Cuts, drug shortages and now extra work: inside the pharmacy crisis

Rishi Sunak’s promise of a chemist’s ‘revolution’ sounds like good news but piles more pressure on a struggling service.

The pharmacy – or chemist’s – used to be the beating heart of the high street. A familiar face would dispense anything from advice for an earache to the right factor of sunscreen to take on holiday. But for many of us, the local pharmacy is no more, as local branches close and the friendly faces behind the counter become increasingly overworked and out of pocket.

On the face of it, yesterday’s promise of a pharmacy “revolution” by the Prime Minister is good news for everyone. New powers granted by the Government mean that seven million patients a year who are suffering from conditions such as sore throat, shingles and urinary infections can now get prescriptions of antibiotics directly from pharmacies without a GP appointment. Many patients will be relieved that there will be fewer illnesses demanding that souldestroying 8am scramble for GP appointments, and the tyranny of the call queue.

“In many ways, the announcement is positive,” says Tase Oputu, chair of the English Pharmacy Board for the Royal Pharmaceutical society. “Both pharmacists and patients used to find it frustrating when we sent them off to the GP for a condition we knew we could diagnose and treat ourselves. We are fully trained professionals, and despite these new prescribing guidelines, know when a patient needs referring for more urgent care.”

But, Oputu says, the fresh guidelines will certainly add “extra work” for the community pharmacists she represents.

For those working behind the counter, “extra work” is something of an understatement.

“Our workload keeps going up, and pharmacists are exhausted,” says Dr Leyla Hannbeck, a clinical pharmacist and chief executive of the Association of Independent Multiple Pharmacies. “As every day goes by, we are losing money. The Government has put aside £645million to implement this service, but it is nowhere near enough. Pharmacies are operating under a funding shortfall of £1.2 billion.”

Hannbeck points to the fact that pharmacies’ funding was cut in 2015, only to be reinstated in 2019. “But the amount allocated does not keep up with inflation,” she says. “All our costs have gone up: staff costs, the rise of the minimum wage, and the cost of drugs, particularly. Pharmacists are finding they no longer keep their heads above water. Some are even tapping into their pensions or even calling on their families for money.”

The result is that many pharmacies can no longer afford to operate. According to a 2023 report by the Company Chemists’ Association (CCA), more than 1,000 GP practices and pharmacies have closed over the past seven years, with the most deprived areas hit hardest. “The Government is sleepwalking into a disaster within primary care, and we could soon see primary care cold spots emerge in different parts of England,” said Malcolm Harrison, chief executive of the CCA at the time. In June last year, the chain Lloyds closed 237 pharmacies, with a loss of 2,000 jobs. So why is it then, that in countries such as France or Spain, we still see the brightly illuminated pharmacy cross on every corner? Recent figures from Chemist and Druggist magazine have shown that while the UK has 21 pharmacies

for 100,000 people, France has 33, and Greece as many as 88.

France is a particular beacon of wellness provision: a third of pharmacies are in locations with fewer than 5,000 inhabitants and offer services such as needle exchange programmes, rapid testing for HIV, flu, high blood sugar and strep throat, as well as distributing colon cancer testing kits.

“Many overseas pharmacies are privately run,” says Hannbeck. “In Scandinavia, where I am from, the system is funded differently from the UK. Some pharmacists are paid by the government, but others are privately owned businesses or funded by the patients’ health insurance. In the UK, however, 90 per cent of pharmacies are contracted to the NHS. As NHS funding remains static, and drug costs go up, we continue to struggle. For example, we might receive £2 from the NHS for a painkiller for which the drug wholesaler charges us £5 – and we can’t pass the difference on to the consumer.”

Front-line staff are not only feeling the strain in their pockets, but in the declining standards of behaviour among their customers.

Mark Hewitson is a pharmacist with two practices in Dorset. “In the past few years, the situation has deteriorated, as people can’t get GP appointments, so they take it out on us,” he said last year. “It’s also been the case that in the past couple of decades, as funds are stretched, pharmacists have increasingly been used to handle the growing pressure elsewhere in the NHS. When I first qualified in 2003, pharmacists were long established as trusted members of the community, treated with respect. And I’d like to make clear that the vast majority of our patients still treat us that way. But in my two pharmacies, a growing minority do not.”

Several factors are behind this customer frustration, including an increasing shortage of drugs. Earlier this month, a treatment for controlling epileptic seizures was the latest to be added to a UK drugs shortage list already including 70 vital treatments ranging from cancer to schizophrenia and Type 2 diabetes. One insider called the system “unviable and broken”.

A spokesman for the Royal Pharmaceutical Society said this could be down to “manufacturing problems, key ingredients missing and global demand putting pressure on supplies”. In an attempt to overcome the shortage, doctors are apparently swapping patients onto alternative and similar medicines, which in turn causes those to run out of stock.

“The supply chains are a mess,” says Hewitson. “HRT is a problem, but most of our female customers have been remarkably understanding. But the other day, we had a Parkinson’s patient who was piqued because we didn’t have his meds. This was perfectly understandable – without these vital medicines, it’s difficult for many sufferers to move. In this situation, we do what we can, including borrowing drugs from other pharmacies.”

Patient frustration is projected over the counter. A recent report from the Pharmacists’ Defence Association showed that 85 per cent of pharmacists say they, or someone they work with, have experienced verbal or racial abuse in the previous month while at work. “It’s true pharmacists are increasingly burnt out,” says Tase Oputu.

According to a 2022 wellbeing survey, 89 per cent of respondents indicated they were at high risk of burnout, and 57 per cent reported being frequently unable to take a rest break or were not offered one at all. One in three were considering leaving the profession altogether.

Those on the ground say things took a turn for the worse during the pandemic. Hewitson says: “People went very quickly from clapping us on Thursday nights to threatening physical violence. ‘You’re useless,’ they yell. ‘Why is there always a queue? Where are my tablets? You don’t know what you’re talking about.’”

Six years ago, Hewitson’s pharmacy was robbed of thousands of pounds of cosmetics by “a gang who threatened me with a knife. But until a pharmacist is found on the floor lying in a pool of blood, no one will take this abuse seriously.”

The robbers took several thousand pounds’ worth of stock that day. Hewison calculates he has lost £40,000 from separate thefts. “People are shoplifting again – especially now they are worried about the cost of living,” he says.

“Pharmacies see around 1.6million people a day. That’s more than A&E and GPs put together. Our staff are not earning fortunes: far from it. We pick up all the pieces from the rest of the NHS. We need protection and respect. We need something better.”