Pharmacies are buckling under growing cost and capacity pressures: PSNC Pressures Survey 2023

A survey of over six thousands pharmacies has revealed that the community pharmacy sector is buckling under growing cost and capacity pressures.

The survey conducted by the Pharmaceutical Services Negotiating Committee(PSNC), which also involved two thousand community pharmacy confirms, rising costs, patient demand and
medicine supply issues continue to grip the sector.

PSNC’s 2023 Pharmacy Pressures Survey, run as a follow up to the 2022 pressures survey, provides clear comparative data showing the worsening situation across the sector.

Govt must act now

The result of the survey indeed paints a bleak picture for community pharmacies and it is clear that without urgent action from government and the NHS this will only get worse: more community pharmacies will either be forced to reduce the number of services they provide or, in the worst-case scenario, will be left with no option but to close their doors for good.

The PSNC has urged the government to act now “to save our pharmacies, before it is too late for patients, the public, and the rest of the NHS”.

“This year’s survey clearly shows that community pharmacies are buckling under growing cost and capacity pressures,” said PSNC Chief Executive Janet Morrison.

Funding is needed, without delay, to maintain patient access to the medicines and pharmacy services that they need, she added.

Fully-funded national Pharmacy First service

She said the the best chance for getting significant additional funds into community pharmacies would be possible by including “a fully-funded national Pharmacy First service” in the upcoming Primary Care Recovery Plan.

The introduction of such a service would help inject much needed additional funding into the sector and go so some way to making sure that pharmacies are paid fairly for the work that they do. In addition to introducing a Pharmacy First service, PSNC says the government must also urgently commit to providing an uplift to the funding for the sector.

Despite rising costs, the government has reduced pharmacy funding by 30% in real
terms since 2015. The 2023 Pharmacy Pressures Survey makes it clear that this funding squeeze is no longer sustainable and if not addressed it will only have catastrophic consequences for patient services and access to medicines.

The results of the latest survey indicate that the majority (96%) of pharmacy owners are facing significantly higher costs than last year – up from 80% in the 2022 pressures survey – and many are operating understaffed due to both insufficient funding (48%) and staff unavailability (34%). Yet 92% of pharmacy teams cited a significant increase in requests from patients unable to access General Practice and 71% reported problems sourcing medicines.

Many pharmacy staff (81%) are struggling to cope due to a significant rise in workload and
78% say that their work is having a negative impact on their mental health and wellbeing.

A whopping 78% of pharmacy owners are extremely concerned about their business finances with 41% now extremely worried about their ability to help patients.

This results reflect the extreme levels of stress that pharmacy teams and businesses are currently experiencing.

PSNC said last year’s invaluable insights lent significant weight to PSNC’s business case for a funding uplift as well as wider negotiations and work to influence key decision-makers.

“As we continue to work to raise awareness of the severity of the problems and to lobby for government and NHS action to ease the pressures, the 2023 survey results will be critical in giving our arguments a solid evidence base,” it said.

Stating that these results will be particularly beneficial in discussions ahead of the next Community Pharmacy Contractual Framework (CPCF) negotiations, PSNC added that it has already used the data to secure national broadcast coverage this week, and we will shortly be contacting pharmacy supporters in parliament “to help us to keep reminding government ministers of the key findings”.

“We would like to assure you that the results will be put to maximum use in the coming weeks and months through both our negotiations and our joint influencing and campaigning work – such as the #SaveOurPharmacies campaign – to make the case for further investment in the sector.”

Summary of key findings:

Rising costs

• The survey confirms that pharmacy owners’ operating costs continue to rise. Almost all of the pharmacy companies (96%) responding reported that costs are significantly higher than this time last year; this is up from 80% in last year’s Pressures Survey. Most pharmacy owners (96%) blamed unreimbursed medicine costs, as well as increases in
  wages (91%), rising utility costs (78%) and increased time to source medicines (76%) for these rising costs.
• As a result of increasing cost pressures, 73% of pharmacy owners reported that they didn’t know how much longer the threats to their businesses could be managed. 16% don’t think that they will survive another year and only 7% of respondents considered their pharmacy business to be profitable. These results make clear that the community
  pharmacy sector is at a tipping point with many businesses now at risk of collapse.

Impact on patient care

• Almost all pharmacy teams (98%) and pharmacy owners (97%) reported that patients were being negatively affected by the pressures on their pharmacy. This is up from 92% in last year’s Pharmacy Pressures Survey. Around a fifth of respondents (18% of pharmacy owners and 17% of staff) said that patients were being severely impacted.
• 97% of pharmacy owners reported being unable to source some medicines for patients. 81% said they were unable to spend as much time with patients, and over three-quarters (76%) said they were unable to respond to patients’ calls and emails as quickly as usual. 73% reported longer dispensing times for prescriptions. 65% reported patients waiting longer in the pharmacy for advice.
• Around half (52%) of pharmacy staff said that the pharmacies they work in were unable to provide Advanced services for patients and 44% reported being unable to provide locally commissioned services to patients. Nearly three-quarters (70%) of pharmacy team members reported patients waiting longer in the pharmacy for advice from staff.
• 72% of pharmacy owners said they were concerned about the ability of their pharmacies to help patients: this has increased from 62% in last year’s Pressures Survey. Pharmacists are dedicated healthcare experts and no community
  pharmacy wants to be in a situation where it has to reduce the number and type of services that it provides to patients and the public. However, these figures make clear that without urgent support from government, this trend along with the general standard of care that England’s pharmacies are able to provide, is likely to continue to worsen.

