Pharmacies across the UK have reported massive increases in demand for prescriptions during spring following the announcement of lockdown in March as patients sought to stockpile their medicines. One company noticed this has been followed by a counter period of reduced demand.
The Knights Pharmacy stores – located in North East England, North West England and the Midlands – dealt with an initial staggering influx in demand. Pete Horrocks, superintendent pharmacist of the 70-branch group based in County Durham, says there were two “absolutely crazy weeks” in March. On some days, his pharmacies’ dispensing volume was double the usual, boosting total figures for March across the group up by 12%.
The increase in demand did not last. Knights Pharmacy saw a drop in dispensing volume in May, compared to the usual figures, which continued into the next month. “We are now seeing about a 6-7% drop on where’s expected,” Mr Horrocks says.
Mr Horrocks attributes the change to many patients ordering medicines early, as well as GP surgeries issuing fewer prescriptions, having halted face-to-face consultations.
There has also been a “significant decline” in over-the-counter sales since the end of March, he adds. “It’s still very much the case that people who are out and visiting the pharmacy have one thing in mind – they’ve come to get their prescription,” he says.
“We are not seeing general browsing and ad hoc purchases, so [demand] has definitely not returned to normal. That has an impact on the professional services we offer.”
180,000 phone calls
Dispensing pressure has been worsened by staffing problems – Mr Horrocks estimates that up to 10% of the company’s workforce had to take time off work at some point during the pandemic.
A significant increase in the number of telephone queries Mr Horrocks and his teams have had to deal with accompanied the surge in demand. In April, the group received a record 180,000 phone calls, more than double the 74,000 it had in December.
“Those calls are for various reasons – people checking whether we’re open, if their prescription is ready, or just wanting some general advice,” says Mr Horrocks. “Every one of those calls is an additional pressure on the team.”
As the sector looks ahead to the recovery phase – and a potential second wave of COVID-19 – Mr Horrocks says he is conscious of the “rapidly approaching” flu season and how important it will be that his customers can receive their vaccination.
“It’s [figuring out] how we get to a point where not only our customers feel safe entering a consultation room, but also our staff feel safe as well,” he adds.
Sandie Keall, chief officer for Tees local pharmaceutical committee (LPC), agrees that how services are resumed is a major concern going forward. But she also says this period poses a “huge opportunity” for pharmacy.
“It’s about a different way of working,” she says. The pandemic has highlighted that to go completely remote “would be a mistake” because it is not always the most efficient way of reaching patients, but the sector needs to think about how it can provide the option of virtual support.
“We are always going to need the reliable ‘I’m going to see John in the pharmacy and I know I’ll get good advice’, because that model works,” she says. “I think there’s space for both [virtual and face-to-face communication], but we need to be mindful that we have a huge population that needs that contact.”
Another concern for the sector is whether the NHS test and trace system will temporarily close some pharmacies, Ms Keall says. “That’s a big piece of work, you don’t just close the door and that’s it.”
Sustainability of pharmacies
An additional ongoing cost for pharmacies is acquiring personal protective equipment (PPE). After an initial delivery in March of packs from Public Health England containing 50 masks, 200 aprons and 100 pairs of gloves, contractors have been left to source their own supplies. Mr Horrocks says prices have come down from the wholesalers, but they are still double what they would have been pre-COVID-19.
“We’ve got this underlying increased cost to being able to open and operate, which will be affecting the bottom-line sustainability of the pharmacies, but obviously it is necessary for our staff,” he says.
A boom in requests for medicine deliveries further compounded financial woes for community pharmacies. Mr Horrocks was frustrated by the national medicines delivery service, the detail of which was released by NHS England in April, as it did not include patients aged over 70.
“We’ve been able to use the service to support some of our patients, but others have been reliant on our goodwill to cover the costs.”
Ms Keall says a recruitment problem has emerged for the service as many of the original volunteers are now beginning to return to work. “The volunteer network is shrinking,” she says.
However, there is some fresh demand for deliveries. People from black, Asian and minority ethnic (BAME) backgrounds are shielding because of new evidence of their vulnerability to COVID-19, Ms Keall says.
Both Mr Horrocks and Ms Keall say there has been invaluable support from the surrounding communities that has helped alleviate the pressures on pharmacies.
One of Mr Horrocks’ branches has been given free use of a vehicle by a local garage for making deliveries. Meanwhile, Tesco donated mobile phones to all pharmacies in the Tees area to provide a direct pharmacy line for other health professionals, such as end-of-life practitioners, who need rapid access to medicines, Ms Keall says.
Ms Keall says collaboration with other pharmaceutical committees has been useful. Her organisation heard about the Tesco initiative from another LPC. If one committee has implemented a successful initiative, others can use it as a model.
“We have also been involved with our COVID-19 hospital (which has never opened) but they brought community pharmacy into the fold early to look at if that hospital opens, how we discharge people safely,” adds Ms Keall. “I think the liaison with wider groups has meant that if we do get a second spike then we are ready for it.”
Pharmacy has been a pillar of support for national healthcare throughout the pandemic. But as demand slackens, Mr Horrocks wonders whether the sector will receive the recognition it deserves.
“There have been thank yous from government," she says. "But it felt like that was only after someone said: ‘Do you realise what these guys are doing out here?’”