Revealed: The reasons behind temporary pharmacy closures
A C+D investigation has found that more than 20,000 instances of reported temporary pharmacy closures occurred in England over a 12-month period. But what were the most common reasons pharmacies told NHS England were behind these closures?
A continuing debate on part and full-day pharmacy closures and the causes behind them has sparked different views in the community pharmacy sector.
Some have argued that there is a concerning lack of pharmacists, which is driving the closures due to a lack of staff. Meanwhile, others have disputed this, claiming that many pharmacists are now being more discerning about their pay and working conditions.
However, this impasse could soon be broken. The Department of Health and Social Care (DH) has recently confirmed to C+D that it is "monitoring temporary closures of community pharmacies".
Within the context of this debate, NHS England (NHSE) provided C+D with the data it held about temporary pharmacy closures over one year – from 1 October 2021 until 30 September 2022 – in response to a freedom-of-information (FOI) request.
C+D has analysed this data* and found that 3,660 pharmacies across England reported these closures – with some temporarily shutting more frequently than others – over the 12-month period.
The affected pharmacies reported temporarily closing a total of 20,924 times. In some cases, these closures only occurred for a matter of hours rather than full days, according to the data.
So what were the reasons provided to NHSE to justify these temporary closures and what needs to change to prevent them from happening in the future?
What is NHSE’s view on temporary pharmacy closures?
An NHSE spokesperson told C+D that it manages pharmacy closures "in line with the appropriate regulations" both at a national and local level, "ensuring that patient care and safety are maintained".
"We are working closely with NHS system leaders and pharmacy representative bodies to support community pharmacy teams and maintain access to pharmaceutical services," they added.
"Locum could not be found"
The results of C+D's investigation shed a little more light on some of the reasons behind temporary closures. Although NHSE did not expand on the reasons for closures provided by contractors, there were some observable trends.
According to C+D’s analysis of the NHSE data, pharmacies provided "locum could not be found" as the reason for having to close temporarily in 10,637 instances, while "no cover found" featured 811 times.
Some closures were attributed to staff sickness. In particular:
- "Short notice staff sickness" appeared on 2,891 occasions
- "Pharmacist called in sick" was entered on 19 instances
- "Sickness" was given as a reason in 10 instances
Reasons relating to COVID-19 only appeared seven times in C+D’s analysis, while "locum cancelled at short notice" was only provided on 16 instances.
There were some instances where NHSE did not provide C+D with the reason given** for the temporary closure, and C+D has asked NHSE for further clarification on this.
Although a mixture of multiples and independents reported temporary closures, the majority of instances reported to NHSE were from pharmacy branches owned by bigger companies.
For example, Lloydspharmacy and Boots recorded 7,461 and 6,031 instances respectively where branches closed temporarily.
Boots told C+D that there were occasions where it had to "temporarily reduce opening hours" at some of its branches "as a result of pharmacist availability". Lloydspharmacy declined to comment.
Demand for pharmacists outstripping supply?
Looking at the data uncovered by C+D, it would be easy to draw the conclusion that some pharmacies are being forced to temporarily shut their doors because they are finding it so difficult to secure locum cover.
Indeed, Company Chemists’ Association (CCA) chief executive Malcolm Harrison claims that the data uncovered by C+D "clearly demonstrates that the demand for pharmacists in England is outstripping supply".
However, not everybody is quite so certain. In response to C+D’s investigation, Pharmacists’ Defence Association (PDA) director Paul Day claimed that closures are occurring even when there is locum cover to be found.
It is an argument that the union has often made, including over the summer when PDA chair Mark Koziol penned an eviscerating letter to NHS and regulatory bosses over "unnecessary" temporary pharmacy closures.
In the letter, the PDA claimed to have seen evidence of closures being announced up to four weeks in advance. It also claimed that some locums were being pressured to reduce their pre-agreed rates or else risk having their shift cancelled, with the resulting temporary pharmacy closure being publicly blamed on what the union termed "a supposed" pharmacist shortage.
Responding to C+D’s analysis, Mr Day acknowledged that "it may be true" that some pharmacies could not find a pharmacist "prepared to locum in the environment found in their pharmacies, for the rates that they want to offer". But he stressed that there are "record numbers" of pharmacists on the register.
"It may be true that some employers were unable to find a pharmacist prepared to locum in the environment found in their pharmacies," Mr Day said.
Similarly, Tohidul Islam, the CEO of support group The Pharmacist Cooperative, told C+D that some locums are refusing to work for certain multiples due to "extremely poor working conditions, very low staffing levels" and because they have not dealt with IR35 rules in the manner suggested by HMRC.
"We strongly believe, and have for some considerable time, that the closures are a direct symptom of poor business planning, management and a complete inability to listen to the profession," he stressed.
Crisis reflects pressures on community pharmacies
For some, temporary closures seem to be a symptom and not a disease, showing the untenable pressures community pharmacy is under.
Pharmacy companies are adamant that temporary closures only happen when there is no other option.
Mr Harrison remarked that many temporary closures only reflect "very small parts" of the day "as pharmacies try tirelessly to plug gaps at short notice".
He insisted that closures were an "absolute last resort", with CCA members "working extraordinarily hard to ensure patient access".
