The real reason your local pharmacy is closing down

Suzanne Osborn has visited Bliss Chemist for years, for what she calls “general maintenance”. Having lived in Kilburn since 1968, and just up the road from the pharmacy for a decade, she is on friendly terms with the staff and enjoys stopping by for a chat.

Like many high street chemists, Bliss is not only somewhere to pick up prescriptions and paracetamol. “It’s part of the community,” says Osborn, 83. “People rely on it enormously.”

For more than 40 years it has survived in this bustling corner of north-west London. But like many pharmacies nationwide, today Bliss is struggling. Amid serious financial pressures it is barely breaking even. “We’ve gone over and beyond delivering on everything we’ve been asked, but we have been treated poorly, being asked to do more for less,” says owner Sonal Davda, who took it over a couple of years ago.

She is far from alone in worrying about the future of a business on which local lives depend. Almost two thirds of pharmacies in England are now losing money, according to a recent survey by Community Pharmacy England (CPE). One in six could vanish from the high street within a year, and patient care is already being impacted.

Hundreds of other pharmacies have already closed since the pandemic, with rural areas in England so badly affected that industry leaders have warned they are at risk of becoming “pharmacy deserts”. A dozen areas around England have been left with less than 15 pharmacies per 100,000 people, according to analysis by the National Pharmacy Association (NPA). Since 2015, there has been a net loss of nearly 1,200 pharmacies, with the financial year 2023-24 alone seeing a record 432 closures, figures from the Company Chemists’ Association show.

Lack of funding from NHS England is a major problem, pharmacy owners say. While the cost of drugs has increased, the money the Government reimburses to chemists for them has not kept pace. CPE, which represents all community pharmacies and is about to negotiate a new contract with the Government, has warned that NHS funding has fallen by 30 per cent in real terms since 2015. The proportion of the NHS budget spent on pharmacy services has fallen from 2.4 per cent to 1.6 per cent during this time, they say.

“They’ve cut, cut, cut funding,” says Davda.

The National Pharmacy Association – which represents about half of the UK’s community pharmacies – is now balloting members on “work-to-rule” action that could see chemists cut their opening hours in protest at the funding shortfall. It says an extra £1.3 billion is needed each year to plug the “financial hole.”

Yet the sector has meanwhile seen a growth in the volume of prescriptions issued, to the point that pharmacies now supply over 1.1 billion items a year.

When these items cost more than what the NHS will pay for them, pharmacies face tough choices. “We’re healthcare professionals as well as running a business, so we’ll dispense them at a loss,” Davda admits. “There literally isn’t any profit. From month to month I’m only just about breaking even.”

Pharmacy teams spend hours each day trying to find medicines affected by availability and pricing issues, says Suraj Shah, drug tariff and reimbursement manager at CPE. In the past year, about 150 medicines have had pricing issues each month.

“Some of the NHS medicines are supplied at a loss with pharmacy owners often having to cover the differences in costs out of their own pockets,” he says.

One such drug is the antipsychotic medication Haloperidol. Its lowest buying price is currently £18 for 5mg, but the NHS reimburses just £3.54 of this. When a patient came into Bliss with a prescription for the drug recently, staff had to call the doctor’s surgery and ask them to prescribe an alternative. “It’s really tough sometimes for the patient,” says Abhishek Patel, the store manager.

Etoricoxib, which eases pain and inflammation for patients with rheumatoid arthritis, is another drug that costs more than the price the NHS will pay. Though it’s currently available for £7.55 per 90mg, NHS England reimburses pharmacies only £6.54. Unless the patient is willing to pay the difference, the pharmacy can only dispense it at a loss. With some drugs, there is simply too much at stake not to do so.

“For heart or blood pressure, it can be fatal if you stop taking certain medications,” says Patel. “In some cases, the patient ends up needing treatment in hospital and that costs the NHS more than the drug itself.”

We’re sitting in one of the pharmacy’s four consultation rooms: a sparse, clinical space where patients receive blood pressure checks, contraception, weight loss management and flu jabs in privacy, and discuss sensitive ailments. Beyond the door, a trickle of customers enters the shop to collect prescriptions and exchange pleasantries with staff or each other.

“Say hi to mama,” pharmacy assistant Maria Coutinho calls to one young woman as she picks up her mother’s medication.

Coutinho, 50, has worked here for almost eight years and planned to stay until she hit retirement age. “Now I don’t know if my job will be secure until then,” she says. “It’s scary.”

If prescription drugs no longer pay, pharmacies can in theory make money from providing other services, such as flu vaccinations. Indeed, they are encouraged by the Government to do so. The problem, says Davda, is that providing these services brings additional costs, such as those associated with paying extra staff. Visiting a housebound patient to administer a flu jab would cost £70 in staffing hours, she says, but the NHS would reimburse just £15.91. While Davda wishes she could offer an at-home service to those who need it, the sums just don’t add up. “I have to decide between paying my staff and helping a patient, and it’s heartbreaking,” she says.

“It’s not a good position to be in as a business, as an owner,” agrees Patel. “But you can’t just close the shop, because people’s lives are attached to it…[and they] have a special relationship with the team. Everyone knows our staff by name.”

