Community pharmacy in Britain: a changing market

Chronic underfunding of the community pharmacy sector has continued to take its toll, with a net loss of 295 pharmacies across Great Britain since our previous analysis in March 2022. The number of community pharmacies in England has fallen for the fifth consecutive year.

Underlying these net figures is a shift in ownership from large multiples to small multiples and independents, mainly down to the sale or closure of most LloydsPharmacy’s branches.

Between March 2022 and October 2023, there was a net fall of 1,058 pharmacies among the large multiples, whereas small multiples have gained 195 pharmacies and independents have gained 568 pharmacies (see Figure 1). Small multiples have seen the largest shift in market share, from 13.2% in March 2022 to 17.0% in October 2023.

Large multiples

Although several large multiples have sold or closed branches over the past year, the most dramatic overhaul has been for LloydsPharmacy, which has sold most of its high street stores and closed all 237 branches in Sainsbury’s supermarkets. As of October 2023, LloydsPharmacy now operates only 138 pharmacies —­­ 90% fewer than in March 2022 (see Figure 2).

LloydsPharmacy branches have largely been bought by independent pharmacy owners and local businesses. Large multiple Rowlands Pharmacy acquired 30 LloydsPharmacy branches in Scotland in May 2023, while small multiple Dears Pharmacy has taken over 12 branches, doubling its Scottish presence. Online pharmacy Lloyds Direct, which was part of the LloydsPharmacy group, was bought by Pharmacy2U in October 2023.

Well Pharmacy, now Britain’s second largest multiple with 736 pharmacies, closed three pharmacies between March 2022 and October 2023. A spokesperson told The Pharmaceutical Journal that the company’s principles are to “invest and grow in the pharmacy market, as demonstrated through our recent acquisitions of Lexon and Knights Pharmacies in April 2023”.

As part of this ongoing activity, the spokesperson added that “[Well Pharmacy] also considers divestments and consolidations when the opportunity arises”.

Asda and Tesco also announced closures during 2023, with Asda closing seven pharmacies that had been “running at a loss for a number of years”, according to a spokesperson, and Tesco closing eight pharmacies. Boots — which is still the largest multiple by far, with over 2,000 branches — announced in June 2023 that 300 of its pharmacies would close over the next year, in addition to the 200 branches that had closed since 2019.

Small multiples

Over the past 18 months, several small multiples have increased the size of their networks (see Figure 3). Imaan Healthcare, for example, has grown to 60 pharmacies nationwide, with 26 purchased recently and another 10 in the pipeline (latest acquisitions not reflected in our data).

Saghir Ahmed, its director of operations and business development, told The Pharmaceutical Journal that most of the pharmacies are in North West England and Yorkshire, although there are some in the Midlands and South East England too.

“Though the multiples are divesting, and they will have their own reasons for this, we have been acquiring pharmacies and in areas that we want to grow presence,” he says.

“Unlike the multiples, where they want uniformity in their service across their estate, we at Imaan Healthcare believe that, though there are some standards and expectations that cannot be compromised from our service, we allow our pharmacy teams freedom to create a service that is for purpose for their community.”

Sharief Healthcare is another small multiple that has grown since our previous analysis and has more than doubled in size from 26 pharmacies to 55 pharmacies. Sharief Healthcare owns many of the Allied Pharmacies in Wales and other areas of England.

LP HCS is a new business unit within LloydsPharmacy parent group Hallo Healthcare, incorporated in November 2022, which provides specialist pharmacy services to the NHS and private sector, including NHS trusts, mental health trusts and prisons.

Independents

With a net increase of 568 pharmacies and 246 owners since March 2022, the number of independent pharmacies continue to grow.

While most independent proprietors (76.5%) own a single pharmacy, a higher proportion have purchased a second pharmacy, at 15.3% in October 2023 compared with 13.6% in March 2022 (see Figure 4).