This is a sentiment echoed by the Association of Independent Multiple pharmacies (AIMp). A spokesperson for the group told C+D that its member pharmacies only close "when there is no other alternative available".
AIMp members are "family-owned businesses with well-established relationships with their patients in local areas", the spokesperson said. But it is nevertheless "fact that in certain parts of the country, it is very difficult to recruit pharmacists", they added.
And while "thousands of pharmacists" from hospital and community pharmacy have been recruited into primary care networks, "the lack of funding to community pharmacy has made it very difficult for so many pharmacies to invest in the workforce", they pointed out.
An issue of money
Recruitment pressures are only one of many issues contractors are facing at present.
National Pharmacy Association (NPA) director of corporate affairs Gareth Jones told C+D: "The high number of temporary pharmacy closures is clear evidence of endemic problems in relation to workforce and pharmacy finances."
Similarly, Mr Harrison pointed to the flat funding England’s pharmacies have seen since 2017 as a cause for worry. Community pharmacy’s stagnant funding is "having a deeply concerning impact on the sector", he stressed.
"[The] government cannot expect pharmacy to continue to deliver greater volumes of supply and care services when the funding made available no longer covers costs," he said.
"The high number of temporary pharmacy closures is clear evidence of endemic problems in relation to workforce and pharmacy finances," said Mr Jones.
Pharmaceutical Services Negotiating Committee (PSNC) CEO Janet Morrison pointed to the "crippling effect" staff shortages and "other pressures" are having on the sector.
Findings from PSNC’s Pressures Survey found that 23% of contractors had been forced to temporarily close their branches due to staff shortages, she said. These shortages, coupled with "rapidly" rising locum rates, have meant that some pharmacies have permanently reduced their opening hours "to cope with the current situation", she added.
Ms Morrison added: "This paints a bleak picture for the future, both for pharmacies and for the patients and communities they serve."
"Disruptive" and a cause for concern
Temporary pharmacy closures are particularly concerning due to their potential negative impact on patient care.
For the PDA’s Mr Day, "every avoidable closure is a concern to the pharmacists we represent".
"They know that beyond these numbers are actual patients with genuine needs for medicines and/or services, which will have been unavailable from a closed pharmacy."
Similarly, Mr Jones believes that these closures can have "a disruptive impact on neighbouring pharmacies and can damage the reputation of the wider pharmacy network in the region".
"If this situation persists, there is a danger that local NHS systems will start to question the sector’s reliability to deliver services like the Community Pharmacist Consultation Service," he warned.
What should be done?
Even if not everybody sees eye to eye on the causes behind temporary pharmacy closures, the organisations C+D spoke to were united in their view that something has to change. However, views on what exactly needs to change remain contested.
For Mr Islam and Mr Day, it is for the NHS and the General Pharmaceutical Council (GPhC) to step in and take action.
"It is now high time that the NHS deal with this matter properly, fairly and proportionately with any action having, at its centre, the health and welfare of the public for whom the dispensing contracts are supposed to benefit," Mr Islam said.
He suggested that monetary fines should be imposed on pharmacies that temporarily close, with the amount dictated by the number of items the pharmacy could have been expected to dispense on an average day. Meanwhile, repeat offenders should lose their contract with the NHS, he proposed.
"It is now high time that the NHS deal with this matter properly, fairly and proportionately," Mr Islam said.
Read more: Health boards in Wales make strides in tackling temporary pharmacy closures
Others argue that the government should put its hand in its pocket and remunerate community pharmacy more fairly.
The AIMp spokesperson said: "We are once again calling on the decision makers to take the workforce challenges that our sector is facing seriously, and treat community pharmacy fairly," they added.
Meanwhile, Ms Morrison said that C+D’s findings further prove that the government and NHS must work with community pharmacy on a "long-term workforce plan" and provide the sector with "sustainable funding".
"We are once again calling on the decision makers to take the workforce challenges that our sector is facing seriously," the AIMp spokesperson said.
The systemic reasons behind temporary pharmacy closures remain a hotly debated topic. While some dispute that there is a shortage of pharmacists in the UK, others say that factors including Brexit and an exodus of community pharmacists into primary care make finding staff increasingly difficult.
But regardless of which side is correct in their analysis, it is clear that something has got to give. With the DH monitoring the impact of temporary closures, perhaps the government will find a solution to the problem once and for all. If it does not break the impasse, the community pharmacy sector could find itself in an unmendable state.
*Caveats on C+D’s analysis
NHSE provided reasons for closure by each ODS code (a pharmacy's unique identifying code). However, in calculating the total of instances of closures, it did not factor in the ODS codes without a corresponding trading name and the instances without a corresponding closure date.
These represent around 2.6% of the total reasons provided and have been excluded from C+D’s analysis.
NHSE only provided the duration of closures (in hours) for some pharmacies. Because this dataset was incomplete, this metric has been left out of C+D’s analysis.
C+D has asked NHSE for the full data on the duration of closures.
Any ODS code corresponding to an online pharmacy has been excluded from this analysis.
**Some pharmacies had selected “other, please fill column U” as a reason, according to the dataset shared by NHSE. C+D has asked NHSE to share the data entered under “column U”. In other instances (1,773), no reason for the closure was reported by NHSE.