Osborn, a retiree who recently underwent surgery on her arm and leg, values this relationship, popping in about three times a week for one reason or another. “You can discuss your treatment here or what your medication is doing,” she says. “If anything had gone wrong [post-surgery] I would come here immediately. This is my first port of call. I know I would get a good response from these people.”

Belinda Sinclair, who is “living on ibuprofen” while awaiting a hip replacement, sees Bliss as a kind of community hub. Aged 73, she has lived around the corner for 40 years and comes in regularly for painkillers and blood pressure medication. “They know me,” she says. With accessing a GP a near-impossible task in many areas, she notes that chemists are filling a crucial gap. “We need them because our doctors – we don’t get to see a doctor!”

Several of Bliss’s more isolated elderly patients come in for a cup of tea and some human contact, as well as whatever they require to keep their bodies ticking along.

Once dubbed County Kilburn, the local streets of large Victorian houses, alongside the multicultural cafes and shops near the pharmacy have historically been home to a large population of Irish emigrants, many of whom arrived in the 1950s. Since the 1970s, they’ve been joined by others from the Caribbean and Asia. Bliss sits just off the lively High Road, immortalised by the name of Ian Dury’s band, Kilburn and the High Roads. There are high levels of deprivation in parts of this diverse neighbourhood, and the pharmacy caters to a number of vulnerable patients.

The NPA’s findings suggest deprived council areas are experiencing higher levels of pharmacy closures. As Paul Rees, its chief executive, has warned, this threatens efforts to tackle health inequalities.

But the funding shortfall is not the only reason for the sector’s difficulties. Drug shortages – reports of which have increased since 2021 – have added to the challenges, with pharmacists reporting that much of their time is spent trying to source medications. In January, the Pharmaceutical Journal highlighted a 67 per cent increase in reports of potential shortages from manufacturers between 2021 and 2023. The British Generic Manufacturers Association reported an even more dramatic 100 per cent increase in medicine shortages in the two years to January this year.

Here, the industry finds itself at the mercy of global factors, including increased demand, manufacturing and distribution problems and shortages of ingredients. But it’s also thought that some medicine shortages may be artificial, created by the suspected hoarding of medications by suppliers when prices are low. The war in Ukraine, the Covid pandemic and Brexit have also played their part, with increased energy costs affecting manufacture and supply.

In the last few months, supplies of medications for ADHD, epilepsy and diabetes have all been hit, with patients and pharmacists both suffering.

“Patients are frustrated at being pushed from pillar to post trying to obtain medications,” says Shah. “For pharmacists, it means they have to spend time away from the frontline, talking to wholesalers and manufacturers to obtain stock or contacting the patient’s GPs to try and arrange for alternative prescriptions. This is becoming quite a barrier to the delivery of clinical services by pharmacy teams.”

The high cost of rents and other overheads has also hit high street chemists, as well as the scourge of shoplifting. (Bliss lost about £300 of stock to thieves recently. Police examined the CCTV but the culprits were long gone.)

Davda says the growth of pharmacies attached to GP surgeries means that shops like hers are losing out on business too – and that surgeries are effectively “competing with us instead of supporting us”.

In some parts of the country, competition comes from online pharmacies. But while it is convenient to buy prescription-only medicines over the internet, it is sometimes possible to do so by entering false or incorrect information, and this lack of checks can be life-threatening. In 2020, Katie Corrigan, a 38-year-old nurse from Cornwall, died after accidentally overdosing on codeine she had purchased online. Her parents have called for tougher regulation of online pharmacies.

Whatever the potential risks, the practice of buying medications over the internet grew significantly during the pandemic as patients struggled to see their GPs.

At the same time, the sector is struggling with the kind of workforce pressures that have plagued other industries of late, meaning that recruiting staff has grown harder. Reasons for this are thought to include the general post-pandemic desire for more flexible or home-based working, as well as pharmacists switching to work in GP practices rather than in retail.

This perfect storm of setbacks has left the sector in a parlous state. “Pharmacy owners have seen their costs grow whilst their base NHS funding has been cut in real-terms, putting them under immense financial pressures,” says Shah. “In the last few years, we’ve heard of pharmacy owners having to dip into pensions or borrow money to stay afloat. They’re having to take desperate measures. Many that were previously just about managing are having to fold completely and are forced to sell up or close.”

Nor are the big pharmacy chains immune from these headwinds. Last year, Boots announced plans to close 300 pharmacies, while the LloydsPharmacy chain – once the second biggest in the UK – filed for liquidation in January, having blamed the cut in government funding for its growing losses (the firm continues to trade online).

Those who remain in the market are despondent. “We’re being thwarted at every turn,” says Davda. “Why does no-one think about what’s going to happen if high street pharmacies are lost?”

The Department of Health and Social Care agrees that pharmacies “have been neglected for years” and says it is monitoring closures closely. “Pharmacies are key to our plans to make healthcare fit for the future, as we shift the focus of the NHS out of hospitals and into the community,” says a spokesman. “We will expand the role of pharmacies, making better use of pharmacists’ skills, including accelerating the rollout of independent prescribing.”

If Bliss were to disappear from Willesden Lane, locals know they would lose more than just a shop. “[There would be] a loss of sense of community,” says Osborn. “People rely on it enormously. It is extremely important that this place survives.”