Analysis from Newcastle University, Health Equity North, and the University of Manchester, has shown that availability of community pharmacy services in England has reduced, particularly in deprived areas.

Researchers investigated how access to community pharmacies changed from 2014 to 2023, examining relationships between pharmacy availability and factors such as how urban the area is, and socioeconomic deprivation.

Decrease in pharmacies

In England, more than 90% of people live within a 20-minute walk of a community pharmacy. However, overall availability of pharmacies has decreased with the number dropping from 1.6 pharmacies per 10,000 people to 1.5.

The most deprived areas were 65% more likely to lose a pharmacy compared to the least deprived areas, the study published in BMJ Open revealed.

Lead author Dr Eman Zied Abozied, Research Associate at Newcastle University, said: “Pharmacies are one of the only healthcare options available on the high street where people can be seen without an appointment.

“They play an important role in helping people access the care they need, especially in the most disadvantaged areas where there might be fewer GPs. Funding cuts across the sector have seen many community pharmacies close, which could fuel inequalities in healthcare access.

“While it is encouraging that our analysis shows that most people still live close to a pharmacy, the reduction in the number of community pharmacies is a cause for concern. Pharmacies are serving a higher number of people, with the biggest decline in availability in communities that have the greatest health needs, leading to immense pressure on services and staff.

“Pharmacies in the most disadvantaged areas may not be able to offer the full range of clinical services due to funding cuts and staffing pressures.

“If community pharmacies are required to deliver more clinical services to support other primary care organisations, it is important that they have the appropriate funding to be able to achieve this.”

Pharmacies are an important part of the healthcare system and are well placed to reach those most in need. They deliver a range of public health and clinical services, such as smoking cessation advice and support, emergency hormonal contraception, hypertension screening and ‘flu’ vaccination programmes.

Recent funding cuts and closures of community pharmacies prompted health inequalities researchers to explore whether the ‘positive pharmacy care law’ – which means people in more deprived areas have better access to pharmacies - is still in operation, and the implications of this on commissioning of future services.

It found that the positive pharmacy care law remains in place but has eroded over time. Pharmacy availability is decreasing, especially in poorer areas, meaning more people must rely on each remaining pharmacy.

The research team says that due to the nature to the NHS Community Pharmacy Contractual Framework in England and the tiered levels of services, “there is potential that there will be less capacity to provide the additional enhanced clinical services for community pharmacies located in the most deprived areas”.

More investment needed

The study showed:

• In 2014, the most deprived areas had 2.28 pharmacies per 10,000 people compared to 1.37 per 10,000 people in the least deprived areas; by 2023, this dropped to 2.01 and 1.33 per 10,000 people, respectively.
• The decline in pharmacy availability per 10,000 people was most severe in the most deprived areas (-0.27 per 10,000 people or an 11.8% reduction between 2014 and 2023)
• Urban areas experienced a significant decline in pharmacy availability - an 8.2% reduction (from 1.81 to 1.66 pharmacies per 10,000 people) between 2014 and 2023.

The academics behind the analysis say reinvestment in the community pharmacy network will help address challenges within the sector and reduce inequalities in access to health care.

Dr Luke Munford, Health Equity North Academic Co-Director and Senior Lecturer in Health Economics at The University of Manchester, said: “There needs to be more investment in community pharmacies if they are to effectively deliver the vital public health services they provide to people across England.

“Our study shows that more pressure is being placed on pharmacies with this being felt more keenly in deprived communities where health outcomes tend to be worse.

“The implications of inaction could see less capacity to provide much need services to those most in need and further widening of existing health inequalities.”

Reference:

The Positive Pharmacy Care Law Revisited: an area-level analysis of the relationship between community pharmacy distribution, urbanity and deprivation in England. BMJ Open. Eman Zied Abozied et al.