Independent pharmacists are closing and “patients are suffering”

Image: Busby’s Pharmacy, Grove Park

Independent pharmacists launch petition to raise awareness for the ‘dire situation’ they are facing

Bridget Osborne and Matt Smith

The organisation which represents independent pharmacists, the NPA, has launched a petition to make politicians and the public aware they are facing a dire situation, with many closing under the pressure of rising drug costs, shortages of key medicines and new measures implemented by the government.

They say ten pharmacies are closing each week and three quarters of independent pharmacists find their accounts are now in the red, yet pharmacists are at the forefront of a new healthcare strategy to relieve pressure on GPs by asking patients to consult their local pharmacist first on a range of medical problems.

Among the independent pharmacies in Chiswick which are asking customers to sign the petition is Busby’s in Grove Park and Sabel Pharmacy on Chiswick High Road. Busby’s owner Sue Birch and Sabel’s co-owner Rachel Patel spoke to The Chiswick Calendar about the problems pharmacists are facing.

Images: Rachel Patel, Sabel Pharmacy

Drug shortages have got “worse and worse”

Rachel has had her pharmacist licence for over 30 years. She told us the situation with drugs shortages has been constantly deteriorating over the last few years to a point she felt was  unprecedented in her career:

“I’ve been qualified 31 years and it’s just got worse and worse. I’ve not known anything like it in the last two to three years, it’s just got progressively worse.”

The reason for drugs shortages is multifaceted, she explained, with ongoing issues facing manufacturers:

“Most drugs are made in a very small number of places. Different companies will outsource to different manufacturers, but there was a fire and some lost a licence, all of this impacted on supply.

“Brexit has made it harder to import medications and most of our medications aren’t made in the country, they’re made abroad.”

These shortages, which are happening around the world, are also exacerbated in the UK by what she describes as a political refusal to pay the suppliers enough.

“Which means that [the suppliers] will automatically, as you would expect, rather supply whatever they’ve got to a market that will pay them.”

From one or two drugs unavailable… to over 50%

Sue has also been in the industry for a long time. She has run the pharmacy in the rank of shops beside the railway at Grove Park for nearly 30 years.

For the first time ever last year, she found her accounts were in the red. She blames difficulties of getting hold of drugs to meet prescriptions, and a shortfall in the money the government is paying pharmacists for them.

“It started being difficult to get hold of drugs pre-Covid. Losartan, for example, a drug used to control blood pressure, was suddenly unavailable. Atorvastatin, used to lower cholesterol, was also beginning to be problematic.”

“Recently Trulicity, which was developed for people with stage two diabetes, has disappeared. It’s just not available.”

Post-Covid, the problem has intensified:

“It’s gone from being one or two drugs that are unavailable, or above the drug tarrif price, to more than 50%.”

The drug tariff is the price mechanism by which the Department of Health and Social Care (DHSC) regulates its drug budget. They give pharmacists a list of drug prices each month and pharmacists know if they buy drugs at more than that price, they will not get the full amount back from the government.

Because prices have risen so quickly, the DHSC has been reevaluating what they are prepared to pay, and updating the list several times during the month, but last month they stopped doing that, Sue told us, and now they only send the list out once a month.

That means in practice that pharmacists are buying and dispensing drugs, but only at the end of that month will they be able to tell whether they will get their money back.

Image: Losartan; Atorvastatin

“Patients are suffering”

Does that mean that patients are going without the drugs they need?

“No, because I can’t see somebody not having their medication. It does mean that sometimes we have to say to people they will have to come back, or we can give them one of the drugs on their prescription but only a few of another drug, to tide them over until the end of the month.

“Sometimes we have to send people to the big companies like Tescos or Boots, but we have had people come back and say they couldn’t get them either.”

“Patients are suffering. It’s the time involved in having to shop around, but also a lot of it is the anxiety caused because patients don’t know whether they will be able to get their drugs or not.”

Image: National Pharmacy Association petition

Pharmacists out of pocket

It does mean that Sue ends up out of pocket. Quite by how much for this year she is not yet sure, but after 26 years of running the shop she was surprised to find herself in the red for the first time last year.

“I knew it was bad, but I hadn’t realised it was quite that bad.”

The amount she loses on a drug that costs more than the set tarrif can be just a few pennies, or in some cases it can be more than ten pounds on one prescription.

“Drug bills are going up sometimes by as much as 50%. I used to pay £8,000 a month to a particular wholesaler. Now it’s £12,000.”

Sue buys from two of the major wholesalers in the country, AAH and Alliance. If she cannot source the drugs she needs from them, she will then go to ‘shortliners’, companies such as Bestway and Sigma, which specialise in sourcing specific drugs from manufacturers.

She buys through Cambrian, a buying group organised in a similar way to a cooperative.

“They won’t send us any drugs that are above the drug tarrif.”

Sabel Pharmacy also loses money on their NHS services, to the point where they rely on their private services to stay afloat.

“If we didn’t have any private income we wouldn’t be able to operate at all” Rachel told us.

“The last full day off I had was three weeks ago”

On any given day Sue has about four A4 pages of drugs she can’t source through Cambrian or through other suppliers. The amount of work this creates in searching online and on the phone to find drugs means she is working much longer hours.

“The time consumed by trying to obtain drugs has escalated out of sight. It used to be the case that we’d put the order in, get the drugs and dispense them. Now there are about ten processes to go through.

“You put the order in, realise the drugs are not arriving and check why – whether it’s a supply chain issue from the wholesaler or a cost issue; if it’s cost, you search around to see if you can find it within the cost, you contact the patient to explain, and / or contact the GP to alter the prescription to something that is available.

“I start work at 9am and am often still there at 3am. The last full day off I had was three weeks ago.”

One thing she has done, which has reduced the necessity of queueing in her shop, is to process prescriptions only when customers come in.

“The big orders, or the regular orders we make up as soon as the prescriptions come in from the GPs, but one-off prescriptions we wait until the person comes to collect to dispense, because we found we were spending time making up prescriptions that sometimes sat there for months and weren’t collected.”

“They’re paying us as cheap doctors”

The Government has also recently introduced ‘Pharmacy First’, which effectively formalises the service experienced pharmacists have always provided in giving over the counter advice on minor ailments.

There is now a specified number of conditions for which they are allowed to recommend treatments, such as sinusitis, ear and throat infections, uncomplicated urinary tract infections, impetigo and shingles, and for which they are paid accordingly.

“It’s a very good idea, but it takes about 20 minutes per patient to see if they meet the criteria and to submit the paperwork, to fill out whether they have been referred by a GP, by 111 or whether they are a walk-in, and it’s something you can’t delegate. It has to be done by the pharmacist. They’re paying us as cheap doctors.”

She finds patients are annoyed they cannot just come in and pick up their drugs as per the prescription in the way they used to. She finds herself trying to explain the very complicated mix of factors which has made things so difficult, over and over again.

Now she is also asking them to sign the National Pharmacy Association’s petition, in the hope the next government will do something to help them. According to the NPA 1,400 independent pharmacies have closed in the past ten years.

You can sign the petition at Busby’s in Grove Park or at Sabel Pharmacy on Chiswick High Road.

Read more stories on The Chiswick Calendar