It’s no secret that English health funding is in a state of crisis. Despite an ageing population with an increasing need for the NHS, it seems that no part of the health service has made it out unscathed from the Government’s tireless quest to shave £20bn from the NHS budget.
Community pharmacy is no exception to this cost-cutting mission. Funding reductions totalling over £200m over the next two years have sent the sector reeling, with no one able to quantify just how badly the cuts will affect pharmacists – until now.
New data uncovered by The Pharmacist has given the first comprehensive insight – in pharmacists’ own words – into how the sector’s new funding package could affect those on the front line, revealing the dangerous extent to which it could jeopardise local businesses, jobs and patients’ health.
With nearly 2,000 pharmacies, 12,000 jobs and numerous clinical services at risk, Jeremy Hunt’s legacy as health secretary looks set to affect the sector for years to come.
With so much money pouring out of community pharmacy, it’s little wonder that many businesses are fearful that they could be forced to close.
Responses to a survey by The Pharmacist reveal that 15% of 156 respondents feel their pharmacy is at risk of closure because of the cuts. Extrapolating these results to the 11,688 community pharmacies in England suggests that 1,812 could be at risk of shutting.
So why is the Government allowing this to happen? The number of pharmacies has risen by 20% over the last 10 years and Hunt has said that supporting ‘clusters’ of pharmacies in the same area is a waste of NHS finance.
Unsurprisingly, the sector is feeling ‘venomous’ towards the Government. Pharmacy owners have called the severity of the cuts ‘unsafe’ for patients and said that the Government is ‘putting front-line healthcare into the trenches’.
Some contractors see pharmacy closures as a key aim of the cuts, rather than an unfortunate consequence. Al Patel, a contractor in Lewisham, south-east London, says: ‘[Hunt’s] legacy will be a reduction in the number of pharmacies. That’s his main aim.
‘He’s not very well advised. His role is sitting in an office, looking at the data. He’s not physically going out there to see what’s happening.’
Tony Schofield, a pharmacy owner in South Shields, Tyne and Wear, agrees. He says: ‘It’s just a smash and grab. The impact on family-owned businesses and small independents could be horrendous. I think there will be bankruptcies.’
Many in the sector are made more frustrated by the situation because those making the decsions do not seem to realise the consequences. Royal Pharmaceutical Society (RPS) board member Sid Dajani, who owns Wainwrights Chemists near Southampton, says: ‘I feel very angry because I’m being told what to do by a bunch of people who have no experience of [the sector] – and yet they hold the purse strings.
‘What we need are experts and specialists who understand the situation and the fabric of community pharmacy – people who know how the domino effect works.
‘We have too many captains of the Titanic and General Custers in very crucial positions in the Department of Health (DH) and NHS England.’
Forced to make as part of the package, the DH confirmed the introduction of the Pharmacy Access Scheme (PhAS), with the stated aim of ensuring that a baseline level of patient access to NHS community pharmacy services is protected. Qualifying pharmacies will receive an additional payment, meaning they will be protected from the full effect of the reduction in funding.
However, just 11% of pharmacists who answered The Pharmacist’s survey said they were on the first list of eligible pharmacies, with one respondent saying they felt ‘sick to the stomach’ once they realised they did not qualify.
More data from the survey, which was carried out between November 2016 and January this year, shows that even those pharmacies that do manage to stay open could face casualties in the form of job losses. Assuming the survey’s sample is representative, 51% of pharmacists expect some of their staff could be made redundant because of the cuts.
Those who said their staff numbers could fall estimated that, on average, two staff at each pharmacy are at risk. This means that a potential 12,000 community pharmacy workers in England could lose their jobs.
Schofield says that job losses are ‘inevitable’. He has recently made 12% of his staff redundant across his pharmacies. ‘We were so shocked at what the impact of the money was going to be that we had to do it and do it fast,’ he says.
‘And yes, that did mean making people redundant just before Christmas. It’s not something I’m proud of, but unfortunately we have a duty to the staff remaining to keep the business viable.’
