‘I have to try 25 pharmacies to get my medicine’: inside the chemistry dilemma

Community pharmacies have long been a mainstay of the high street, providing the one health center many of us take for granted. Where else can you go for free advice, available without a doctor’s appointment, to pick up your prescriptions, access NHS services such as vaccinations, and stock up on essential health items?

Yet these primary care services are battling their own health crisis, with major drug shortages and 10 prescriptions a week closing in England. “There has definitely been a failure to appreciate community pharmacy for what it does,” says pharmacist Thorrun Govind.

“If this continues, we will continue to see more closures. People are losing easy access to healthcare in their high streets, at which point they are already struggling to get GP appointments. , making it easier for them to end up in A&E. This affects the whole system.”

Successive governments have created plans to empower pharmacies to treat more conditions and ease the burden on doctors, calling them the “front door” to the NHS. However, behind the scenes, funding has fallen from 2.4 per cent of the NHS budget to 1.6 per cent in the last 10 years, says Paul Rees, chief executive of the National Pharmacy Association (NPA ). Last week, a report found that one in six pharmacies could close within a year, as patients struggle to access a supply of medicines.

England now has the lowest number of community drugs since 2005, and experts say the most vulnerable people in society are being hit the hardest.

“Too many pharmacies are closing and poor areas are the most affected, increasing the inequality in the provision of health care which is a growing and most unaccepted feature of our country,” says Caroline Abrahams, director of charity Age UK.

“Drugs are important, locally available resources, especially for older people living with health conditions who often rely on them for advice and support, not just prescriptions. With our aging population we need more of them, not less. ”

Permanent closure is not the only issue; Struggling pharmacies have been forced to cut staff, hours and services to stay afloat. Two-thirds have reduced their hours since 2005, and in the past 12 months, 96 percent of pharmacies have cut back on locally-provided services, such as providing contraceptives. emergency deliveries and smoking cessation services. A third has stopped providing national pharmacy services such as vaccinations.

Meanwhile, demand for the drugs has increased since the outbreak began, says pharmacist Fin McCaul, a spokesman for Community Pharmacy England.

“Community pharmacy was the first point of call for people when they couldn’t get to their doctor, and that continues. It’s usually for free advice, not a paid service,” he says. .

“We have also seen a 15 percent increase in the number of orders. Partly because of the increased number of people but mainly because, with Covid, people are getting sicker. We have seen an increase in heart rates , diabetes and other health problems like long-term Covid, so people need more drugs than ever.”

One of them is Lydia Wilkins, a 25-year-old journalist from Sussex, who has many health problems due to prolonged Covid. Wilkins, who is also autistic, is used to using her community pharmacy, but says the closures, unpredictable opening times and staff shortages have made access even more difficult.

Wilkins used to operate Lloyd’s Pharmacy. As part of a large high street chain, located within her local supermarket, this was easily accessible for disabled patients like her.

He says: “It had wide corridors, fixed opening hours and generally clear information on signage.

When Lloyd’s closed its branches last year, Wilkins – who often uses a cane to help him walk – was left with two nearby options. The other, he says, is small, expensive, understaffed and rarely open, with a “nightmare” walk up to the door. One has nowhere to stay while you wait, and staff shortages have made opening hours unpredictable, leading to wasted and frustrating trips.

“If you look online, you might believe there is access from 9am to 5pm, but that’s not the case. The actual hours seem to change frequently, but you can’t look online, no one answers the phones , and there’s no sign on the front of the shop telling you if the pharmacy – at the back of the high street shop – is closed,” he says.

So, what causes these problems? Paul Rees, chief executive of the National Pharmacy Association (NPA), explains: “Over the last 10 years, there has been a real 40 per cent reduction in NHS funding for community pharmacy. There is also there is a £108m shortfall in the amount that pharmacies are reimbursed for providing NHS medicines, so they are doing this at a loss. Pharmacies are on their knees, and 1,500 have closed.”

Meanwhile, he adds, there is a sense that pharmacists are being asked to do more with less – such as the Pharmacy First initiative, which was supported by the former prime minister (and the son of a pharmacist ) Rishi Sunak.

