‘Without your help, Rishi, many chemists will close for ever’
Step inside Prime Minister Rishi Sunak’s former family pharmacy in a leafy suburb of Southampton, and you wouldn’t guess that Britain’s High Street chemists are collapsing en masse under the weight of a financial crisis and overwhelming demand.
Mr Sunak’s mother Usha owned the well-ordered shop between 1995 and 2014. In recent years, the Prime Minister has spoken fondly of how he used to help her fill in prescriptions and do the accounts.
This wasn’t some humble ‘life above a shop’, though. Mr Sunak’s pharmacist mother and NHS GP father paid for him to attend the world-famous Winchester College public school (where boarding fees are currently £45,936 a year), where he was head boy.
A sense of social advantage persists today: the pharmacy sits on a small parade between beauty clinics and a delicatessen butcher’s, overlooking wooded parkland, on a hill of large, comfortable detached homes. On the wall outside, the pharmacy’s original Art Deco clock still keeps perfect time. Inside the store, now renamed Bassett Pharmacy, the pharmacist greets me politely but warily.
Ready with a remedy: Rishi Sunak behind the counter of what was the family pharmacy
Yes, he agrees, the wider world of independent community pharmacies might look precarious. But not here, he maintains. ‘We’re OK.’
Walking past the orderly queue of smartly dressed retirees awaiting prescriptions, one can only wonder if Mr Sunak’s rosy memories of helping out with the business can explain the apparent tardiness in tackling the disaster threatening community pharmacies.
For while the Government hopes these very businesses will play a key role in easing the burden on GPs and the NHS, community pharmacies are collapsing under the weight of NHS underfunding, spiralling drug prices and overheads, staff shortages and a failing GP service.
Many are facing closure, with huge consequences for all those who rely on them.
It has been calculated that the NHS payments on which independent pharmacies rely have effectively shrunk by 30 per cent, as a result of spiralling costs and growing demand, since they were set in 2015.
And while there have been repeated calls on the Government to address this financial crisis, they have had little apparent impact.
Mr Sunak’s mother Usha owned the well-ordered shop between 1995 and 2014. Pictured: the pharmacy under its previous signage
Now, as Good Health can exclusively reveal, the bodies representing pharmacies large and small across the country have come together to write a direct letter to the Prime Minister, asking for his help.
Seb James, the chief executive of Boots; and Kevin Birch, the chief executive of LloydsPharmacy, are among the signatories who warn that unless the Government can help resolve the crisis ‘engulfing community pharmacy businesses of all sizes’, many pharmacy owners believe their businesses will not survive 2023. For the reality at many pharmacies is not like the world of the PM’s old family business. Instead, it is what Dinesh Ganatra wakens to every morning with a tight knot in his stomach. ‘What’s today’s new crisis? That’s my first thought,’ he tells me.
Dinesh has been working in community pharmacies for 43 years and runs a small chain of six branches, one in Yorkshire, two in East Anglia and three within the M25. ‘I am currently forced to work 75-hour weeks. I am 66 years old, diabetic and have bad knees and failing vision in one eye,’ he says.
‘Despite poor health, I am opening up the Norwich branch tomorrow morning because a shortage of pharmacists means the shop wouldn’t be able to operate otherwise.
‘My plan was to retire five years ago but the worsening financial situation made that impossible.’
It was almost eight years ago that pharmacies’ basic funding deal from the Government to provide NHS services was last negotiated. It should cover dispensing costs including staff pay, IT systems and other overheads.
The price set back then was £1.27 per item. But inflation and rising bills mean dispensing actually costs more like £2.
This shortfall in prescription funding can hit community pharmacies in poorer areas twice as hard as those in more affluent places, such as the Sunaks’ former family shop.
Earlier this month, a report from the NHS Business Services Authority revealed that the average number of prescription items issued per person in the 20 per cent most deprived areas in England was nearly double that in the rest of the population — 33 prescription items, compared with 17 in the remainder of the country.
