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Drop in clinical services income felt ‘acutely’ as pharmacists report thousands lost

By Rachel Carter and Isabel Shaw

27 Oct 2020

Pharmacists have lost thousands in monthly income after having no choice but to pause clinical services during the first wave of Covid-19, a survey by the Pharmacist has revealed.

The survey found a quarter (24%) of 78 pharmacists had missed out on over £2,000 a month between March and June, while a further 26% said they had lost between £1,000 and £2,000. Another 23% had lost between £500 and £1,000 and 27% said they lost less than £500.

One pharmacist commented: ‘We ceased private professional services entirely from 20 March to 1 June, and I estimate a reduction in turnover of around £25,000 from these services alone.

‘Furthermore, the reintroduction of the services has been hit by travel restrictions and lack of confidence in long haul holidays, so turnover is down 70% for June, July and August.’

Another respondent said that the drop in income from services was being felt ‘acutely’, as margins get tighter due to the ‘increased drug costs and extra provision of PPE’.

The survey, to which a total of 104 pharmacists responded, looked at the impact of the pandemic on private, locally commissioned, or advanced services offered by pharmacies.

After a raft of cuts to NHS funding in recent years, pharmacists have sought to diversify their income streams by offering more services – but Covid has caused many to be put on hold.

Of 92 survey respondents who answered a question on how much of their overall annual income comes from services, 27% said clinical services make up 0-5% of their income, while a third (33%) said this revenue stream accounted for 6-10%. Another 24% said services made up 11-20% of their income, while 15 respondents said services account for over 20%.

Between March and June, almost half (41%) of 78 survey respondents said they had ceased operation of clinical services entirely, while others managed to keep some running using social distancing and PPE (35%) or via telephone calls and digital technology (19%).

CASE STUDY: ‘At this moment in time we are simply stumbling along’

Tajinder Singh, superintendent pharmacist at Totley Pharmacy, told the Pharmacist he has been losing around £1,000 a month since April, due to clinical services being paused.

‘I’ve lost £6,000 so far and if this goes on for a year, which is what’s going to happen, then I’m going to eventually lose over £12,000,’ he said.

Mr Singh has also so far not been able to do more flu vaccinations than he did last year – which could have helped to claw back some funds – because of the shortage of stock.

‘The extra 50p they’ve given us per flu vaccine this year cannot compensate for all my thousands of pounds in losses…and there isn’t any stock around,’ he said. ‘We’ve begged all the manufacturers for more vaccines, and they can’t give us any.’

Mr Singh has a range of PGDs for clinical services and said he has managed to offer some at a safe distance, but patients ‘don’t really have the appetite for it and are very aware of the Covid risk’, so the demand ‘is massively down’ and his travel clinic has completely ‘died’. 

‘We haven’t totally given up on the idea of doing NMS and MURs, but it’s hard when the footfall is simply not there – also GPs are not really seeing patients, so they’re not getting new medicines.’

Mr Singh also stressed the need for pharmacies to be paid for the extra clinical work they have taken on during the pandemic – which has recently been highlighted by PSNC.

‘Pharmacies are open but it seems like we’re just picking up the slack for everyone else, rather than offering new or [our own] current services,’ he said. ‘If the money doesn’t come from our services because we’re not able to provide them, or because we’re doing too much other work, then we’d take some money for that other work – but we’re not getting that.’

He added that it felt like his pharmacy was ‘at this moment in time simply stumbling along’ and the loss of services, combined with massive increases in expenses and no extra income from anywhere else, will mean that he is left with no choice but to make cuts next year.

‘In terms of financially as a business, Covid has been terrible for us – we are having to do so much extra work, we’ve got to buy so much extra stuff to do the job, make extra payments to delivery drivers, and over the counter sales have just died because nobody’s in the pharmacy.

‘And in terms of the professional job, we’ve been paid less to do more, so it’s been horrific.’

Resuming services

The survey, which ran from 30 July to 14 September, found almost three-quarters (70%) of 78 respondents had got some services up and running again over the summer, while 8% said all their services were back in operation. The remaining 22% said services were still suspended.

Pharmacists cited social distancing measures and having adequate space in the pharmacy to implement these was the biggest barrier to resuming services, followed by a lack of footfall.

One pharmacist said that the pandemic had reduced their pharmacy’s footfall to ‘zero’. ‘We only have a few walk-in customers and the sale of OTC meds has gone – nothing is selling and many medicines are now coming up to their expiry date, which means a further loss to our pharmacy as no income is being generated,’ they added.

Another respondent said that the cleaning down time required to deliver services safely meant some were ‘no longer financially viable’.

Some pharmacists also commented on fears for their own safety and protection from the virus, with one stating that they felt ‘very uncomfortable’ about the measures proposed to allow pharmacists back into a consultation room. Another respondent said they were less inclined to provide personal advice in a consultation room ‘because of the risks involved’.

