The full extent of the struggle by Scotland’s community pharmacies to stay open in the months following the ending of pandemic restrictions is shown in data released to healthandcare.scot by NHS boards – but pharmacists themselves say a change in the law could ease the impact of there being too few pharmacists to meet demand.

Community pharmacy operators are obliged under their contracts with the NHS to notify their board each time they vary their normal opening hours. This includes opening late, closing over lunch or finishing early, as well as full day closures.

Under UK pharmacy regulations, a pharmacist must be present for any prescriptions to be dispensed.

Ten NHS Boards provided data in responses to Freedom of Information requests by healthandcare.scot for the year from 1 July 2021 to 30 June 2022, with four boards not responding.

The data reveal that hundreds of community pharmacies had to close due to a mix of reasons – all based on there not being enough people on site. These were listed as staff shortages, there being no pharmacist available, illness and COVID outbreaks in their team.

Over the 12 month period, 3,445 unplanned closures were notified.

The organisation representing Scotland’s high street pharmacies, Community Pharmacy Scotland (CPS), says community pharmacy is under continuing pressure:

“There are a number of pressures at the moment – some expected such as the winter period, but others less so – increasing costs of medicines and shortages of antibiotics come to mind. So, whilst workforce is not the only source of challenge, it is one of the main concerns and exacerbates all the other difficult parts of the job.”

In the second six months of 2021, 1,602 closures were notified. This increased to 1,843 in the first six months of 2022.

The CPS spokesperson couldn’t comment on whether the number then increased or reduced in the second half of this year:

“We don’t hold data for pharmacy closures ourselves, but what we can do is put this all in perspective. Even making an assumption that all of the closures quoted are full days – which we know they are not – the unplanned closures represent less than 1% of the community pharmacy network’s normal opening hours.”

Workforce vacancies and wellbeing

The CPS spokesperson added that Scotland’s pharmacy sector across community, primary care and hospital is facing continued understaffing:

“We expect the shortage of employed pharmacists and team members to persist for some time yet. There are simply more job opportunities than there are pharmacists at the moment. This is a great thing for the profession but in practical terms it leaves us with community, hospital and primary care sectors of practice which do not have the resource that they would like to achieve their ambitions.”

The three areas which had the most pharmacy closures were NHS Lothian followed by NHS Greater Glasgow and Clyde then NHS Highland, with ‘staff shortages’ being the main reason logged for pharmacies closing.

In an open letter to MSPs at Holyrood in September, Clare Morrison, then Director for Scotland of the Royal Pharmaceutical Society, the professional organisation for pharmacy, said the issue goes beyond shortages of staff:

“To attribute the problem to a workforce shortage alone would be an extreme oversimplification.

“In some cases, the working environment for pharmacists is not optimal.

“Our workforce wellbeing survey of pharmacists working across all sectors identified issues including pharmacists’ inability to take rest breaks which are essential for both patient safety and staff welfare; unsafe staffing levels; a lack of access to training and development; inflexible working arrangements due to fixed pharmacy opening hours; and an unsupportive culture. Addressing poor working environments could reduce long-term vacancies.”

Ms Morrison continued:

“We want patients to benefit consistently from access to high quality, safe pharmacy services. A closed pharmacy cannot help patients at all, but neither is it desirable to open a pharmacy that is inadequately staffed. Community pharmacy owners are NHS contractors and therefore must report a closure to their local NHS board via well-established processes."

Monitoring closures

Ms Morrison explained that the initial responsibility for addressing pharmacy closures lies within NHS Scotland’s health boards:

“It is up to boards to monitor closures, look for patterns and take action if a pharmacy is in breach of their NHS contract. NHS board directors of pharmacy have contractual levers available to them which are described in current pharmaceutical services regulations; they are best placed to advise on whether these levers are sufficient.

“Furthermore, if either community pharmacies or individual pharmacists do not meet professional standards, then there are existing regulatory and legal mechanisms in place which pharmacy’s regulator, the General Pharmaceutical Council, can advise you on.”

CPS says greater flexibility could be possible under new UK legislation governing the pharmacy sector, that might reduce the number of instances where community pharmacies close their doors:

“The new Pharmacy Order provides the regulator with the power to be more flexible in this regard and we would like to see a robust debate about how we might enable pharmacy teams to work differently for their communities.”

In the meantime, a Scottish government spokesperson says NHS boards need to work in partnership with pharmacy providers to try to keep community pharmacies open:

“Health boards are responsible for the provision of services within their board area, and we would expect the boards and community pharmacy contractors to work collectively to ensure that there is appropriate access to services.

“Community pharmacy contractors must ensure they provide the full range of NHS pharmaceutical services as agreed with their health board. If they are unable to do so they should liaise with their health board primary care contracts team who will work with the contractor to minimise any disruption to patient care. Health boards can take a range of actions in response to any breach of terms by a pharmacy contractor.

“The Chief Pharmaceutical Officer has put in place a National Workforce Forum to address the short, medium and long term requirements for the profession.”

Across the ten boards that responded, the total number of unplanned changes to hours over the period was as follows:

NHS Ayrshire & Arran – 306 altogether, 163 in 2021, 143 in 2022

NHS Borders – 123 altogether, 44 in 2021, 79 in 2022

NHS Dumfries and Galloway – 210 altogether, 21 in 2021, 189 in 2022

NHS Forth Valley – 296 altogether, 106 in 2021, 190 in 2022

NHS Grampian – 324 altogether, 161 in 2021, 163 in 2022

NHSGG&C – 657 altogether, 155 in 2021, 502 in 2022

NHS Highland – 382 altogether, 82 in 2021, 300 in 2022

NHS Lanarkshire – 148 altogether, 36 in 2021, 112 in 2022

NHS Lothian – 696 altogether, 552 in 2021, 144 in 2022

NHS Tayside – 303 altogether, 139 in 2021, 164 in 2022

 

Read more: RPS Scotland director moves to HIS; Renewed campaign to divert people from going to A&E; Plans for a more inclusive pharmacy sector;

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