EXCLUSIVE Pharmacy closures in deprived areas are not only impacting physical access to a local pharmacy. They may also be exacerbating health inequalities for those who are less likely to access online services.

The Pharmacist’s exclusive mapping of pharmacy closures suggested that the most deprived areas in England have lost nearly five times as many community pharmacy premises as the least deprived areas in the last five years.

And while our figures are based on General Pharmaceutical Council (GPhC) data of registered community pharmacy premises in England, we estimate that 90% of the more than 1,600 that have closed since 2019 provided NHS services.

Many of those closures were also in deprived rural and/or coastal areas, which the Countryside Alliance has previously described as ‘digital not-spots’ due to poor 5G coverage, leaving residents ‘left behind’ and ‘often unable to access the most basic of services online’.

Figures on pharmacy closures were put to NHS England as part of the Health and Social Care Committee’s (HSCC’s) pharmacy inquiry earlier this year.

In response, NHS England director for primary care Dr Amanda Doyle suggested that the provision of pharmacy services was balanced ‘in a different way’ amid a 9% reduction in the number of local community pharmacies, alongside a 9% increase in distance-selling pharmacies.

But Ade Williams, director and superintendent pharmacist of M J Williams Pharmacy Group in Bristol, told The Pharmacist that suggesting that pharmacy closures could be replaced by online services was ‘a false dichotomy’.

‘The pharmacy is no longer just about supply, it is now about equitable access to NHS care. And when the pharmacy closes, that is what is lost,’ he said.

Bricks and mortar community pharmacies also rely on ‘trust built over time’ and an ‘insight into how people and communities work’.

‘They're able to offer the care in a manner that is very accessible, and equitable, and community pharmacies excel at that.’

Jonathan Cooper, owner of Cooper’s Chemist, recently told The Pharmacist that the services his pharmacies provide ‘can’t be replaced with an online service’.

Speaking to The Pharmacist during the National Pharmacy Association’s recent ‘day of action’, he said the group’s patients ‘really appreciate the services we offer and they don't want to lose that’.

‘It can't be replaced with an online service. It's just not the same. Especially in our Great Ayton pharmacy… the average age of our patients is much higher. Most of them don't use the internet.

‘We do a lot of things for them, including free deliveries, which we're not getting reimbursed for. But also ordering the prescriptions for them and making sure that things are right. They can't get that online. And they would be really stuck if we were to close this branch down.’

Dr Emma Stone, director of evidence and engagement at the UK digital inclusion charity Good Things Foundation, warned that online pharmacy services ‘only benefits people with the digital skills, devices and connectivity needed to use these services’.

She told The Pharmacist: ‘Over eight million adults lack the most basic digital skills – and it is mostly people who are older, with health conditions and disabilities, and who live in deprived areas who face digital barriers.

‘We can't let digital divides - and health inequalities - deepen in our communities.'

People who need online health are struggling to access it

Jonathan Hassell, creator of an internationally-recognised standard for accessible IT services – ISO 30071-1 – told The Pharmacist that the patients most in need of health services were also the ones struggling the most to access online services.

‘Online health is a massively growing area, but a lot of the people who need online health are people who have difficulty seeing, or they get confused with passwords,’ he said.

Frustrations with using websites and apps were cited by 81% of people aged over 65 in a survey of 1,296 people carried out by digital accessibility service Hassell Inclusion in November 2023.

‘They didn't feel like [the websites and apps] were actually made for them,’ Mr Hassell told The Pharmacist.

More than one in 10 (11%) of over-65s said they would spend more time online if websites were more accessible for them, as did 26% with deteriorating eyesight, 20% who have problems with memory, and 15% who have difficulties with hearing or walking, according to the survey.

Mr Hassell suggested that improving online accessibility could be key to serving patients in these groups.

More than half (55%) of those surveyed were using the internet to order prescriptions, and six in 10 over-65s surveyed said their confidence in using apps and websites was ‘good’ or ‘very good’.

And he suggested that if contractors were transitioning to using more online solutions, they could serve this audience, retain customers and attract new ones by offering an accessible digital service.

‘There is something about that relationship with your pharmacist that is valuable to people,’ he said.

‘If [contractors] want to move into that digital space, especially if they're having to close any stores, then they can retain some of their customer base if they actually understand how all of this works,’ he told The Pharmacist.

‘Online pharmacies can be a solution if they're accessible.’