This leaves pharmacists such as Dinesh struggling to make ends meet. ‘I do all my company’s admin, so I constantly see the financial and bureaucratic burdens we suffer and the outrageous demands on us,’ he says.
Seb James, the chief executive of Boots is among the signatories who warn that unless the Government can help resolve the crisis ‘engulfing community pharmacy businesses of all sizes’, many pharmacy owners believe their businesses will not survive 2023
Dinesh is just one of the many community pharmacists whom Mail readers have singled out for their key role in the community, while highlighting their fears that this vital lifeline is under threat.
The letter from Hazel Lee, an 89-year-old from Norfolk, who wrote to us about Total Health Pharmacy in Thetford, which is part of Dinesh’s chain, was typical: ‘I don’t think I would survive if the place was closed down,’ she said.
Hazel has come to rely on the pharmacy because these days she can only normally obtain phone consultations with her GP.
These usually don’t resolve her problems, she says, as what she really needs are face-to-face consultations and support. Yet as it is reported today, one adult in four who needs to see a GP can’t get an appointment, according to Office for National Statistics data.
‘In the chemist’s they help with my blood-pressure monitoring, general pains and things like that,’ Hazel tells me. ‘But the staff there will do a whole lot more.
‘For example, my eyesight is afflicted with macular degeneration [which blurs the middle part of vision]. I went to the hospital and was given an eye injection and pamphlets to read that made no sense to me. At Total Health they sorted out some helpful medication, went through the pamphlets with me, then printed me a 12-page guide of easy dos and don’ts.’
And when a driver smashed into her parked car last year while she was in it, the pharmacy again stepped in. ‘I felt badly shaken, so I went in for help. The young lady assistant settled me, then she took me home in her own car.’
Dinesh tells me: ‘Hazel is typical of the people who depend on us. There are countless other Hazels. Locally, people don’t get as much help from the NHS as our staff provide nowadays. Despite everything, our staff still manage to give the highest level of service. They see people in desperate need and their hearts go out to them.’
Mr Sunak’s pharmacist mother and NHS GP father paid for him to attend the world-famous Winchester College public school (where boarding fees are currently £45,936 a year), where he was head boy
But, compounding the pressure on independent community pharmacists, those wonderful workers are fast disappearing.
‘The NHS has poached about half of my trained staff,’ Dinesh laments. ‘I used to have 67 pharmacists on the rotas for my six branches. Now I have only 19. The NHS poached 48 of them to stem its own staff shortages in hospital and GP surgery pharmacies, by offering pay rates that I can’t afford to match now. The health service gets paid to offer pharmacists higher salaries. I don’t.
‘All I’m getting from the health service is less money overall every year to cover prescription costs, while my labour costs and business overheads are spiralling.
‘Any other business would put up its prices to compensate. But we have zero power to change medicine prices because they are set by the NHS — and currently they make us operate at a loss.
‘As a result, our remaining staff all have to work harder to make up for the shortages, which means their work pressures are effectively doubled. My area manager recently burned out at 51. He just couldn’t face the workload any more.
‘I reckon I started to burn out three years ago but I have no option but to keep going.’
A report revealed that the average number of prescription items issued per person in the 20 per cent most deprived areas in England was nearly double that in the rest of the population
A survey published this month by the Royal Pharmaceutical Society found that those working in community pharmacies were at higher risk of burnout (96 per cent) than those in all other health service sectors, such as GP practices and hospitals (80 per cent). ‘It feels like the community pharmacy network is being systematically dismantled,’ says Dinesh. ‘But if we disappear, the whole NHS system will collapse.
‘It seems like people in the Government don’t care.’
While Dinesh tries to keep all his pharmacies open, others are closing. Already this month the huge chain LloydsPharmacy announced that it is withdrawing all 237 of its pharmacy services from Sainsbury’s stores in 2023.
It only bought the pharmacy network in 2015, but now says that ‘in response to changing market conditions’, it is pulling out.
Outside Sainsbury’s, LloydsPharmacy operates about 10 per cent of UK community pharmacies. But analysts say it has sold some branches in recent months.
