Yesterday I got an email from Medscape covering, inter alia, a short piece by one Dr. Rob Hicks, quite possibly the chap at reference 1 (which seems to be very thin on dates), covering much the same ground as reference 2. The gist seems to be that more than half of our pharmacies were operating at a loss and that many were going to close when the increases in business rates kicked in. Poor areas, where pharmacies were likely to be most reliant on the income from fulfilling NHS prescriptions, were likely to be most affected.
As someone who is very reliant on getting NHS prescriptions – no less then eleven pills a day – this caught my eye.
I start by saying that I am familiar with three pharmacies here at Epsom. Boots (a large chain) and Pearl (a small chain) in the High Street and the Horton Pharmacy (an independent) on the site of one of our former mental hospitals, a little to the west of the town proper.
Boots is bright and clean, it is part of a big store and I find it rather impersonal. I prefer to use Pearl next door, a much smaller chain, based, as it happens, in the very part of Mitcham Road in Tooting which I used to visit on a regular basis until a few years ago. Snapped above from Street View. The Horton Pharmacy is not on any of my regular circuits, at least not any more, so it is not convenient, although he supplements his income with lots of vaccinations and I do visit for those purposes. And we do visit the fine fish and chip shop on the same complex from time to time.
There is lots of information about the pharmacies in England available from the NHS. So, for example, I was able to download a spreadsheet about the numbers of pharmacies from reference 3, turned up by Bing on some simple search key.
In fairly short order, this resulted in the graphic above, in which small means independent or a branch of a chain with five or fewer outlets and medium one with more than five but less than 100 outlets.
With a bit of help from Gemini, I was able to sort out the X-axis a bit – in which not using scatterplot was my big mistake. Which new graphic, keeping an eye on the scale of the Y-axis, showed that we had lost getting on for 1,000 pharmacies 2023-2024, around 10% of the total.
This loss is mixed up with the closure of Lloyds Pharmacy and its thousand or so branches, a small chunk of which helped to make the Pearl we have today.
Gemini tells me that another factor was GP health centres transferring what had been GP workload to nurses and others – including pharmacists. Which drained away the pool of pharmacists available to regular pharmacies. And he goes on to tell me that the biggest driver is the decade-long squeeze on the Community Pharmacy Contractual Framework (CPCF).
All of which is a reflection of the uneasy interface between the public sector national health service and the privately run – but largely publicly funded – pharmacies. A bit like outsourcing.
An interface which is also – at least in my case – the scene of plenty of IT flavoured hiccups. There is plenty of learning going on here.
All this against a shifting background of various central initiatives like ‘100 Hour Pharmacy’ (around 15 hours a day for a near seven day week) and ‘Pharmacy First’ (which aims to move first line treatment for various minor ailments to pharmacies). Not to mention a big hike to minimum wage and a big hike to business rates.
All of which does not encourage the entrepreneurial pharmacist to invest – and does indeed suggest more problems to come.
Other matters
The business with CPCF reminds me that NHS dentists are often complaining about their contractual framework too – one symptom of which is that most dental work is done outside that framework – and another is that there is slippage back to the bad old days when a lot of it does not get done at all.
Finding out about the number of prescriptions did not prove so easy as finding out about the number of pharmacies. There is lots of stuff out there – including an elaborate management information system which is hosted by Oracle – and I dare say what I was looking for was out there somewhere. Maybe I should have gone to ONS. Maybe I should have asked Gemini. Maybe tomorrow.
Other countries with different histories and different geographies can have different arrangements. In the US, for example, mail order is much more important than it is here. Canada, Australia and – I dare say, Russia in spades – are in the same case.
Having run out of time, I close with a fantasy. A correspondent tells me that our Secretary of State for Health is rather keen on technology – so perhaps he will dump the problem on Amazon. Which has the added benefit of pleasing the chap over the water. Unfortunately, having killed of the network of pharmacies, all the jobs and all the quirky human contact, he finds that Amazon can then drive a rather hard bargain.
Denting the fantasy a bit more, Gemini points to the need for some medicines for cold-chain transport, to the amount of waste which results from 90 day prescriptions – routine in the US – and to the amount of theft from porches.
Conclusions
Fulfilling prescriptions, the retail end of the health business, is very big business and is also a growing business. Both because clever new medicines continue to arrive and because the population is getting older.
So the piece from Medscape with which I started and what might have been thought to be just a bit of lobbying from the small end of that business, does reflect a real problem. A real problem which is not just money, although more of that would surely help.
A real problem which the likes of Nige and his mates at Reform are unlikely to solve on the back of a fag packet or in the bottom of a pint glass. Or, indeed, senior citizens on their laptops of an evening, even with the considerable help of Bing, Google and Gemini. Serious wonk work is called for.
PS 1: in the margins of our chats, Gemini often tries, not yet very successfully, to make small talk. Small talk which, until recently, has often involved the granite outcrops of Devon - aka tors - which I once asked him about. While now, his focus for these purposes seems to have shifted to the Shans and the Golden Triangle, this last having once been important in the opium business. Now, I believe, more into telephone scam factories - although Gemini has yet to latch onto that. Investigating my interest in the Shans is left as an exercise for the reader.
PS 2: a nice turn of phrase at reference 5 this (Friday) morning:
‘… Sunak’s original line would not have saved the election, but it would have shown there was still a point to the Tories. Instead, the party that once mocked opponents for believing in a “magic money tree” turned out to have built its own house in the branches…’.
References
Reference 1: http://www.drrobhicks.co.uk/home/.
Reference 3: https://opendata.nhsbsa.net/dataset/pharmacy-openings-and-closures. Part of the NHS Business Services Authority Open Data Portal, no less.
Reference 4: https://en.wikipedia.org/wiki/LloydsPharmacy.
Reference 5: The Conservatives’ foundational sin: A party that once mocked the ‘magic money tree’ appears to have built its own house in the branches - Robert Shrimsley, Financial Times - 2026.
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