible for people who are currently struggling. Claire Anderson, President of Royal Pharmaceutical Society said: "It's fantastic that pharmacy teams in every sector of pharmacy across Great Britain are providing care that can improve health inequalities, with many patients able to access pharmacy services very easily. Brilliant examples of this shine through in the paper.

Munira Wilson, the Liberal Democrat MP for Twickenham, highlighted the impact of the community pharmacy closures in the Hampton area, and the severe financial challenges facing community pharmacies across England during an adjournment debate in the House of Commons on Friday. She also raised concerns about the impenetrable bureaucratic processes surrounding new pharmacy license applications and closures. Wilson highlighted the closure of two Boots pharmacies in Hampton last autumn, including one in the deprived ward of Hampton North. The Tangley Park pharmacy closure left the entire ward, which lacks adequate public transport, without a pharmacy, severely affecting elderly and vulnerable residents. "The nearest pharmacy is now a mile away on foot, a distance which is difficult to cover for the elderly and those with mobility issues, certainly more than a 20-minute walk, the measure that previous ministers like to use to highlight pharmacy accessibility," she said.

Many community pharmacies are under severe financial strain due to chronic underfunding and a mismatch between medicine costs and reimbursement rates. A report by the National Pharmacy Association (NPA) revealed that NHS underpays pharmacies by up to £75 a pack for common medicines, resulting in losses of thousands of pounds each month. The NPA analysis found that, in many instances, NHS funding covers only one-fifth of their purchase costs for medicines. Nemesh Patel, Managing Director of the Southdowns Pharmacy Group, said the current pharmacy funding contract is "completely broken and beyond farcical." Sharing their struggles, he tells Pharmacy Business: "Our teams are wasting hours and hours trying to just source medication for patients when they could be better using that time to clinically support our patients, and then when it comes to reimbursement, the drug tariff prices or concessionary prices are structured such that on hundreds of medications we dispense per month, we will be making a significant financial loss, each and every single time our pharmacies dispense that medication."

In a powerful display of unity, thousands of pharmacies across the UK participated in a nationwide protest today, organised by the National Pharmacy Association (NPA), as part of its #saveourpharmacies campaign. The NPA's day of action was aimed at drawing attention to the severe crisis in pharmacy funding that has forced 1,400 pharmacies to close over the past decade and left thousands more struggling. Participating pharmacies showed their protest through various actions like dimming lights, blacking out their windows, wearing black for the day, or discussing pharmacy funding with customers. Many pharmacies also seized the opportunity to interact with parliamentary candidate, urging them to address the funding crisis.

The trade bodies and four largest pharmacy chains in England, have jointly written to the Secretary of State for Health, Steve Barclay, warning that the sector needs urgent investment for sustainability. The letter from AIMp, CCA, NPA, PSNC, Boots UK, Lloyds Pharmacy, Well, and Phoenix UK, warned that the 30 per cent real terms funding cuts that pharmacies have faced over the past seven years have left many businesses in a cashflow crisis. The letter said that the government is facing a choice over the future of the country's 11,000+ community pharmacies, with permanent closures likely and medicines supply at risk if no urgent action is taken. "If the funding situation is not addressed, the sector is likely to move rapidly towards many permanent closures of pharmacies." The organisations say that once these closures start, they will be hard to stop, as the sector is now so fragile other pharmacies would struggle to pick up the slack.

The nationwide implementation of the Pharmacy First service is viewed as a significant development that benefits pharmacies, primary care, and the broader National Health Service (NHS). Pharmacy teams are striving to ensure its success despite challenges within the industry landscape. However, not all pharmacists are able to reap the benefits from it. Recently, two members of Numark shared their experiences of how the scheme is impacting their pharmacies. Graham Phillips, who owns Letchworth Pharmacy in Hertfordshire, revealed that patients are responding favourably to the service. "It's all good, people are just delighted to have easier access to care," he said. In its first month, Letchworth Pharmacy provided around 100 consultations, and Phillips envisions that as the service matures, they will be able to conduct an average of 200 interventions per week. "That will make it financially viable for us and mean that we're acting at scale from an NHS perspective. That's 200 GP appointments we've freed up in a week - that's a huge capability and capacity bump for the NHS," he added. Graham credits part of his success with Pharmacy First to the strong relationship he has established with local GPs in his area.

The Royal Pharmaceutical Society (RPS) England Chair Thorrun Govind has called for Government action to support pharmacy teams experiencing huge demand for their services. "Pharmacy teams are under immense pressure at the moment, in common with other NHS services, and working extremely hard with health service colleagues to provide the right care for patients," said Govind. "As winter pressures mount, pharmacies see increased numbers of patients seeking support with illness and also because they have heard other areas of the health service are struggling to cope. The society has also stated staffing pressures, alongside an increase in workload has created an extra burden which takes a toll on the wellbeing of pharmacy teams. Govind added: "Issues such as medicine shortages can also take up many hours of time for pharmacy teams tracking down medicines when they could be directly helping patients. In community pharmacies, rising costs and fairly static funding are adding to business pressures. "However, pharmacies remain the most accessible part of the health service and provide expert advice to patients without the need for an appointment and are open long hours and at weekends."