Last September, a report by Ernst & Young, the London School of Economics and University College London warned that thousands more community pharmacies in England might close by 2024.
In response to the Sainsbury’s closures, Janet Morrison, the chief executive of the community pharmacies’ negotiating body, the Pharmaceutical Services Negotiating Committee (PSNC), told Good Health: ‘Community pharmacies have had their funding cut by some 30 per cent over the past seven years and are facing more extreme pressures than ever before. This significant shrinkage by the second largest pharmacy chain is one of the clearest signals yet of just how much all community pharmacies are struggling to make ends meet.
‘Many are at breaking point. Without further investment, more permanent closures are likely.’
The chief executive of the Association of Independent Multiple Pharmacies (AIMP), Dr Leyla Hannbeck, added: ‘If organisations like Lloyds and Sainsbury’s are struggling to make pharmacies pay, where does that leave the rest of us?’
And the impact of closures will be felt most keenly by the most vulnerable, often older and more frail patients. If the Government ‘continues to ignore our appeals for fair funding, they will be failing millions of people who rely on pharmacies for accessible healthcare, including many vulnerable older people’, says Mark Lyonette, chief executive of the National Pharmacy Association.
This ever-mounting crisis is why the Mail launched a campaign last autumn for proper government funding to save our independent community pharmacies.
Dinesh said: ‘All I’m getting from the health service is less money overall every year to cover prescription costs, while my labour costs and business overheads are spiralling’
Building on our initial call for public support, earlier this month a consortium of community pharmacy organisations that includes the PSNC and the AIMP, announced plans for a campaign for fair pharmacy funding.
They have now written directly to Rishi Sunak, saying that while they are keen to help alleviate the pressure felt by collapsing GP services by taking on new roles such as prescribing medications for blood pressure and minor ailments, this is ‘not achievable’ unless the Government can help resolve the funding, workforce and capacity crises. They add: ‘Without urgent intervention we are moving towards large numbers of permanent pharmacy closures, putting the safe supply of prescription medicines at risk.’
As Janet Morrison told Good Health: ‘This is a critical time for community pharmacy and it’s important that the Prime Minister knows that.
‘It’s good news that the Government sees community pharmacies as part of the solution to NHS challenges. But the PM should also know that community pharmacies need sustainable investment, urgently, to avoid devastating consequences.’
Adding to the consortium’s calls, last week the All-Party Parliamentary Pharmacy Group launched a report that demanded the Government ‘take urgent action to relieve the funding pressures on the community pharmacy sector’.
The chair, Taiwo Owatemi MP, told Good Health: ‘People are shocked to learn how many local pharmacies are lost each year due to financial pressure. If ever there was a time to properly fund and support our pharmacies, it is now.’ An extra £750 million is the minimum needed, according to the Company Chemists’ Association, which warned this month that government underfunding means the community pharmacy sector is losing this amount annually.
‘It’s a fraction of what the Government wasted on the PPE scandal,’ says Dinesh. As well as funding, ‘on a more modest but crucial scale we need a change in our pharmacy-supervision rules,’ he says.
He explains: ‘Under the present rules, if I dispense a medicine and put it on a shelf all ready to go, my highly experienced shop staff can’t give it to customers unless I’m physically there in the shop.
‘But I can hand that same medicine to a delivery driver to give out on their rounds and it’s perfectly OK. That’s the sort of insanely inefficient bureaucracy that drains our dwindling time and energy.’
With the impetus of the Mail’s campaign behind them, the clamour from health professionals and politicians to take action is growing to a crescendo.
Will it be enough to shake Rishi Sunak from any rose-tinted reveries to address the harsh realities facing so many? Millions of patients, including people with serious health needs just like Hazel Lee, can only hope so.
For a digital copy of the template letter that you can copy and paste to send to your MP, email: [email protected]
Has your local pharmacy helped you? Email us your story, or write to: Good Health, Daily Mail, 9 Derry Street, London W8 5HY
We pay £12 for antibiotics… and the NHS only gives us £2 back
By Julie Cook
Dimple Bhatia, 48, is owner and superintendent pharmacist director at Tollesbury Pharmacy, near Maldon in Essex, where he has worked for 15 years.
