Pharmacy owners in England, Wales and Northern Ireland have voted in favour of taking collective action, according to a ballot carried out by the National Pharmacy Association (NPA).

Some 99% of participating pharmacy owners said they were willing to limit their services unless funding is improved.

The NPA said that subject to agreement from its board, it would likely recommend its members to take action from January unless the government offers the sector a suitable and sustainable funding deal before then. As the NPA is a trade association, any action taken as part of its ballot are advisory.

NPA chief executive, Paul Rees, told The Pharmacist that he hoped the scale of the response – which represents around a third of the community pharmacy network – would bring attention to the sector's plight, as similar action by the British Medical Association (BMA) has done for general practice.

High turnout suggests 'anger and desperation' among pharmacy owners

Some 63.5% of NPA members in England, Wales and Northern Ireland took part in the ballot, representing 3,399 community pharmacies in total.

Contractors voted overwhelmingly in favour of withdrawing services that they are not contractually required to provide and currently offer unfunded:

  • 97.8% voted to serve notice on opening hours above the minimum required by their contract – meaning fewer pharmacies will be open in the evenings and at weekends.
  • 93.3% voted to stop delivering medicines to patients' homes for free if the service is not funded.
  • 96.1% voted to withdraw from locally commissioned services, including some local addiction support services, emergency contraception and stop smoking support.
  • 99.2% voted to refuse to co-operate with certain data requests above those required for patient safety and contractual minimums.
  • 96.8% voted to withdraw from supplying free monitored dose systems (medicine packs) that the NHS do not pay them to provide, other than those covered by the Disability Discrimination Act.

Mr Rees told The Pharmacist that the high ballot turnout was likely increased following 'markedly' higher levels of 'anger and desperation' felt by pharmacy owners since the chancellor's Autumn Budget last month.

'There was a lot of talk on the grapevine of the budget being positive for pharmacists, but actually it's only been negative. So what was already a very tough situation has become doubly desperate as a result,' Mr Rees said.

He said the government needed to 'cover the cost' of increased National Insurance employers contributions and national living wage increases for pharmacies.

'Pharmacies need cash now'

In addition, the sector still does not have funding arrangements in place for the current financial year, and Mr Rees expressed concern that a contract for 2024/25 might not be reached at all.

'With every passing day without there being a deal, members will be that much more enthusiastic about taking action' he said.

'Lots of pharmacies are closing... pharmacies need cash now because so many owners are clinging on by their fingertips,' he said.

The NPA has sent the results of the ballot to the government, and Mr Rees said he hopes it makes ministers understand 'the level of anger and desperation amongst pharmacy owners'.

'We have to end of the era of the cutbacks'

Mr Rees stressed that whatever is put on the table must 'not have any element of cutback for the sector'.

Any percentage uplift must take into account of the recent National Living Wage and National Insurance contribution hikes, otherwise it 'could turn out to be a cut', he warned.

'This has to be the end of the era of the cutbacks... the sector needs to be stabilised and reinvested in,' he added.

Current funding putting patient safety at risk

Pharmacy teams are working 'twice as hard' amid a 40% real terms funding cut and increasing service delivery and dispensing volumes, warned Mr Rees.

'There comes a point at which you have to say the trajectory of travel is no longer safe,' he told The Pharmacist.

'We want to ensure patient safety. So, the benefit of reducing services is A, it means that pharmacies are more sustainable. And B, it means that they're not having to work at such an extreme pace that there is any risk for patient safety.'

'Pharmacies need to still be in existence in order to deliver care'

The NPA stressed that it agreed with the government's priorities of preventative and community care.

But Mr Rees said that the pharmacy network needed 'to still be in existence' if it was to deliver this agenda.

'Rome is burning, and we need the government to move fast,' he said.

'It's far better for there to be pharmacies offering reduced services than no services at all because they've been closed down.

'This is a case of dying or surviving, and we want to help our members survive. So in this current era of extreme austerity, it's only by withdrawing some services, reducing some services, that a number of pharmacies will be able to carry on operating.'

'Pharmacy owners are not a radical bunch, but something simply has got to give'

NPA chair Nick Kaye stressed that decision to take action was not taken lightly.

'Pharmacy owners are not a radical bunch, we have never proposed action like this before, but after a decade of underfunding and record closures, something simply has got to give,' he said.

'Pharmacies desperately want to support their local communities with access to medicines and advice but have been forced into an untenable position by a decade of underfunding which has led to a record number of closures.'

And while the ballot is not statutory or binding, Mr Kaye noted that it reflected a depth of feeling that left the NPA 'no option' but to recommend action to its membership of pharmacy owners.

He added: 'As a third-generation pharmacist, I deeply care about my patients, as do pharmacy teams across the country, but I have never experienced a situation as desperate as this.

'The ballot result overwhelmingly shows the sheer anger and frustration of pharmacy owners at a decade of cuts that is forcing dedicated health professionals to shut their doors for good.

'Pharmacies don’t want to reduce services but we will be left with no option but to suggest that pharmacy owners should consider acting on the clear ballot results if government does not act to protect this vital and much-loved part of our health service.'

Government asks pharmacists 'to work with us'

In response to the NPA's ballot results indicating that pharmacy owners want to take action, a Department of Health and Social Care (DHSC) spokesperson said:

'Community pharmacy has a vital role to play as we move the focus of care from hospital to the community under the fundamental reforms in our 10 Year Health Plan.

'Unfortunately, we inherited a system that has been neglected for too long and is no longer supporting the pharmacists we need to deliver for patients at a local level.

'We are committed to working with the sector and would encourage all pharmacists to work with us to achieve what we all want – a service fit for the future.'