Independent community pharmacies in England, Wales and Northern Ireland could be limiting their services to patients in the New Year following a near unanimous vote in favour of collective action in the National Pharmacy Association’s ballot (report Patrick Grice and Richard Thomas). 

In the ballot pharmacy owners unanimously said they were willing to limit some aspect of their services “in the interests of patient safety” if improved funding is not forthcoming.

With 3,399 (63.5 per cent) of NPA members in England, Wales and Northern Ireland taking part – 3,049 pharmacies in England and 350 from Wales and Northern Ireland – the vote “reflects the sense of anger among pharmacy owners”, says NPA chair Nick Kaye.

In response to the options set out in the ballot, pharmacy owners in England voted:

• 97.8 per cent voted to serve notice on opening hours above the minimum required by their contract – meaning fewer pharmacies will be open in the evenings and at weekends

• 93.3 per cent voted to stop free home deliveries of medicines

• 96.1 per cent voted to withdraw from locally commissioned services, including some local addiction support services, emergency contraception and stop smoking support

• 99.2 per cent voted to refuse to co-operate with certain data requests above those required for patient safety and contractual minimums

• 96.8 per cent voted to stop supplying free monitored dose systems other than those covered by the Disability Discrimination Act.

The NPA has urged the Government to meet and discuss an “urgent uplift for pharmacy funding to guarantee patient safety and services for vulnerable people – alongside a modernisation of pharmacy with a funded expansion of clinical services”.

The Association has warned that without a “significant uplift” in funding it would have no choice but to recommend pharmacies to withdraw services to patients. “We will await a response from the government before deciding to advise its members to take collective action, but action could take place in the new year,” it says.

Any actions taken as part of its ballot are advisory, says the NPA.

Safety concerns

Independent pharmacies also voted in favour of a motion saying pharmacy owners “cannot guarantee community pharmacy services will remain safe into the future if the current depressed funding, pharmacy closures and increasing workload continues”.

The results of the ballot come shortly after the Budget on October 30 increased National Insurance contributions and the National Living Wage. So far, the Government has not committed to supporting pharmacies to cover these rises, unlike other parts of the NHS.

Some 700 pharmacies have shut in England in the last two years, severely impacting access to medicines and care for the local communities they served, says the NPA. Over the last decade, over 1,250 pharmacies have closed.

Pharmacy funding is set by devolved governments, but most pharmacies voting in Wales and Northern Ireland also voted for action in protest at underfunded medicine reimbursement.

Medicine funding arrangements through the Drug Tariff are set by the Westminster government for pharmacies in England, Wales and Northern Ireland.

Scottish pharmacies have a separate system and are not involved in the current ballot.

NPA chair Nick Kaye said: “Pharmacies desperately want to support their local communities but have been forced into an untenable position by a decade of underfunding.

“The sense of anger among pharmacy owners has been intensified by the Budget – with its hike in National Insurance employers’ contributions and the unfunded National Living Wage increase – which has tipped even more pharmacies to the brink.

“The ballot result overwhelmingly shows the sheer anger and frustration of pharmacy owners.

“We strongly agree with the new government’s ambition to boost community health care and hope to meet with them to discuss a new funding deal for pharmacies and modernisation of pharmacies to increase the number of clinical services they deliver, as long as they are properly funded.

“Pharmacy owners are not a radical bunch, we have never proposed action like this before, but after a decade of underfunding and record closures, something simply has got to give.”

Recommendations & reaction

The NPA will now make recommendations on collective action to members in January should the Government fail to make a satisfactory funding offer. This will enable ministers to “digest the results” owing to the strength of the yes vote and the high turnout, the Association claimed. 

Commenting on the ballot results, Company Chemists’ Association chief executive Malcolm Harrison said: “The results of the NPA ballot serve to underline the huge pressure that pharmacy contractors face, following a decade of underfunding. It is imperative that CPCF renegotiations for 2024/25 commence without delay.

“The Government and NHS must uplift all elements of the contractual framework, to stop further reductions in pharmacy opening hours and permanent pharmacy closures, and to ensure that patients can continue to receive the medicines and clinical care and advice they need.”

Numark chair Harry McQuillan said the ballot result had “once again brought into sharp focus the financial crisis facing community pharmacies – but for many independent pharmacies, this is an everyday reality that has reached breaking point. Rising operational costs including the increase in national insurance and minimum wage will push many to the brink.

“Our members across the country, but especially those in England, are sharing stories of overwhelming financial strain, and, sadly, some have had to close their doors for good,” he continued. “Each closure leaves a gap in healthcare provision, impacting patients who rely on their local pharmacy for advice, care, and essential services.

“Independent community pharmacies need immediate, sustainable funding from the Government to keep their doors open. Without action, more closures are inevitable, and the ripple effect on community healthcare will be profound.”