NPA urges the government to be transparent with the sector on negotiations for a new pharmacy contract
It was an unprecedented move, to call for the first ballot in the 103-year history of the National Pharmacy Association (NPA), and now the organisation has warned that it’s more than just a scare tactic and pharmacies will go through with action in January if there isn’t an acceptable resolution forthcoming from the government.
“We’re looking for the government to consider our ballot, digest the results, and then come up with a proper proposal for community pharmacy – a fair deal,” chief executive officer Paul Ree told Pharmacy Business.
“If that’s not forthcoming, we’ve got a board meeting in a couple of weeks, we then need to decide when to take action, but we would be looking at taking action in January.”
The NPA announced the results of the collective action ballot on 14 November in which nearly all pharmacy owners, who participated in the ballot, voted to limit their services, insisting that a lack of additional funding is jeopardising patient health and safety.
“Our members have voted, they’ve spoken clearly, and unless the government come up with a fair deal soon, we will regrettably have to move to the next step, which is calling for action,” said Rees.
The NPA estimates about 700 pharmacies have shut in England in the last two years, with more than 1,250 closing in the last decade and three quarters struggling with debt.
“The global sum for community pharmacy 10 years ago was £2.6 billion. Today, that sum is still £2.6 billion,” Rees said.
“There’s been inflation. There have been utility bill increases, there have been national living wage increases. Community pharmacies had no increase (in-line with inflation) from the NHS or the government.”
Rees added that in real terms, what this means is that funding has fallen by 40 per cent after adjusting for inflation since 2015/16.
“Community pharmacies are actually delivering more services. Pharmacy First is a good example of that. They’re dispensing more medicines because the average person is taking more medication, so they’re doing more and more work for less and less money.
“They reach a tipping point when they can’t keep delivering services that are safe for patients. They feel they’ve reached the point when they need to start reducing services in order to ensure that they can still honour patient safety.”
Growing desperation among pharmacy owners
Rees revealed the strength of turnout by community pharmacies for the ballot exceeded what he had expected and showed the level of desperation that pharmacy owners are feeling at the moment.
Over 63 per cent of NPA members in England, Wales and Northern Ireland took part in the ballot– representing 3,049 independent community pharmacies in England alone, or 3,399 with Wales and Northern Ireland included.
Nearly 98 per cent of pharmacy owners in England voted to reduce their opening hours to the minimum required by their contract. This could result in fewer pharmacies remaining open during evenings and weekends.
More than 93 per cent voted to stop offering “unfunded” free home deliveries of medicines, and over 96 per cent voted to withdraw from locally commissioned services, including certain addiction support, emergency contraception, and stop smoking services.
Almost all voted to refuse cooperation with data requests from other healthcare providers beyond what is necessary for patient safety and contractual requirements.
The majority of pharmacy owners also voted to stop supplying free monitored dose systems (medicine packs) that are not funded by the NHS, except those covered by the Disability Discrimination Act.
“The extent to which pharmacy owners are prepared to reduce services did surprise me in one respect, but having said that, the level of anger and desperation is clear when you go and speak to them,” said Rees.
“There’s a state of emergency, there’s a crisis within community pharmacy. There are pharmacists taking out loans, second mortgages, borrowing money from relatives, taking money out of pension pots because every month they are dispensing medicines and they’re not being fully reimbursed by the NHS.
“They’re doing work on behalf of the state and they’re not being paid for it, so the money’s going to come from somewhere.
“The reason there haven’t been more closures is that so many pharmacy owners are dedicated to their communities that they carry on working.”
Budget adds to their pressure
He added that the timing of the Budget further exasperated the difficult situations the many community pharmacies find themselves in.
From April 2025, the national living wage will increase 6.7 per cent to £12.21 per hour, and the national minimum wage for 18–20-year-olds will increase 16.3 per cent to £10 per hour.
The Budget saw a hike in the amount employers pay in National Insurance contributions. From April, the rate will rise from 13.8 per cent to 15 per cent, and the salary threshold at which it is paid will fall from £9,100 a year to £5,000.