According to the survey, the roles most in danger of redundancy are medicine counter assistants (34%), dispensary assistants (31%), delivery drivers (24%) and locum pharmacists (18%). More than a quarter of respondents said that all roles in their pharmacy are in jeopardy.
Other contractors are having to consider cutting wages. Almost 70% of respondents to the survey said that they are thinking about lowering locum pay for pharmacists, dispensers, and accuracy checking technicians, while 77% are considering stopping or reducing the number of locum shifts they book.
A quarter say their pharmacy will consider making pre-registration pharmacists pay for their training, and 7% say that they already do this.
The dire financial situation many contractors are finding themselves in means they are being pressured to look for other ways to reduce costs. Sadly, for many this means compromising the range of clinical services they are able to offer patients.
Over half of respondents to the survey said that they would consider cutting further training for dispensing and healthcare assistant staff. Nearly four in 10 said that they would consider cutting prescription deliveries for housebound people and their domiciliary dosage service, or reducing the service.
Around a quarter said that they would reduce or charge for care home inspections, training for care home staff, and training for GP reception staff.
It’s understandable that being forced to charge for such services leaves a bitter taste in many contractors’ mouths. One respondent to the survey said that they will have to consider charging for all services that are not fully funded by NHS England or their local clinical commissioning group (CCG).
Another explained that they might be pushed into introducing new fees ‘despite our own moral and compassionate intentions’.
‘Never saw it coming’
The Government insists that it has the sector’s best interests at heart. Health Minister David Mowat tells The Pharmacist: ‘Patients deserve the best possible care, which is why this Government is committed to building a modern pharmacy sector that is fit for the 21st century.
‘Pharmacists are a vital source of knowledge and information, as well as providing services such as flu jabs, health checks and, of course, dispensing vital medicines.
‘Our modernisation package will make the most of these skills and transform how pharmacists and their teams operate in the community, ensuring the public receives the very best care in the places they need it, seven days a week.’
But financial fears and the prospect of losing one’s livelihood have taken a toll on the profession’s morale. Almost nine out of 10 (87%) pharmacists who took the survey said they have experienced added stress or anxiety as a result of the cuts.
For others, it is becoming increasingly easy to question their choice of career. Patel says: ‘You wonder why you’re in this job and what’s going to happen to the next generation.
‘The whole of healthcare is a complete shambles and I think it’s going to fall apart. I never saw this kind of thing coming. Clearly, pharmacies are in the front line [of healthcare] as much as doctors are. But doctors are seen as gods, so whatever they say [goes], whereas for us, nobody ever listens.’
One respondent to the survey describes the personal impact on them: ‘I have been physically ill, and my anxiety levels are high, with insomnia. I will feel guilty abandoning the patients and staff I have served for the last 25 years, but I don’t feel I can keep going with this amount of pressure.’
Another says they are feeling ‘totally worthless’ and ‘wondering how on earth I will cope with the dramatic reduction in salary coupled with the further increased workload. It is now a 24-hour-a-day job.’
Independents in particular are struggling to cope, raising concerns that many will lose out to the multiples. One pharmacist asks: ‘Is it worth carrying on or should I just retire and sell to the large companies?’
If respondents to The Pharmacist’s survey are right and the cuts do force a large chunk of English pharmacies to close, it’s very worrying to think about the impact this could have on an already overstretched health system.
The irony of the Government extolling pharmacy’s potential to unburden parts of the system while simultaneously cutting its funding hasn’t been lost on Schofield.
As he puts it: ‘Hunt’s legacy is going to be that he had a resource that could have been an answer to his problems and he didn’t even realise what it was.’
What the new funding package means for you
• At the end of 2016 the Government imposed a two-year funding package on community pharmacy, with a £113m reduction in money spent for this year.
• Total funding for 2016/17 has been reduced to £2.687bn – 4% lower than 2015/16. Overall funds will decrease to £2.592bn for 2017/18, or another 7.5% drop.
• Since December, establishment payments have been reduced by 20% and in April will be lowered again by 40% on 2015/16 levels. A pharmacy that currently dispenses over 3,150 items a month and receives £1,673 a month will be given just £1,255 a month from April.