Anna Matthews, a young pharmacist from Wales, purchased her first pharmacy, in partnership with another local pharmacy business owner, just seven years after graduating. She bought the pharmacy in Nantyffyllon, Wales, from the large multiple Well and renamed it Nanty Pharmacy, opening in September 2023.

Matthews is a newly qualified independent prescriber and is passionate about increasing access to clinical services for her local community. She says that she has lots of ideas for service development and will be focusing on upskilling her staff to be able to support the move towards a more service-driven model. She is optimistic that funding for pharmacies will improve and is passionate about promoting her clinical services and improving the public’s understanding of what pharmacies can offer. “It’s a risk, but one worth taking,” she says.

Per capita fall

While some pharmacies are changing hands, many are closing permanently. Every integrated care board (ICB) area in England has experienced a fall in the number of community pharmacies per capita over the past five years. Birmingham and Solihull ICB has seen the biggest change, from 2.6 pharmacies per 10,000 people in 2018 to 2.0 in 2023 (see Figure 5).

Jeff Blankley, chief officer at Birmingham and Solihull Local Pharmaceutical Committee, told The Pharmaceutical Journal that contractors in Birmingham and Solihull delivered a 10% item increase over the past two years, which translates into a huge increase in work for many contractors where a nearby pharmacy has closed.

“Coupled with the challenges of dispensing at an overall profit each month, and the workforce pressures, I have seen contractors close or consolidate in several areas of the LPC. And the remainder continue to provide care in their local community in some very challenging circumstances,” says Blankley.

Buckinghamshire, Oxfordshire and Berkshire West now has the lowest number of community pharmacies per 10,000 people, at 1.3. The Black Country and West Birmingham, Cheshire and Merseyside, Lancashire and South Cumbria, and South Yorkshire and Bassetlaw have the highest number of community pharmacies per capita, at 2.1 per 10,000.

Pockets of closures

There have been 1,064 pharmacy closures in England since 2018 and 371 new openings, resulting in a net loss of 693 pharmacies (see Figure 6), with pockets of high numbers of closures in London, Birmingham and North West England, where the number of pharmacies per capita were the highest.

In 2022/2023, the highest number of closures was within the Cheshire and Merseyside ICB area, where 19 community pharmacies closed and 8 community pharmacies opened.

Matt Harvey, chief officer of Community Pharmacy Liverpool, told The Pharmaceutical Journal that ten community pharmacies in Liverpool had closed over the past year, which were “a mixture of multiples and independents, who have struggled to make their businesses work in the current strained environment”.

“We have also seen a reduction in hours locally with most 100-hour pharmacies choosing to reduce hours following regulatory changes,” Harvey added. “This is leading to increased pressure on the remaining estate. Unfortunately, I foresee further closures in the pipeline.”

The future

Further closures are predicted across England unless substantial new NHS investment is forthcoming. A report published by academics at University College London and the London School of Economics in September 2022, commissioned by the National Pharmacy Association (NPA), highlighted that inflation-adjusted English community pharmacy remuneration was already 25% below its 2015 level.

“There is a strong case for reducing the risk of NHS community pharmacy closures that would be damaging to public interests in better health. A pharmacy network collapse in England would threaten the safe supply of NHS medicines, increase health inequalities, inflict political costs and slow or stop the provision of enhanced clinical care in community pharmacies,” it said.

Commenting on pharmacy closures in England in 2022/2023, Helga Mangion, policy manager at the NPA, told The Pharmaceutical Journal that downward movement of pharmacy numbers was “inevitable in the light of long-term underfunding”.

“In fact, these closure figures tell only part of the sad story of decline, because many independent pharmacies are hanging on by their fingernails by reducing opening hours and reducing value-adding services, such as home deliveries,” she added.

“A brighter future is possible for community pharmacy, based on properly funded clinical services within a truly integrated health service and a long-term shift of NHS resources to primary and preventative care.”