In Shilpa Shah’s area of North-East London, people ‘can't afford to be ill’.

With many people accessing free prescriptions, community pharmacists in the area tend to give advice and recommend home remedies for self-limiting minor ailments, instead of over-the-counter treatments that patients would have to pay for.

For a sore throat, patients might be told to drink honey and lemon in hot water and have plenty of warm soothing drinks. For a headache, they are advised to drink lots of water, or get some rest.

But sometimes, ‘you do have to recommend something that will soothe their symptoms’, Ms Shah, CEO of the local pharmaceutical committee (LPC), told The Pharmacist. ‘They've got family commitments, they've got to get to work, they can’t take sick days, they often work in jobs that are based on nil hours, where you don't get paid if you don't work,’ she said.

Since last autumn, with the cost of living on the rise, community pharmacies in the area have seen an increase in patients saying that they could not afford to purchase the over-the-counter medicines that they were recommended.

And when patients were unable to pay, the pharmacy has had to refer them to general practice to get a prescription so that they would be eligible to receive the items for free on the NHS.

Sending patients, who had come through to the pharmacy via a Community Pharmacy Consultation Scheme (CPCS) referral, back to the GP and then having them come back to the pharmacy with a prescription to collect the item, led to increased workload for everyone, said Ms Shah. She also felt it caused ‘rigmarole’ for the patient and ‘feels like a waste of so many NHS resources’.

‘That's just sending people around the system for no reason, because the reason they were sent to us in the first place was because they were low acuity conditions,’ she told The Pharmacist, adding that the idea behind the CPCS was to avoid patients using a GP appointment that could have been used for a more complex case.

"Minor ailments schemes have been around for ages. But we really need it now"

Recently, Ms Shah took the chief medical officer of the North-East London Integrated Care Board (ICB) to visit local pharmacies and outlined the need for a local minor ailments scheme that would cover the cost of over-the-counter items for patients eligible for free prescriptions.

The reaction was positive. ‘He said: “Let's do this. Why aren’t we already doing it?”,’ Ms Shah told The Pharmacist.

‘It's not a new idea. Minor ailments schemes have been around for ages. But we really need it now,’ she added.

Local GPs were also supportive, she said. ‘They really want this to happen,’ explained Ms Shah. ‘They see the patient need, but they also see the value to the system of people going to the community pharmacy, not having to take up [a GP] appointment that could otherwise do for someone else, which we know will also take the pressure off urgent care. So, it's a win-win for everybody.’

She added: ‘We think in the long run, anything that you can put into community pharmacy, as long as it's remunerated appropriately, can only benefit the system, because, by dealing with it there, it stops the person having to go somewhere else.’

The ICB was now looking into how such a service could be funded on a local level.

Pharmacists witnessing ‘destitution’

The cost of over-the-counter medicines made national news headlines in recent weeks when the London borough of Tower Hamlets reported that Calpol was the most shoplifted item in the area.

Lutfur Rahman, Mayor of Tower Hamlets, described the reports as ‘utterly devastating’. ‘It shows how much the cost-of-living crisis is hurting our residents when they cannot afford basic medicines for their children,’ he added.

And community pharmacist Ade Williams said the reports were eye-opening. It was ‘not about condoning theft’, he said, but that people should not be put in a situation where this was their only option.

‘Undoubtedly there will be other unmet needs in this situation,’ added Mr Williams, who runs a community pharmacy in Bedminster. ‘I have witnessed patients forgoing their own prescribed medication to purchase pain relief for their children.’

‘We now have patients who give us money to keep, to help cover the cost of others in the community who cannot afford items,’ Mr Williams said, although he added that accessing this option could carry ‘an unfair burden of shame on those facing it’.

He said that he supported campaigns to end prescription charges, which he said could be a barrier to healthcare. ‘Ironically the NHS was formed to put an end to situations like this, pharmacy must now be alert and responsive to this unspoken need with dignity,’ Mr Williams added.

Options for patients to access over-the-counter healthcare supplies without a prescription are limited. Foodbanks don’t receive or give out medicines, while support such as free school meals and ‘Healthy Start’ vouchers only cover food and milk.

Sabine Goodwin, coordinator of the Independent Food Aid Network (IFAN) told The Pharmacist that the solution was for people to be able to access adequate income so that essential items, like medicines, formula and nappies were affordable.

IFAN advocates for a cash first approach, which helps people access financial advice and any financial aid that they are entitled to, in order to reduce the need for emergency food support.

And pharmacy leaders see opportunities to help within the sector.

Speaking at a recent Westminster Health Forum on health inequalities, policy manager at the National Pharmacy Association (NPA) Helga Mangion, said that community pharmacists were seeing the impact of cost of living crisis 'at first hand'.

‘One thing that we are witnessing, as a sector is a phrase that was used very much in Dickenson times, and that is “destitution”,’ she said – which was impacting people's health and people's medicines.

She said that the sector saw patients ‘who come in, see what they need, make a decision, but then they're finding their way back to the GP’. She suggested that a ‘lack of affordability’ of medicines was disrupting the success of policies for community pharmacy to support people within primary care networks (PCNs).

At the same event, Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies (AIMp), said it was ‘incredibly concerning’ that people were unable to pay for medicines due to their level of poverty.

‘For us pharmacists, access to medicines is part of the very fabric of the society. No one should be in a position where they haven't got access to medicines,’ she said.

She added that reading stories like Tower Hamlet council’s reports of people shoplifting Calpol was ‘very heartbreaking for professionals like pharmacists who are within these areas of inequality’.

But she said that a minor ailments scheme would allow pharmacists to support families who were struggling to pay for their medications.

"People shouldn’t be having to steal Calpol"

In Scotland, Wales and Northern Ireland, all patients can access free prescriptions and can also access over-the-counter medications through a walk-in minor ailments service based in community pharmacy.

Thorrun Govind, England chair of the Royal Pharmaceutical Society (RPS) said that it was ‘sad that patients in England aren’t able to access the same services’ as in other devolved nations, ‘particularly with regard to minor ailments’.

‘The government needs to seriously address the cost-of-living crisis when it comes to healthcare, and make sure that we have parity with Scotland, Wales and Northern Ireland when it comes to prescriptions too,’ said Ms Govind.

She added that in England, ‘it was short sighted to scrap the minor ailments scheme that was available across the country many years ago, and now we are seeing the impact with parents having to steal Calpol to look after their children’.

And in a tweet, she said that a national Pharmacy First service could assist with the cost-of-living crisis. ‘People shouldn’t be having to steal Calpol,’ she wrote.

Would Pharmacy First cover OTC medicines?

While a national Pharmacy First service has been long proposed, Ms Shah told The Pharmacist that it would not come soon enough for the patients she knew in North East London who were struggling to access medicines.

‘The government keeps talking about a [national Pharmacy First] scheme, it would be good to understand if that scheme was going to happen and what it involves, because then the ICB wouldn't have to do it if it was nationally funded. But we don't want to hold our breath on that as patients need help now,’ she said.

The Department of Health and Social Care (DHSC) confirmed to The Pharmacist that some ICBs were looking into programmes that include the free supply of over-the-counter medicines, but that there were no such plans for a national programme. They added that they were unable to comment on any plans for Pharmacy First specifically.

Last month DHSC said that an online notice that appeared to suggest that it was set to explore an ‘expanded service to treat common conditions in community pharmacy’ should not be interpreted as an announcement of the service or a guarantee of research into it.