The PDA is calling upon Eluned Morgan to take the necessary action to stop corporations that own and operate community pharmacies from making commercial decisions to close, even though they have an existing commitment to the NHS to provide a pharmacy service to local communities.
Denying patients access to a community pharmacy can mean the denial of their ability to receive necessary medicines, advice, and services, some of which may be life critical. The PDA believes it is only a matter of time before serious harm to patients’ health will be caused by the decisions of mainly large chains of pharmacies to close some of their branches for all or part of a day, instead of engaging an available pharmacist to cover their agreed opening hours.
Minister of Health and Social Services for Wales, Eluned Morgan
How did this start?
While a small number of unforeseen closures have always occurred from time to time in pharmacies for genuine reasons, the indiscriminate scale at which closures have now become commonplace seems to have evolved over the last 20 months. The PDA notes that the dramatically increased scale of closures followed certain events:
- On 18 March 2020, in the early height of the Covid-19 pandemic, a joint letter from the UK regulators (GPhC and PSNI), explained to pharmacy owners that in extreme circumstances there may be a need to depart from established procedures in order to care for patients and their families. This statement can be found here. It was exceptional action during a global emergency. The PDA believes that this gave some pharmacy businesses the opportunity to consider the financial benefit of operating some of their pharmacies without a pharmacist present, also known as ‘remote supervision’.
- Within hours of the announcement, there were reports from pharmacists that some pharmacy businesses were pre-booking locum pharmacists to simultaneously cover more than one branch. This was against the spirit of the new regulatory flexibilities and in clear breach of safety regulations.
- By 27 March 2020, the conduct of some pharmacy owners had become so concerning that the GPhC felt the need to write to trade bodies, the CCA, NPA, and AIMp, to highlight that some companies were going beyond the advice in the statement and standardising these arrangements, asking them to ensure their members ceased this practice. To read the letter, click here.
- By June 2020, still in the first year of the pandemic and while employed and locum pharmacists were giving their all to the efforts to deal with the pandemic, the PDA noted that some employers were beginning to claim they could not find locums to cover their shifts, something which the PDA described at the time as ‘Crying Wolf’.
Two narratives, one inaccurate and the other not the whole story
Since the above events, the issues around avoidable closures have occupied more and more of the discussion around community pharmacy. At the same time, two narratives have clearly been apparent in the media and elsewhere promoted by some organisations:
Firstly, the disputed but much-repeated claim, despite factual data to the contrary, that:
- “There is a shortage of pharmacists”.
Secondly, that:
- “…guidelines dictate that some pharmacies must close if there isn’t a responsible pharmacist present”, as one multiple chain was reported explaining in a local newspaper this week.
Those familiar with the subject will know that the reason a pharmacy cannot open without a pharmacist is that they are professionally qualified, and therefore uniquely able to keep a pharmacy and all the medicines within it safe. Without a pharmacist present, a community pharmacy simply becomes a shop.
Evolution of reported closures
The PDA has also noted a rapid evolution of closures as some pharmacy owners have seemingly become emboldened as no effective action or penalties to stop the closures has been taken by Government, regulators, or the NHS (who are the client that commissions and funds the community pharmacy contracts).
- STAGE ONE: Initially pharmacists reported that companies were advertising shifts, negotiating with locums, but ultimately refusing to pay the rates required, and therefore chose to close the pharmacy instead.
- STAGE TWO: a: Next, as pharmacies were closing more frequently, locum and employed pharmacists reported that they could find no evidence of any efforts by the pharmacy owner to avoid closure by engaging a locum.
- STAGE TWO b: Simultaneously, a new trend for employed pharmacists to be scheduled in advance to work at one pharmacy in morning, and at another in the afternoon became noticeable, with no apparent attempts to engage a locum to cover the other halves of the days.
- STAGE THREE: One large multiple chain booked locum cover at agreed rates, but then subsequently told those pharmacists if they did not accept a reduction in the agreed rate, their bookings would be cancelled. Consequently, the PDA have been told that some have been cancelled. These incidents are current or in the near future so, such closures may not yet have happened, but it seems likely that this approach will result in pharmacies being closed, despite a locum not only being available, but previously booked and then cancelled by the company.
- STAGE FOUR: Some pharmacies are now communicating to patients up to a month in advance to say their pharmacy will not be open when it should be, claiming ‘unforeseen circumstances‘. That known events, a month in the future, can be described as ‘unforeseen’ has been subject to significant scorn on social media.
Often, patients are being told that closures are because the companies were ‘forced‘ to close due to a ‘national shortage of pharmacists‘. In fact there are more pharmacists registered in Great Britain than ever before.
What needs to be done
Since the PDA’s open letter to regulators, Health Secretaries, and Chief Executives of the NHS, stories in local newspapers of pharmacy closures and social media discussion has continued.
The situation continues to present significant risk of harm, and PDA members across the health sector have consistently raised concerns that something must be done by those responsible for safeguarding patients and overseeing the NHS. The PDA has concluded that to protect patients, and ensure their ongoing access to pharmaceutical care, should:
- Empower the Care Inspectorate Wales to regulate the business behaviours of companies that operate community pharmacies, including their premises, staffing levels, safety, and treatment of patients.
- Introduce a regime of financial sanctions on any businesses who breach standards.
- Provide the NHS the ultimate option to take failing pharmacies into special measures control, where the operation of that pharmacy is taken over by NHS.
Based on the actions of those who have taken commercial decisions, regardless of the potential patient impact, to unnecessarily close their branches, the PDA believes these measures are what are now what is required to adequately protect patients and provide communities with access to the pharmacies they rely upon.
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