‘I have cancer but I can’t afford to have time off’ – the pharmacy owners priced out of taking leave

Running your own business is a swings and roundabouts game. When things are good, you can reap handsome rewards. But when times are tough, the pressure can feel relentless.

The strain felt by community pharmacy owners of late is well documented: headlines touting ‘severe hardship’ and hundreds of businesses ‘teetering on the brink’, once unthinkable, are now unsurprising.

The Pharmacist recently conducted a survey among more than 300 readers about the pressures facing the sector, including 43 pharmacy owners, which asked about the impact of ongoing financial struggles.

The findings reveal a perfect storm of funding pressures, staff shortages and locums demanding high rates preventing contractors from having time off work. More than three-quarters (77%) of pharmacy owners said they were sometimes, often or very often unable to take leave because they can’t find anyone to cover.

One Essex-based pharmacy owner, who was recently diagnosed with cancer, says she has to rush through hospital appointments because her pharmacy is left understaffed when she is not there.

‘I had an appointment at lunchtime, but I literally had 20 minutes and I had to run back because I can’t get people to cover,’ Seema* explains. ‘I’ve got to have surgery and radiotherapy and I’ve been told that my recovery time will be at least three to four weeks.

‘Instead of concentrating on my health, I’m worrying about whether I’ll be able to find cover for the pharmacy.’

If Seema manages to get a locum, her bottom line will take a hit because like many others, she will likely be charged over the odds. Some 63% of pharmacy owners answering the survey reported having to pay way above market rate for locums. Other measures included paying an agency (47%) and bringing in someone less qualified than they need (30%).

Several contractors told The Pharmacist that appropriately qualified and experienced locum staff are charging exorbitant rates, effectively pricing pharmacy owners out of being able to take time off work.

ARRS affecting community pharmacy

When the additional roles reimbursement scheme (ARRS) was launched in 2019, pharmacist roles were popular. By December 2024, there were 7,253 pharmacists working in general practice. But community pharmacy suffered a blow as a result.

According to the Company Chemists’ Association, as of May this year, the number of FTE community pharmacists in England was at its lowest since 2017 when workforce data were first collected.

Consequently, locums are highly coveted and come at a premium, explains Joshua*, a contractor in the Midlands. ‘Issues started then [at the rollout of ARRS], and it created a bit of a drop in the market, but you could still get locums as long as you booked a fair distance in advance,’ he says.

‘The problem got a lot worse due to Covid and, due to supply and demand, locums were charging incredibly high rates. Then it became an expectation that they’re going to keep working for high rates.’

As a result, Joshua hasn’t had more than two days off work since before the pandemic. Some hard-earned holiday he’d booked a few years ago was brought to an abrupt halt when the locum he’d arranged pulled out last minute – on the morning the holiday started while Joshua was at the airport.

‘[Locums] often accept a booking at the agreed rate, and then the day before or even on the morning, they’ll say, ‘I’m not well – I can’t cover it – but I know someone who’s available for these dates’. It’s invariably a friend who will then charge a lot more, and they’re working in tandem.’

Locums dictating terms

The General Pharmaceutical Council (GPhC) was made aware of such practices back in 2022, Joshua says, but it does not have a role in setting or regulating rates for locums. And problems continue across the country.

One pharmacy owner based in the southwest has similar experiences, often struggling to find locums to cover if he needs to take any time away from his pharmacy for any reason.

‘Locums are still happily charging whatever they want to charge. I’ve told some, ‘You can’t keep charging this because the whole industry is in crisis’, but they just say, “Well, other people are doing it, so we won’t work for you if you don’t want to pay”,’ Nick* says.

He recalls a recent occasion where he approached 22 different locums to offer a day’s work a few weeks in advance, and all of them saying they couldn’t help. ‘They’re waiting for a higher rate at the last minute, so they’ll leave their options open,’ he says.

As a result, Nick is simply not in a position to take time off work, with the ripples felt by his family. ‘The last time I had a break was a year ago. It’s a long weekend rather than proper holidays now. Obviously, my family suffers. My wife suffers, my children suffer – my youngest says, “Dad is always at work”. It’s so stressful.’

Temporary closures a ‘very last resort’

As pressures on community pharmacy mount, owners are forced into taking desperate measures. A quarter of respondents to The Pharmacist’s survey said they’d had to resort to temporary closures or reducing their dispensing hours.

John*, a community pharmacy owner in the north, says if he needs any time off these days, even just a few hours here or there, he has to consider shutting his doors – something that once was out of the question.

‘I probably went 10 of 15 years never, ever closing – even in deepest, darkest winter with four feet of snow, staff would walk to work. And during Covid, we always remained open,’ he comments. ‘But temporary closures have increased this year. I’ve had to do it a handful of times for a number of reasons.’

Among those reasons, he cites being five staff members short – including two pharmacists – and difficulty finding reliable, affordable locum cover.

‘I don’t like temporary closures – it’s a very last resort. I will signpost and report as appropriate, but it still sits very heavily on my shoulders because I have a responsibility to remain open as best I can,’ John adds. ‘But I can’t magic people [into covering].’

Consequently, John says, he faces a tough choice between taking much-needed time off or fulfilling his contracted opening and dispensing hours.

‘You're never off as a business owner. You can put an out of office on and you can be away, but you will constantly get questions. If somebody calls in sick, they'll call me and I go in to support the branch, so you’re always on call,’ he comments.

The perpetual catch-22

Hundreds of others are in the same boat, according to Community Pharmacy England (CPE). Its recent Pressures Survey highlighted that 42% of pharmacy owners reported having reduced their opening hours and 15% have cut back on some national services.

In addition, Healthwatch England research published last September showed that, in 2023, more than 46,000 hours were lost in community pharmacy because of temporary closures, with an average closure length of three hours and 40 minutes.

The main causes of these closures, the patient healthcare watchdog said, were staff shortages and problems finding locums, with higher closure rates recorded in rural areas, those with fewer GPs per capita, and those populated by older patients.

These cohorts are the very patients in greatest need of community pharmacy services, so pharmacy owners often sacrifice their work-life balance to keep their doors open.

‘I work 55 hours a week just as a pharmacist on top of running the business,’ said one contractor. ‘In terms of booking annual leave to go away and detach myself for a few days, I haven’t done that for three years.

‘I know quite a few other owners who don’t take days off because they just can’t. It’s not worth it because you’re stressed out in the morning wondering whether cover is even going to turn up.’

For this pharmacist, temporary closure is not an option. ‘That would not be viable. You have to give justifiable reasons and have contingency plans, and patients will simply go to another pharmacy to get their prescriptions, and they’ll get signed up there. It would severely damage the business.’

So, pharmacy owners remain stuck in the perpetual catch-22: needing a break from the mounting pressure, yet unable to take a break because of it.

Meanwhile, Seema is considering the ‘heartbreaking’ prospect stepping away from community pharmacy for good. ‘As much as I love this profession, I’ve had enough. I want out. I can’t cope, especially with my ill health. I know the time has come for me to step away,’ she says.

‘I’ve done everything for pharmacy, and I’ve always spoken out, but what am I fighting for?’

* not their real names