Community pharmacies in the most deprived areas of England are more likely to close compared to other areas, despite being a vital lifeline for patients, an investigation by The Pharmaceutical Journal has revealed.
The investigation has quantified, for the first time, the positive impact of community pharmacy in deprived areas, showing that they provide 50% more NHS services to local people compared with other areas where patients are healthier.
The Pharmaceutical Journal used the UK government’s indices of deprivation to analyse data published monthly by NHS Business Services Authority on the 4.2 million claims for NHS contractual services by community pharmacies in England.
In the 10% most health-deprived areas of England, 17% of all claims (720,978) were made by community pharmacies. This works out as an average of 401 claims per pharmacy premises for carrying out contractual services between October 2021 and September 2022.
In the 10% most healthy areas of England, 5.3% of claims (220,497) equated to an average of 266 claims per pharmacy.
However, The Pharmaceutical Journal analysed the same deprivation index alongside latest available NHS Digital data on pharmacy openings and closures and found that 27 (23%) of the 118 pharmacy closures that occurred in the same time period were in the most health-deprived areas, while 5 (4%) were in the 10% most healthy areas.
The findings fit with the long-term trend of closures in England, with an analysis conducted by the Company Chemists’ Association in October 2022 showing more than 40% of community pharmacy closures between 2015 and 2022 took place in the most deprived areas of England.
This is despite an NHS England report into prescribing, published in January 2023, that found that polypharmacy increases with relative deprivation, with people in more deprived areas more likely to have prescriptions for ten or more different medicines in at least one month of the year.
In September 2022, the National Pharmacy Association (NPA) warned of a “looming pharmacy collapse” without additional government funding.
And on 19 January 2023, LloydsPharmacy announced plans to withdraw pharmacy services from all Sainsbury’s stores over the course of 2023 “in response to changing market conditions,” affecting more than 200 branches.
Janet Morrison, chief executive of the Pharmaceutical Services Negotiating Committee, described The Pharmaceutical Journal’s findings as “very worrying”.
“If even those pharmacies that are dispensing numerous prescriptions and offering plenty of services cannot make the sums add up, then something is clearly not right at the core of pharmacy funding,” she said.
“Pharmacies have a real role to play in most deprived communities to help reduce health inequalities — but only if those pharmacy businesses have access to fair funding levels.”
Adam Todd, professor of pharmaceutical public health at Newcastle University’s School of Pharmacy, commented: “The uniqueness of the community pharmacy network, in terms of accessibility, is the geographical distribution of them. So potentially, if this [trend of closures in deprived areas] continues to happen, the uniqueness of the community pharmacy network — and the positive pharmacy care law — could be in jeopardy.”
In 2014, Todd published a study in the BMJ that introduced the ‘positive pharmacy care law’, after finding that 99.8% of people living in areas of high deprivation had access to a community pharmacy within a 20-minute walk, compared with 90% in more affluent areas.
Todd added that pharmacy closures will potentially “exacerbate health inequalities”.
“If you’ve got a pharmacy that’s commissioned to provide services, to prevent disease, promote health and also reduce inequalities, and yet those services are no longer there for a community, I think it certainly doesn’t make much sense in terms of how this fits with the overall strategy of reducing inequalities,” he said.
A spokesperson for the Department of Health and Social Care told The Pharmaceutical Journal that it is “carefully monitoring access to pharmaceutical services and there remains twice as many pharmacies in deprived areas compared to less deprived areas”.
Box: What is the government doing to tackle health inequalities?
In 2021, NHS England launched the ‘Core20PLUS5’ initiative, which aims to focus on people living in the country’s 20% most deprived areas and has identified five clinical areas for improving health inequalities: maternity, severe mental illness, chronic respiratory disease, early cancer diagnosis and hypertension case-finding.
Integrated care boards were granted £200m by NHS England in 2022/2023 to help meet specific targets relating to these five areas, including to have “75% of [cancer] cases diagnosed at stage 1 or 2 by 2028”.
There have been calls for similar initiatives in both Scotland and Wales. In July 2022, the Welsh NHS Confederation Health and Wellbeing Alliance called for the Welsh government to produce a “plan for reducing poverty and inequalities in adults and children”, after a Public Health Wales report found that the COVID-19 pandemic had widened existing health inequalities in the country.
Similarly, in Scotland, a a report published by the Health, Social Care and Sport Committee in September 2022 called for urgent action to address health inequalities and make the issue “a major public health priority”.