The Association of Independent Multiple Pharmacies (AIMp) has called upon all pharmacy organisations to unite and collectively represent the sector. While underlining the need for the sector to adopt a straightforward manifesto that can be presented to the public, politicians, and decision-makers, the association also advocated for a revitalisation of the 'Save Our Pharmacies' campaign, injecting it with renewed energy and a stronger sense of purpose. AIMp pointed out that a lack of cohesion is one of the factors contributing to the sector's struggle in gaining attention. "The current trajectory of community pharmacy is unsustainable," said Dr. Leyla Hannbeck, Chief Executive of AIMp. "To tackle the significant challenges ahead, we must work together cohesively. The most effective approach is to actively engage with Parliament, leveraging politicians from across the political spectrum to advocate for our cause." Meanwhile, the association urged various pharmacy bodies to unite in support of the Pharmacy All Party Parliamentary Group (APPG) to enhance its effectiveness and broaden its influence, rather than working independently.

Our Totton branch has an incredibly high volume of original pack dispensing, roughly 45,000 items. As we became busier and busier in the dispensary we were finding that our pharmacists, dispensers and other technicians simply didn't have capacity to deliver the services that we needed them to. We all know there is a real emphasis right now on pharmacies doing more services and we knew we had to change the way we operate to survive. So we decided it was time to look into a sound automation solution for our medication dispensing process, one that would allow us to free up the time of the pharmacists and the rest of the team so they could better support patients. After a lot of research we invested in Centred Solutions FLOWRx Hub and InStore solutions which were installed late last year. It provides us with the whole package and has automated our entire dispensing process from picking to packing and labeling to checking. Our situation was quite unique as we bought the system initially for our existing high-volume pharmacy in Totton so the hub and the spoke are actually on the same site. People wouldn't usually look at a hub and spoke solution for that kind of set up but it has allowed us to significantly free up time in store for more services. What it has also done is allow us to look at other opportunities to grow and expand. The pharmacy landscape is changing and there are lots of opportunities coming up. We have found that having your technology and the right infrastructure in place to support your existing footprint before you expand is the ideal way to grow in a safe and controlled way. We never thought that five years ago we would buy another pharmacy, yet we have already bought one and are now in the process of buying two more. I'm not worried about the increase in volume this expansion will bring because I know our technology is going to be able to support it. The pharmacies we are buying are struggling but having our solution already in place m

Janet Morrison, CEO of Community Pharmacy England (CPE) has emphasised that stabilization of the sector is essential before any solutions can be delivered to fix the "struggling" health service. Speaking at the recent SIGMA UK Community Pharmacy Conference 2024, Janet described the current contract as "unaffordable" and warned that pharmacies are becoming "unsustainable." "Without an urgent funding uplift, the sector is facing a 'house of cards' collapse that will seriously impact communities, patients, and the safety of medicine supply. "So, first of all, we have to secure the stabilization. We have to make sure you can keep the lights on and the doors open, and that's critical," she stated. Janet pointed out that if the sector is stabilized and a fair deal is achieved, community pharmacies could effectively deliver solutions for the government that meet their policy goals. However, she noted that negotiations for the Community Pharmacy Contractual Framework (CPCF) for 2024-2025 cannot resume until the budget is published on October 30.

The National Pharmacy Association (NPA) has been in dialogue with the senior management of NHS Property Services to bring down the rent for community pharmacies based in NHS health centres. Association said: "Community pharmacies based in NHS health centres are struggling to make ends meet due to expensive rental rates." It is calling for pharmacies to have the ability to renegotiate rental rates part way through a contract. Gareth Jones, Director of Corporate Affairs at the NPA, said landlords need to take into account that pharmacy spending power is shrinking and the previous formula used to set rental rates is no longer fit for purpose. "It no longer makes sense to calculate based on historical assumptions about how many prescriptions the co-located GP will generate for the pharmacy," he said.

Parliamentarians continue to highlight the serious challenges faced by community pharmacists, calling for increased support for the sector. On Wednesday, January 8, during Prime Minister's Questions, Marie Goldman, Liberal Democrat MP for Chelmsford, drew attention to the issue of pharmacies dispensing medications at a loss. Goldman cited the case of a pharmacy owner in her constituency who is 'sometimes forced to pay over 100 times more' for a particular mental health drug than the contract reimburses. Dipak, the pharmacy owner, has been serving his community since opening his pharmacy in 1991, often greeting patients by name. However, he is now struggling to keep his business afloat as his NHS contract no longer covers the cost of the drugs he dispenses. "Dipak is dipping into his life savings to keep the pharmacy afloat. I am sure many other pharmacies are doing the same," Goldman stated. She asked the prime minister whether he agreed that "no pharmacist should be forced to use their own money to keep their pharmacy viable."