'I'm reluctant, but I have to cut costs': The contractors supporting NPA action

The Pharmacist speaks to three pharmacy owners about why they are supporting the National Pharmacy Association (NPA)'s call to action, if a new satisfactory deal is not agreed for the sector.

At 8:30 on a Saturday morning in a small town in County Durham, a queue is already forming outside contractor Kevin Simpson's pharmacy.

Within an hour, 'there'll be 20 people stood waiting for attention', Kevin tells The Pharmacist.

‘There'll be a mixture of people picking up prescriptions. There'll be a mixture of people who haven't ordered their prescription and want an emergency supply. There'll always be two or three of those.

‘There'll be a couple of Pharmacy First referrals, and mums who haven't got a referral with a poorly child.

‘It's a very poor community, with lots of people who depend on benefits. We do an awful lot of monitored dosage systems, and we do an awful lot of deliveries [unfunded].'

One pharmacist and three other staff members do their best to respond to patients, but 'it can be extremely stressful', says Kevin.

‘Sometimes you get somebody who’ll not wait at the back of a queue, and demand attention in front of everybody else... I'll get abuse,' he says.

'I don't know many people who would put up with it, if they weren't being paid appropriately at the same time,’ Kevin tells The Pharmacist.

And at the moment, national pharmacy funding doesn't cover the costs of this Saturday morning session.

Pharmacy action would 'severely inconvenience patients'

Reducing the pharmacy's opening hours in line with the NPA's call to action would ‘severely inconvenience’ patients, Kevin says.

‘It's the only pharmacy there. I would say the nearest pharmacies are in a radius of five miles away, in surrounding towns.

‘I'm reluctant to do it, but if there's no money to pay the bills, then I have to cut costs,’ he says.

With his business partner, Kevin owns seven pharmacies in the North East of England, four of which have already reduced their opening hours to core minimums to keep costs down.

'Pharmacy margins have run out'

Despite the introduction of Pharmacy First and other additional services, Kevin says the funding for these services doesn’t and shouldn’t cover core business costs.

‘We can't sustain our businesses on Pharmacy First, emergency contraception and supervised substance misuse. Those are additional services – the core business is dispensing 10,000 prescriptions a month, and that does not sustain my business. And any amount of extra work that that I'm given doesn't alleviate the basics for the core funding.

‘We've been getting £1.28 per prescription for eight years, and the minimum wage has gone up by £6 in that time,’ he says.

‘So where's the funding come from? That’s come from pharmacy margin, pharmacy profits, and they've run out.

‘And for the last couple of years, we've been working in the belief that something will change. It is desperate,’ he adds.

Contractor Kevin Simpson outside one of his pharmacies.

'I haven't got money to repair broken shutters in my pharmacy'

Kevin says he’s had no reassurance that any deal agreed with the government will cover the costs pharmacy owners have absorbed in the last year when the five year arrangement expired.

In response to the rolling over of the five-year deal into 2024/25, Kevin says that funding has not continued adequately.

‘I've shown MPs my bank balance, and I've shown them how much personal money goes into some of our pharmacies every single month, just to keep the cash flowing until we get paid.

‘As owners, we’ve been paying our staff, but we haven't been paying ourselves,’ Kevin adds.

‘I haven't got money to repair broken shutters. In one of my pharmacies, one of the shutters is down because I haven't got £5,000 pounds to repair it. Vehicles need replacing, but I'll delay that,’ he says.

‘If somebody told me in December or September last year what was coming then I could have made arrangements,’ he says.

‘It was absolutely ludicrous that we didn't have anything on the 1 April 2024 when our previous contract ran out.

‘Even more ludicrous that we're now two weeks away from the 1 April 2025 and we have no idea what the government hasn't planned for us.

‘Doctors knew before Christmas [what their funding settlement was] - they weren't happy, but they knew and could plan. We don't know. We've no idea.’

'Pharmacies can't make investments because we don't know if we'll be able to afford them'

Contractor Patricia Ojo

Patricia Ojo, a contractor in Eltham, South East London, is also feeling the frustration of being unable to plan for the future.

‘We can’t make plans, we can’t make forecasts, because we do not know what is happening.

‘We can’t make investments because we do not know if we’ll be able to absorb those investments.

‘It's not acceptable. As a contractor who's got patients who really, really depend on us, we need to know.

‘There's got to be an uplift in the funding to actually make our businesses sustainable and viable,’ she tells The Pharmacist.

In particular, she says the cost of dispensing means pharmacies are ‘subsidising the NHS day in, day out’.

‘There's several items that I dispense on a daily basis that I know that I'm literally not going to get reimbursed for. I'm constantly making the decision to put my patients first. But how long can we keep doing this for?’ she says.

Funding uncertainty has meant Patricia has ‘held off employing staff’ and ‘held off making any improvements’ to her premises, including putting in an additional consultation room to be able to deliver more services.

'Pressures are impacting our health and our families'

These pressures are also taking a toll on pharmacists’ wellbeing, she warns.

‘When I don't get to do the work that I have to do, I have to sit here all hours and catch up with that work.

‘Some jobs get paid for doing that, because I'm a contractor, I cannot just get paid for the extra time that I put in there.’

She says pharmacy teams do go the extra mile because ‘we've got patient safety to consider’.

But this comes at a cost of staff well being.

‘Not taking our holidays when we're due to take our holidays, etc.

‘That is our health that is impacted. That is our families that are being denied us,’ she says.

Patricia says she is 'certainly' supportive of the NPA action and that she is currently deciding what the best action will be for her pharmacy to take, while considering the safety of her patients.

'This is the toughest time I've known for community pharmacy'

Graham Jones has owned two pharmacies in West Berkshire since 1992 and 1997 and says: ‘This is certainly the toughest period I've known for running a pharmacy.’

He tells The Pharmacist: ‘The biggest pressure for us is dispensing. We've had closures in surrounding towns [so] people have migrated to our service… we've had some fantastic growth in our volumes, but none of it makes any money… it’s put extra pressure on us for the non-profitable part of the business.’

‘It’s very frustrating when you are dispensing quite a lot of medication at a loss, and then to make up the income, you are having to do a lot of extra services,’ he adds.

Contractor Graham Jones delivering medicines by bike during the pandemic.

Graham says that even before the NPA's call to action, his pharmacies have already reduced their opening hours.

‘We did a number of things during the pandemic to take the pressure off staff, because that's when we had the real big spike in volume.

‘So we started closing at lunchtime a number of years ago.’

He adds: ‘We want to maintain our service level, which has always been exceptionally high, and we are determined to maintain that and develop new services.

‘But if the government thinks we can offer new services [while] expecting us to do our core service at a loss, [that] is ridiculous,’ he says.

'Warm words won't fix the financial reality'

A new contract must ‘actually reflect the reality of what it costs to run a pharmacy’, he adds.

‘We've had plenty politicians of all persuasions supporting pharmacy, but as yet, no action… Warm words don't work against the financial reality,’ he says.

And without improved funding, ‘more pharmacies will be closing, inevitably’, he warns.

Human impact of pharmacy pressures warrants taking action, says NPA chair

This morning, the NPA advised its members to take action to cut opening hours or otherwise reduce pharmacy services, with a funding deal for the sector still not yet announced.

Speaking to reporters in a media briefing this week, NPA chair Nick Kaye said he believed ‘the human being side’ of the pressures facing pharmacy owners warranted taking action now.