The NHS and rest of the public sector are exempt from the tax rise, but not pharmacies or GPs.
Rees said this was emblematic of the way that pharmacy and to a lesser extent, GPs, have been treated by government and the NHS.
“When the government and the NHS think about the health service, they think of hospitals. They think of hospital care. They think of secondary care,” he said.
“When they do think about primary care, they think about GPs and often forget about pharmacy.
“Community pharmacy is always the bottom of the pile – it is treated as a third-class citizen within the NHS and by the government.
“That’s why, yet again, these changes in the Budget are being covered for hospitals, they’re not being covered for community pharmacy. That is the way that community pharmacy has been treated for years. That’s why community pharmacy is now in the desperate state that it is in.”
Swift government action needed
Health secretary Wes Streeting has criticised the NPA’s call to action describing it as “unhelpful degree of sabre rattling” and warning that it will “harm patients” and “put pressure” on other parts of the healthcare system.
Streeting urged community pharmacies to work with the government and be part of the government’s 10-year plan to transform the NHS.
Rees hit back insisting that the government’s lack of clarity over funding and when the pharmacy contract will be announced was one of the reasons behind the ballot.
“The deal that we’re talking about now should have been announced in April, we’re now in November,” said Rees. “Pharmacists are actually operating outside of a contract. They’re dispensing medicines at a loss.
“Every couple of weeks you hear that there might be a deal around the corner, but it never materialises.
“We’re reaching such a late stage in this financial year that there’s now a real risk that when a deal does eventually emerge, it will actually be for this year and for the next financial year – it’ll be a two-year deal and that would be really disappointing.
“Pharmacy owners, so many of them are clinging on by their fingertips. We need the government to move fast and we’re just not seeing that.”
In response to Streeting’s claim that collective action by pharmacies would lead to patient harm, Rees said it was better communities had a pharmacy offering reduced services, and for there not to be a pharmacy at all.
“We do know that some patients will be affected, and that’s something to be regretted. No one proposes action that could affect patient care lightly,” he added.
“Unless these steps are taken, more and more pharmacies will close because they’re running on empty. They are doing more work than they’re being reimbursed for. And if they take these measures, such as stopping free delivery of medicines, stopping free blister packs, if they reduce their hours to core hours, that will make them more financially sustainable, which means they won’t have to completely close down and can still serve patients.
“If they carry on doing all the things they’re doing for now, there’s more chance that more pharmacies will go to the wall, and that’s something we want to prevent in order to safeguard the services that patients receive in local communities.”
Importance of collaboration among pharmacy groups
After the announcement of the ballot back in September, the Pharmacists’ Defence Association (PDA) publicly stated that only trade unions, which the NPA isn’t, can conduct ballots for industrial action.
With over 38,000 members, the PDA is the largest pharmacist membership organisation and the only independent trade union of pharmacists in the UK.
Therefore, it argued that the NPA’s action should not be “inaccurately described as a strike or industrial or collective action.”
The PDA further explained that NPA’s proposed ballot pertains to a contractual dispute between businesses operating community pharmacies and the NHS commissioners in England, Wales, and Northern Ireland.
Additionally, the PDA noted that the NPA is not conducting a ballot for its members in Scotland.
While some reports have stated that pharmacists are being balloted for the first time to take collective action, the PDA pointed out that many NPA members are, in fact, business owners and investors, not pharmacists.
Rees, however, stated that it was important that the sector’s different representative bodies worked together. He pointed out that when the NPA handed a petition to Downing Street as part of its Save Our Pharmacies campaign, they were accompanied by the likes of Community Pharmacy England (CPE), Community Pharmacy Northern Ireland (CPNI), and the Company Chemists’ Association (CCA).
“The sector is crying out for a united front across the bodies,” said Rees.
“We’ve got a good relationship with the with the PDA. We meet with them, and other representative bodies, regularly and we work in a collaborative way.
“They will take slightly different views on some things, but we all want, ultimately, the same result, and that is a fair deal for community pharmacy.”
By Sarwar Alam
