Primary care closures disproportionately impacting deprived areas

More than a third of pharmacy and GP practice closures since 2015 have occurred in the 20% most deprived areas in England, according to analysis by the Company Chemists’ Association (CCA).

When the total number of pharmacy and GP closures are added together, 37% occurred in the bottom two deciles of the Index of Multiple Deprivation (IMD) which measures deprivation based on a combination of factors, including income, employment, education, health, housing, and crime.

The greatest number of closures was in the North West, where 96 pharmacies or GP practices closed, followed by the West Midlands (71 closures) and Yorkshire and the Humber (52 closures).

The CCA said that this decrease in access to primary care would hit deprived areas the hardest, further worsening health inequalities because people living in areas with the greatest health needs would now have to travel further to access primary care services.

Travel costs would force patients to choose between health and living costs, while the time taken to travel to appointments would make it harder to fit appointments around work and caring commitments, the CCA said.

Closures – and the resulting change in healthcare providers – could also be frustrating and distressing to patients, particularly to those with complex health needs, the CCA added.

When patients are unable to access their usual primary care provider, they are more likely to turn to A&E, the CCA said, citing a 2023 study on the population health impact of high GP turnover, published in the BMJ.

This would contribute to overwhelming the NHS and place a greater strain on the remaining active pharmacies and GP practices amid ongoing funding and workforce crises, the CCA added.

It recommended:

1. Investment and modernised funding for primary care
2. A holistic workforce plan to address ‘significant recruitment and retention challenges across the sector’, which the CCA said was ‘in part caused by a siloed approach to the use of the primary care workforce’
3. Reduced NHS bureaucracy, including a push for integrated digital technology and ‘the need to trust professionals to provide high quality care without being required to follow unnecessarily burdensome reporting processes’
4. A review of activity across primary care, ‘thinking more holistically about where resources are deployed in the healthcare system’.
   ‘Community pharmacy has the opportunity to deliver more care for the NHS and support an overburdened GP network. Greater alignment of contractual frameworks, whilst investing in integration efforts, will lead to better patient care,’ the CCA said.

‘This is a wake-up call to the Government – primary care desperately needs investment’ said Malcolm Harrison, CCA chief executive.

He added: ‘The Government is sleepwalking into a disaster within primary care, and we could soon see primary care cold spots emerge in different parts of England. Unfortunately, the communities with the greatest need could see access to primary care services diminish the most which will only worsen health inequalities.

‘The CCA has been warning about permanent closures of pharmacies for some time. The sector is underfunded by more than £67,000 per pharmacy annually, money which could be invested in frontline staff to provide patient care.

Taiwo Owatemi MP, the Chair of the All-Party Parliamentary Group on Pharmacy said: ‘Health inequalities across the country are structural, deep-rooted and continue to have devastating consequences for our most underprivileged communities.

‘It is shocking to think that nearly 40% of pharmacy and GP surgery closures have occurred in the most deprived parts of our country. We know that health is intrinsically linked to economic prosperity – and without sufficient access to basic healthcare, I worry that these communities will see a downturn in life expectancy, opportunities, and the ability to compete with those from wealthier areas, entrenching these inequalities ever more deeply. As ever, it is the poorest who feel the brunt when services are cut.’

Both Mr Harrison and Ms Owatemi called for pharmacists to be empowered to do more to ease pressure on GPs, with Mr Harrison reiterating calls for a nationally funded Pharmacy First service.

‘Pharmacists have the skills already; they just want the opportunity to put them into practice. Yet, this can only happen if the Government is prepared to step up to the plate and make those long-term commitments to the sector that will keep it alive for future generations,’ said Ms Owatemi.

Professor Kamila Hawthorne, chair of the Royal College of General Practitioners said: ‘Workload and workforce pressures are affecting GP surgeries and community pharmacies across the country but can have a greater impact in deprived areas where patients often have more complex health needs, and GPs have more patients per doctor. The loss of a GP practice or pharmacy in these areas will clearly have a stark impact on the community.’

She added: ‘This is why the College is calling on Government to implement a new recruitment and retention strategy that goes beyond the target of 6,000 more GPs it pledged in its election manifesto, as well as investment in GP practices and IT systems to make it easier for patients to access appropriate care. Government must also take steps to cut bureaucracy so that GPs have more time to deliver care to the growing numbers of patients who need it.’