I mentioned in an earlier column that, where I live in leafy south-west London, I was within easy walking distance of five retail pharmacies: three of them owned by the same Walgreens-owned national chain and two of those three sited less than 250 metres apart.
That didn’t seem sustainable and, indeed, it hasn’t been. Two of those five pharmacies have closed in the past six months. The big supermarkets haven’t killed off the local retailers: the experiment of having pharmacies in big supermarkets seems to have been largely unwound, as The Pharmaceutical Journal previously reported.
In January 2023, LloydsPharmacy announced it would withdraw pharmacy services from all Sainsbury’s supermarkets, affecting 237 branches, following what the company called a “strategic review of its operations in response to changing market conditions”.
These changes to the retail market are part of a trend. As The Pharmaceutical Journal exclusively revealed, LloydsPharmacy has ceased operating 90% of its community retail branches in the past 18 months. General Pharmaceutical Council data show that the company was running 138 pharmacies as of October 2023, compared with 1,338 pharmacies in March 2022. The same data also reveal that Boots was operating 2,019 pharmacies as of October 2023, Well had 736 pharmacies, and Rowlands had 399 pharmacies.
The Hallo Healthcare Group, which owns LloydsPharmacy, told The Pharmaceutical Journal that most of its pharmacies were being bought by independent pharmacy owners and local businesspeople. The 90% drop in LloydsPharmacy branches is a significant number.
But does it matter if the ‘invisible hand of the market’ (in Adam Smith’s famous image) is getting to work?
Well, to the average citizen, that probably depends on whether these changes have closed your local pharmacy, leaving you short of alternatives.
That is a parochial issue, of course, but all politics is local. If the community pharmacy sector is more diversely provided (the LloydsPharmacy statement above indicates that many of the sites they have offloaded are not closing, but changing hands), will that not increase its diversity and resilience?
It may do so. Equally, bigger ownership can provide coherent management oversight and economies of scale in purchasing, as well as consumer trust in a national brand. It all depends which are the key drivers of the market.
And community pharmacy closures are a ‘thing’: The Daily Mail recently published this article on closures and, as The Pharmaceutical Journal’s reporting has noted, 91 community pharmacies in England closed in 2022/2023.
There is a bigger practical issue, which is the plans for pharmacy to do more to take pressure off the rest of the healthcare system.
The ‘Pharmacy First’ initiative that NHS England has promised as part of its plan for recovering access to primary care, which will emulate the Scottish model, is due to “launch before the end of 2023”, enabling pharmacists “to supply prescription-only medicines, including antibiotics and antivirals where clinically appropriate, to treat seven common health conditions (sinusitis, sore throat, earache, infected insect bite, impetigo, shingles and uncomplicated urinary tract infections in women) without the need to visit a GP”.
You can see where I’m going with this. For Pharmacy First to be a ‘thing’, you need community pharmacies in which it can happen. And the advantage for NHS England of working with the big chains is that there are far fewer agreements to put into place or quality controls to operate.
But of course, this is to bind ourselves into traditional ways of operating and thinking. Perhaps we are missing the innovative potential of a ‘phantom pharmacy sector’.
There is ample precedent in recent government policy: take its forty new (if fictional) hospitals programme. This aimed to bring the NHS in England 40 new hospitals by 2030, that are neither 40, nor new hospitals. Nor will this happen by 2030.
Then there is the government’s pledge to increase GP numbers by 6,000 over the course of the current parliament. However, there are currently fewer full-time equivalent GPs than in 2019: the number of full-time equivalent fully qualified permanent GPs decreased from 27,088 in June 2019 to 26,543 in July 2023 — a drop of 545 GPs.
And, if that were not enough, the government’s pledge to increase the number of English NHS hospital beds by 5,000 has seen the number fall by 3,000, as a freedom of information request by the Royal College of Emergency Medicine showed.
Reporting on the data earlier this month, The Times revealed that “analysis of NHS England data by the Royal College of Emergency Medicine (RCEM) showed that between January and September, bed numbers in major acute hospitals fell from 100,046 to 97,332”. The NHS ‘Delivery plan for recovering urgent and emergency care services‘, published in January 2023, set out plans to provide over 5,000 additional permanent, fully staffed hospital beds in total.
So, if the community pharmacy sector is to be a big contributor to reducing demand pressures on the health and care system, then surely we shouldn’t confine it to the ‘real world’. Let’s innovate! Let winter 2023 be the time for phantom pharmacies: coming soon to a high street (or metaverse) near you!
Andy Cowper is the editor of Health Policy Insight