Pharmacy First is designed to reduce the stress of general practice by helping pharmacists treat seven minor conditions, including sinusitis and impetigo. But, Rees says, the project was rushed through several weeks, including Christmas.

“Pharmacists are incredibly busy, and they’re not being paid to learn new services. Our members are fully trained nurses, well placed to support the community with minor illnesses, and committed to providing additional patient care. But they need the right support to do that,” he says.

“Currently, two-thirds of GPs do not refer patients to Pharmacy First, and around 75 per cent of people who come into their pharmacy do not meet the Government’s maximum payment threshold.

“The pharmacist will still give medical advice, but they will not usually be paid. That is demoralizing and demoralizing for pharmacists.”

At the same time, NPA members have seen an increase in harassment from members of the public. Rees says: “This is mainly driven by the frustration about the lack of medicine, which is a negative effect of getting less money, because there is not enough money to spend on buying medicine across the country. ”

Dileepa Ranawake, a 34-year-old student from Hull, has been taking methylphenidate – a drug to treat attention deficit hyperactivity disorder (ADHD) – for 18 months but says it is not available “almost everywhere” since at the beginning of the year. .

Ranawake’s quest to find his medicine has turned into a month-to-month battle. “Some months I call 25 pharmacies to find one that has it in stock. “My family lives in south-west London, so sometimes I’ve been trying the pharmacies down there, hoping that maybe I can find it if I go to them,” he says.

“I had to be very proactive, but obviously the level of the situation makes it difficult to keep track and chase all these moving parts.”

The shortage of ADHD medications — along with hormone replacement therapy (HRT) and weight-loss drugs — is partly down to manufacturers struggling to keep up with increased awareness and demand. But this is not the whole story, and it is not just medicine that is involved.

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Mehar Singh, 25, a customer service consultant and chronic disease advocate from Hayes, Middlesex, has faced the problem of running out of medicines. These include the birth control pill she uses to manage the symptoms of endometriosis, and an antihistamine she takes for mast cell activation syndrome.

“Seven times out of 10, my local pharmacy will return my prescription and say sorry, out of stock. “Now I’m going to have to call every pharmacy in Hayes and Uxbridge – probably 10 in total – to try and get the medicine I need,” he says.

In some cases, Singh adds, he had to go privately for an emergency prescription, paying up to ten times the normal price of £9.90 on the NHS. At times, she has used over-the-counter and natural remedies. He says: “I get very scared every time the doctor prescribes something new for me, because I don’t know if I will get it or where to get it.”

Around the world, shortages occur for a variety of reasons, McCaul says: “There could be production problems, such as a team failing to control quality or ingredient supply problems, or they have transportation issues. There are also production costs, and we’ve seen labor costs increase around the world in the last five years.”

But, McCaul adds, the UK has been hit hard because our public pharmacies are reimbursed at the lowest prices for the medicines they provide.

“If you take a blood pressure tablet like furosemide, they’re usually around 80p to £1 in the UK, because that’s what the Government pays us to buy, prepare and put on the shelves for patients,” he explains.

“In Ireland, it’s four times the price, and in central Europe it’s five times the price. So, if there is a shortage anywhere in the world, producers will divert their products to areas where they will get more profit. ”

The NPA held a national day of action on June 20 – the first nationwide protest in the pharmacy sector, with 6,000 pharmacies taking part – and is planning a second for September 19 .

“Community pharmacies are in dire straits, with 82 per cent of pharmacy owners saying their pharmacy is inefficient and 85 per cent making a loss on dispensing medicines,” says Rees. “We need the Government to stick to its word and provide the right agreement to properly support drugs.”

A spokeswoman for the Department of Health and Social Care said: “This government has inherited a broken NHS and medicines have been neglected for years. We are monitoring the restrictions carefully.

“Pharmaceuticals are central to our plans to make healthcare fit for the future, as we move the focus of the NHS away from hospitals and into the community. We will expand the role of pharmacies – making better use of the skills of pharmacists, including speeding up the publication of independent prescriptions.”