He says the pressure of work at his pharmacy, which serves about 3,000 people and delivers prescriptions within a 15-mile radius, is becoming unsustainable. ‘Pharmacy has become a pretty reactive service where your day can’t be planned,’ says Dimple.
‘With the overspill from lack of GP, primary and secondary care appointments, you can spend an hour providing first aid unexpectedly or having to call social services with concerns for a vulnerable adult.
‘There’s also huge patient demand. And with checking 400 prescriptions a day, talking to more than 40 people a day, doing flu and Covid jabs and ordering stock, it’s full-on.’
Dimple Bhatia is owner and superintendent pharmacist director at Tollesbury Pharmacy, near Maldon in Essex, where he has worked for 15 years. Pictured: Dimple Bhatia and customer Debbie Keating
This extra demand, he says, is occurring as overheads soar and government funding falls.
‘For example, we are buying medicines such as omeprazole 20mg for £2.50 a pack and are reimbursed by the Government at 86p,’ he says.
‘Co-amoxiclav 625mg (an antibiotic used for chest infections) we have been buying at £12 but are reimbursed £2.04.
‘Although the Government may announce a concessionary price adjustment at the end of the month for that particular drug, we don’t know if we will be paid for what we have supplied.’
Then there is the personal toll. ‘My work-life balance is rubbish,’ says Dimple, who is married with two children, aged 18 and 15. ‘I’m working 60 to 80 hours a week. I can’t recall the last Sunday when I haven’t had to do paperwork.
‘On my first holiday in three years in July, I asked the hotel to bring me a computer so I could process pharmacy orders. I am typical of most independent pharmacists who just get on with it because we have a responsibility to our patients, staff and families.’
And his customers do really depend on him.
Debbie Keating, 52, who works in website design, says, ‘As we’re a small village, Tollesbury Pharmacy is a godsend.
‘Getting to see a doctor is becoming nearly impossible, so knowing Dimple and the pharmacy staff are always happy to help is so valuable.’
Another regular customer, Susie Devonport, 46, who is a teacher and has multiple sclerosis, agrees: ‘The next nearest pharmacy is 15 minutes away by car, and some people don’t or can’t drive.
‘Recently Tollesbury Pharmacy went above and beyond when my husband cut his knee badly. He had hospital treatment, then needed a specific type of dressing.
‘None of the big pharmacies could help but Tollesbury Pharmacy sorted it for us.’
Like so many pharmacists, Dimple now faces the choice of struggling on or leaving the career he loves. ‘Pharmacy is sinking and surviving only on the goodwill of pharmacy operators,’ he says. ‘If we value the difference that pharmacy makes in the community, we should invest in them.’
Letter: Save our pharmacies
As representatives of NHS community pharmacies and the largest operators in England, we are encouraged that the Government and GPs recognise the central role pharmacies must play in tackling the challenges facing the NHS.
They can free up millions of GP appointments and provide easy- access to urgent care and healthcare advice through a fully funded Pharmacy First service.
But this vision for the future is not achievable unless the Government can help us to resolve the funding, workforce and capacity crises engulfing community pharmacies.
The 30 per cent funding cuts over the past seven years have pushed us to our limit. Many pharmacy owners believe their businesses will not survive this year, and the constraints are degrading patient services.
We have reached a fork in the road: the Government can empower us to do more by providing a blueprint for the future of the community pharmacy network, backed by investment; or we can continue down the path of squeezing funding, in which case we face unprecedented closures, with serious consequences for patients.
Seb James, Boots UK; Kevin Birch, LloydsPharmacy; Seb Hobbs, Well; Steve Anderson, Phoenix UK; Janet Morrison, PSNC (Pharmaceutical Services Negotiating Committee); Malcolm Harrison, CCA (Company Chemists Association); Dr Leyla Hannbeck, AIM (Association of Independent Multiple Pharmacies); Mark Lyonette, NPA (National Pharmacy Association).