On a Friday evening last month, a panicked patient rushed into the Roundhay pharmacy in Leeds, desperate for a life-saving heart drug that two other pharmacists could not supply.
The patient’s GP had rushed him to the Roundhay in the hope that pharmacist Adeel Sarwar could somehow fill the prescription at the 11th hour where others had failed.
The drug, ivabradine, is prescribed for heart failure; it helps control the heart’s electrical activity so that blood is pumped around the body in a more sustainable way.
Adeel thinks he knows why the other pharmacies couldn’t supply it.
The drug is available, but the NHS refuses to reimburse pharmacists the full commercial price for providing it. Such price cuts are so common that some High Street pharmacists are now having to turn away patients desperate for medication – or risk going out of business.
Leeds pharmacist Adeel Sawar (pictured) struggles to keep his pharmacy business afloat thanks to massive NHS underfunding
‘Some pharmacies are reluctant to stock many drugs due to their prices, which are well above the NHS drug rate [the list of drug prices the NHS reimburses],’ says Adel. ‘Pharmacists are forced to make a decision that is as much about survival as it is about ethics; they can tell customers they can’t get the stock.”
In the past few months, wholesale prices for ivabradine have skyrocketed to £40.17 for a 2.5mg pack – while the NHS is pricing it at £19.86, according to the Pharmaceutical Services Negotiating Committee (PSNC), which is responsible for negotiating the reimbursement of pharmacists for medicines on the NHS drug tariff.
If the patient was prescribed four packs, that immediate net loss of £81.24 would have to be paid by the dispensing pharmacist.
Adeel says: ‘I quickly found a supply of ivabradine. We have accounts with eight wholesalers and Alliance Healthcare had it. At £40.17 it was way above the NHS fare price, but my conscience told me to buy it, even though it looked like my company would lose money just filling someone’s prescription.’
Inflation and international supply shortages have driven up the prices of many medicines over the past two years.
An Alliance Healthcare spokesperson told Good Health: “Our wholesale prices reflect the movement in the cost of the products we offer, which naturally fluctuate due to multiple factors.”
This poses a dilemma for pharmacies – themselves struggling with rising energy costs – whether to buy a drug at a loss or not. “Last month I had to save the company with my own money,” says Adeel.
On the last day of March, the government finally said it would raise the tariff price for ivabradine to £40.17. I had no idea if that would happen. Sometimes not, leaving us with a loss. It also falsely assumes that we are able to negotiate a discount [of 20 per cent or more] of the wholesaler while we independent pharmacists are too small [and thus too weak] haggle,” he adds.
Over the past few months, wholesale prices for ivabradine have skyrocketed to £40.17 for a 2.5mg pack – while the NHS is pricing it at £19.86, according to the Pharmaceutical Services Negotiating Committee (PSNC)
‘Even if I manage to buy a drug at the NHS rate price, it’s no cause for celebration: the government automatically knocks 20 per cent off that price.
‘So if I buy the drug for £1 it will only make us 80 pence. Add up all the losses of all the medicines we prescribe each month and you see how big the problem is.’
Pharmacists are currently reporting that between 100 and 150 drugs cost more to buy from wholesalers than the price the government is offering to reimburse.
But that’s not the only way that buying medicines robs pharmacists of valuable time and effort – which the NHS doesn’t pay for.
Adeel says that when drugs are expensive or unavailable, he often negotiates with the GP to change the prescription to a comparable drug that is cheaper and in stock.
This is because pharmacists are not allowed to change a doctor’s prescription, even if it is simply for a cheaper, but equally effective drug.
The only exception is when the Department of Public Health & Social Care (DHSC) rules that a drug is so scarce that it issues a “severe shortage protocol,” allowing pharmacists to swap drugs.
‘Negotiating with GPs now results in more work for everyone,’ says Adeel.