‘Cover contractors’ costs’

Commenting on the findings, Mike Dent, PSNC’s director of pharmacy funding, said community pharmacies had faced ‘significant costs’ related to Covid-19, including the loss of income from clinical services, staff costs, infection control measures, and a drop in OTC sales.

He said: ‘It is good to hear that some pharmacies say they have been able to resume some clinical services, but there are challenges and additional costs to making these Covid-safe.

‘Although the scope of ‘clinical services’ can be difficult to define – we know all pharmacies continued to give clinical advice throughout the pandemic even though many of these consultations will have had no direct funding attached to them.’

He added: ‘PSNC is arguing that all Covid-19 related costs for contractors should be covered by the Government and we have written to DHSC and NHSE&I outlining the costs we believe contractors are dealing with. These peaked in March, but now appear to be rising again as we go into the second peak.’

Sandra Gidley, president of the Royal Pharmaceutical Society, said that community pharmacies had remained open and played a ‘vital role’ during the pandemic by providing key healthcare services, dealing with minor ailments and giving health and care advice.

‘It’s vital the Government recognises this extraordinary contribution and ensures that pharmacy businesses do not lose income when they have been working during these difficult circumstances. We are calling on them to back pharmacy with fairer funding that ensures we are able to build on the incredible work that our profession has undertaken,’ she said.

‘As experts in medicines, pharmacists need support to be able to offer more virtual consultations to people who seek advice and need support with their medicines. This will take some burden off other parts of our NHS.’

She added that pharmacists should be given sufficient supplies of PPE and access to mental health services to help them during the second wave.

‘Significant financial hit’

Malcolm Harrison, chief executive of the Company Chemists’ Association (CCA), said the pandemic had impacted on the ability of all contractors to provide services in a Covid-secure environment and fair funding was needed for the entire sector, given its vital role.

He added that Covid-19 has presented opportunities to change pharmacy practice, which can benefit all contractors, such as digital technology and providing flu vaccines in car parks.

‘We have also successfully campaigned to remove the need for wet signatures for paperwork relating to advance services. As a result, patients no longer need to physically sign for a flu jab, the New Medicine Service (NMS) or Medicines Use Reviews (MURs),’ he said.

Graham Thoms, chief executive for PGD provider PharmaDoctor, said he was ‘not surprised’ by the survey findings and that data from his company’s eTools tells a ‘similar tale’.

‘With severely reduced activity between March and June, there is no doubt that pharmacies have taken a significant financial hit on their private clinical services for the reasons highlighted in the survey,’ he said.

‘There are also encouraging signs as we have begun to see the appetite for pharmacy services returning to pre-Covid levels. Throughout the pandemic, Pharmadoctor has developed new innovative clinical service packages such as our Allergy Test ‘n Treat and Ear Infection services, which we are providing to all pharmacists free of charge. We hope a combination of our support will help them get back to where they need to be.’

CASE STUDY: ‘I don’t have time to reintroduce services’

Dimple Bhatia, superintendent pharmacist at Tollesbury Pharmacy, Essex, told the Pharmacist he hasn’t had time to reintroduce his own private services because he is too busy supporting patients who haven’t been able to access their dentist or GP.

‘Ask anyone locally – the NHS is not open. People haven’t had their reviews and are being sent to pharmacies to have their blood pressure taken or are being told to buy a machine,’ he said.

‘Some people don’t have £40 to spend on a blood pressure machine – and how am I meant to safely teach these people how to use a machine when surgeries won’t?’

Mr Bhatia estimated that he has lost between £2,000 and £3,000 a month since the end of March, and he has not been able to offer any of his private PGDs, such as erectile dysfunction and glucose testing, because these would need to be done in the consultation room.

He’s been offering flu jabs – and MURs over the phone – since 1 September, and if a patient comes in for their flu jab who isn’t on many medications then he has been able to carry out an MUR then too, as the patient is already in the consultation room anyway.

‘This works as we can now get verbal consent instead of having to get written – that has really helped. However, we are only allowed to give out 100 MURs this year.’

Securing PPE, which is a necessary measure for pharmacists to be able to deliver services safely, has also been an issue for Mr Bhatia – ‘we’ve totally abandoned procuring any PPE from the NHS as it takes too long, so we just order it and buy it ourselves,’ he said.

‘That’s had a knock-on effect – I’ve financed all the PPE apart from the £300 the Government offered…we’ve probably spent £1,000s on PPE, money we might never see again.’

He added that the biggest barrier to resuming services is workload – the need for other primary care services to share the burden and make it ‘more equitable’ between all providers.

‘Everyone is thinking about safety, but not about vulnerable people, and then the buck ends up on pharmacy – it is very hard for us to turn away these patients who we have known for years – when every other door has been shut to them. That is really quite hard.’

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