Concerns 100-hour pharmacy easements could risk out-of-hours access

Reduced hours for late night pharmacies could put elderly, vulnerable and end-of-life patients at risk, clinicians have warned.

Regulatory changes came into force last week which allowed pharmacies on 100-hour contracts to reduce their total weekly core opening hours to no less than 72 hours, including the option to close at 9pm rather than 11pm.

Some clinicians have suggested that this blanket approach to late night closing will put out-of-hours patient access at risk and increase strain on other parts of the healthcare system.

But one integrated care board (ICB) said that it was too early to know the impact of these changes, and assured patients that any issues with provision of care would be picked up by the NHS.

Vikki Furneaux, clinical lead and pharmacist at Monkbar Pharmacy, an independent 100-hour pharmacy in York, said that if all of the five late night pharmacies in the city took advantage of the new easements, local out-of-hours provision for patients would decrease, with no provision past 9pm.

And she said that this would particularly impact patients who had been referred to the pharmacy from A&E or an out-of-hours GP service.

Dr Selvaseelan Selvarajah, an out-of-hours GP in London and partner in the pharmacy-led Green Light Group, said that he often issues electronic prescriptions to a local pharmacy after an out-of-hours telephone consultation.

But he said that late-night pharmacies reducing their opening hours would have a particular impact on elderly and vulnerable patients.

‘If the pharmacy is closed, then that forces the patients to travel […] in the middle of the night. Elderly people, vulnerable patients who wouldn’t have to come out except just to get a prescription,’ he said.

‘In Hackney, there are two pharmacies that are open until midnight, in different parts of the boroughs. I'm quite confident that if I send [the prescription] there, the patient will pick it up. Whereas, if that pharmacy closes at nine o'clock, then the patient is going to have to travel in the middle of the night,’ he added.

With public transport not always accessible late at night, patients would be forced to take a taxi, thereby increasing costs, he suggested. And if that was not possible, the prescription would have to wait until the following day, or the doctor would be forced to make a home visit. ‘That would actually be more counterproductive and more expensive for the health system,’ said Dr Selvarajah.

He added that a lack of access to late night pharmacies could particularly affect patients needing end-of-life medications and their families and carers.

Meanwhile, Ms Furneaux said that she thought that the easements around 100-hour pharmacy regulations were too rigid and have not been well thought through.

She said that the pharmacies are not able to take advantage of closing in the morning as they have to receive deliveries and prepare prescriptions, while having a break in the middle of the day makes it hard to recruit staff for split shifts and doesn't work well for patients.

And remaining open later at night is less profitable, she said, as pharmacies are typically only dispensing emergency prescriptions for non-routine patients – which takes longer – and decreases the ability to provide the additional services that are provided during the day.

She added that it would have been more beneficial for the pharmacy and for patients to have been allowed to close on a Sunday morning, when the pharmacy does not receive deliveries and other pharmacies are open, and instead open later in the evening to increase access to patients.

In addition, Ms Furneaux suggested that during the week local pharmacies should have been allowed to share the late-night opening, taking it in turns to remain open until 11pm or midnight and closing at 6 or 7pm on other nights.

Community Pharmacy England (CPE, formerly known as PSNC) told The Pharmacist that it had proposed coordinated closures so that pharmacy owners could ensure one pharmacy remained open if another had to close, but said that this request was rejected by the Department of Health and Social Care (DHSC) and NHS England (NHSE).

And CPE’s Director of Legal Gordon Hockey said that if local areas want pharmacies to be open later, this could be funded by ICBs, who could also fund designated pharmacies to provide end-of-life medicines out-of-hours.

A spokesperson for NHS Humber and North Yorkshire ICB said that its Health and Wellbeing Boards would be monitoring changes to pharmacy opening hours in the coming weeks and months, and assessing the impact of reduced pharmacy opening hours once any changes have taken effect.

‘While some 100-hour pharmacies may choose to apply for a reduction in hours, it won't automatically mean there is a gap in service if there is alternative local provision that patients can access,’ they said.

They added that it was ‘too early to say what the overall impact will be’, but that patients could be assured that if there were any issues, these would be picked up by health and wellbeing boards, local NHS commissioners and NHS England.

And a Department of Health and Social Care spokesperson said that it recognised the importance of maintaining good access to pharmaceutical services for all patients, pointing to the additional £645m in funding for the sector that was announced recently.

'Permitting those pharmacies currently required to open for 100 hours per week to reduce their hours to a minimum of 72 hours, will enable them to remain open and allow patients to continue accessing their services, including during key evening and weekend hours', they added.