Pharmacists also see no benefit from higher prescription costs, which rose from £9.35 to £9.65 per drug dispensed on 1 April. Adeel adds: ‘That’s a tax we collect on behalf of the government; we don’t get paid for that and we don’t see any of the money.’
All this only exacerbates a chronic financial crisis caused by the fact that the contracts of independent High Street pharmacists have not been updated since 2015 to reflect the rising cost of medicines and overheads.
As a result, by 2022, nine out of 10 independent pharmacists will be at a loss in providing medicines to NHS patients, according to a study published last month by the National Pharmacy Association (NPA).
According to figures from The Company Chemists’ Association, some 670 pharmacies will be closed between 2015 and 2022 due to lack of funding.
Pharmacists are currently reporting that between 100 and 150 drugs cost more to buy from wholesalers than the price the government offers to reimburse
Thousands more could follow: one in three pharmacies is no longer financially viable, according to an analysis by Ernst & Young last year.
Such alarming statistics are why the Mail launched the Save Our Local Pharmacies campaign, which highlighted the plight of independent businesses that are a vital lifeline for many patients.
Chronic funding shortfalls have forced Anil Sharma, owner of Lords Pharmacy in Newmarket, to stop opening eight branches at weekends. “Some of our employees have to go to food banks because of the reduction in hours and the amount we can afford to pay them,” he told Good Health.
Last month, Priors Field dispensary in Ely, the constituency of Health Secretary Steve Barclay, was closed.
Yet this growing national crisis seems remarkably low on the government’s priorities. In late March, the health minister canceled a meeting to discuss the threat of mass pharmacy closures with the All-Party Pharmacy Group too late.
Meanwhile, the government is making matters worse by launching a national TV advertising campaign to attract more patients to High Street pharmacies if they can’t get GP appointments.
PSNC Managing Director Janet Morrison says: ‘Municipal pharmacies can offer so much more in terms of complementary health services, reducing the backlog of GP appointments and supporting people with a wide range of conditions.
“However, the current funding levels of pharmacies – which have fallen by 30 percent since 2015 – mean that they work with one hand tied behind their backs.”
Kamal Mahasuria, owner of Kents Pharmacy in East Molesey, Surrey, says: ‘Ministers don’t want to pay us to take on the extra burden; they expect us to help those extra patients for free.’
He knows all too well the personal heartbreak this can cause. In 2019, he and his two daughters, both pharmacists, took over a second pharmacy in East Molesey.
“It seemed viable when we did the sums, but the worsening underfunding meant we had to close it last month,” he says.
“That has been devastating. We feel like we failed and let people down.”
NHS drug pricing was a serious part of this decision. Kamal explains: ‘Omeprazole, the commonly prescribed heartburn medication; we get supplies for over £2 per pack even though the fare price is £1.
At the end of March, the NHS said it would pay us full price for that month. But this point of view changes every month, for every drug; we don’t know now if the NHS will fully reimburse us for the April shortfalls.
“Multiply that situation by hundreds of drugs and you see how it gives us enormous uncertainty, stress and extreme cash flow problems.”
By merging the two pharmacies, Kamal hopes he’s reduced his staff costs and business overheads so that he can hopefully make the remaining dispensary viable.
But that costs money. “Due to the loss of four employees, the company is much busier with the combined load of two pharmacies,” he says. “This puts a lot of pressure on our remaining staff.
‘Due to understaffing, we have to lower the service level. It can take two days to prescribe medication; before it would take a few hours. This causes patients serious stress.’
The situation has left Kamal in the same plight as community pharmacists across England as they struggle to provide patients with NHS medication that the healthcare system often refuses to fund.
“My daughters and I are in the store before it opens at 9 a.m. and long after it closes at 6 p.m.,” he says. “Hopefully we are now financially viable. But that remains to be proven.’
A spokesperson for the DHSC told Good Health: ‘Community pharmacies play a vital role in supporting the NHS and we support them with £2.6bn a year.’