Supply chain and medicines delivery issues

• According to pharmacy team members, nine in ten or 92% of pharmacies are having to deal with medicine supply issues every day; this has increased significantly from 67% in last year’s Pharmacy Pressures Survey.
• Almost all the pharmacy owners (97%) also reported significant increases in wholesaler and medicine supply issues and 71% reported significant increases in delays in prescriptions being issued. Similarly, 93% of pharmacy owners
  said that their staff were spending longer than ever before on medicines procurement, with the average extra staff time needed to procure medicines being 11 hours per week; up significantly from 5.3 hours in last year’s Pressures Survey. However, most worryingly, 87% of pharmacy teams members said that patient health is being put at risk due to medicines supply issues.
• Medicines supply issues have serious implications for pharmacy teams and patients. Almost all of the pharmacy staff surveyed reported that they are experiencing extra workload (97%) and additional stress (96%) due to supply issues, and even more reported that patients are frustrated (98%) and inconvenienced (97%) by these issues.

Staff shortages

• The community pharmacy sector, like other primary care professions, is in the midst of a workforce crisis: 76% of pharmacy team members said their pharmacies were experiencing staff shortages, with 19% of pharmacy owners reporting that their pharmacy had been required to close temporarily because of these.
• 71% of pharmacy businesses are experiencing shortages of pharmacists, and 73% are experiencing shortages of other staff. Difficulties covering staffing or locum costs were the most significant driver of staff shortages, with 77% of pharmacy owner/head office respondents citing this reason. This has increased from 51% in last year’s Pressures Survey.
• Staff shortages inevitably lead to increased pressures on pharmacy teams. 98% of pharmacy team members said that staff shortages had resulted in increased pressure on staff, 86% reported it leading to increased waiting times for patients, and 68% said they resulted in increased working hours for staff.

Increasing workload

• Alongside staff shortages, increasing costs and medicine supply issues, community pharmacy teams also reported an increasing workload. According to the survey results, 92% of pharmacy staff have seen a significant increase in requests from patients unable to access General Practice, as well as increases in requests for help with symptoms for both serious (81%) and minor (96%) conditions within the last three months. There has also been a significant spike in demand in the number of patients seeking advice at a pharmacy about the menopause or HRT (81%) or on antibiotics (91%).
• To add to this workload, 91% of pharmacy staff said they were experiencing delays in the issuing of prescriptions and 84% reported an increase in the level of incorrect information being given by GP practices to patients.

Pharmacy team wellbeing

• Concerningly, 78% of pharmacy team members said that their work is having a negative impact on their mental health and wellbeing compared with just 7% who said that work was having a positive impact on their mental health. When asked to rate how they and their teams were coping with the current pharmacy pressures, 31% of pharmacy staff said they were barely coping. 88% of pharmacy owners said that they were concerned or extremely concerned about the wellbeing of their pharmacy team(s).
• Of particular concern was the fact that 45% of pharmacy teams cited patient abuse as one of the reasons why they are not coping at work. Other contributing factors included increased workload (81%), problems sourcing medicines for patients (71%), increases in patient requests for support (81%) and staff unavailability (34%).

Unplanned pharmacy closures

• According to estimates from pharmacy owners the total cumulative number of hours of unplanned closures by all affected pharmacies in one month was 5,859, this is equivalent to 651 days of closures (assuming 9 hours per typical business day).
• The average number of hours per affected pharmacy was 3.9. The increasing shortage of pharmacy staff has added more pressure on already overstretched pharmacy teams, with 68% of those surveyed reporting that they had been required to work extra hours due to staff shortages.

The current crisis and the future

• The results of the 2023 Pharmacy Pressures Survey paint an extremely worrying picture about the current operational landscape, and the prospects for the future of the sector. The majority of pharmacy owners are ‘concerned’ or ‘extremely concerned’ about a myriad of issues. For instance, more than three-quarters are extremely concerned about the supply of medicines to their patients (79%) and their business’ finances (78%) and over half (56%) are extremely concerned about the wellbeing of their pharmacy teams.
• These results reflect the extreme levels of duress and stress that pharmacy teams and business are currently experiencing and which have driven nearly half (44%) of England’s pharmacies into unprofitability and to many (19%) closing temporarily.