Shortage of drugs sparks wave of violence at pharmacies

The pharmacy shop looks like a bomb has hit it. Wrecked equipment and papers lie strewn about, a gaping hole is smashed in the window.

But it’s not due to a bomb blast — the damage is the result of a customer who’s gone berserk with rage. As three frightened female members of staff shelter behind the counter, he attacks two police officers with a broken chair.

This shocking incident, captured on video, happened early afternoon on the Monday before Christmas at Knights Pharmacy in Port Talbot, South Wales.

Worryingly, such violent incidents are becoming a daily reality for pharmacists and staff. Figures from the Association of Independent Multiple Pharmacies (AIMP) show that more than three-quarters of its members reported regular verbal and physical abuse after the pandemic. Attacks rose three-fold over the Christmas period.

As frustration over a lack of GP appointments and prescription-drug shortages boils over into rage and violence, pharmacy staff are trapped on the frontline.

Community pharmacists — in particular small, independent businesses that are often family run — are already under pressure from soaring drug costs and drastic government underfunding, which means many are closing down, says pharmacist Mohammed Kolia, who is director of the Knights Pharmacy chain.

Others may have to reduce opening times to cut the spiralling cost of wages and heating — ‘which increases customer frustration even further’, says AIMP chief executive Leyla Hannbeck. ‘We are incredibly busy and under strain after years of underfunding, along with other serious pressures such as staff shortages.’

On top of that, some are having to pay for security, which only adds to their financial problems.

Mohammed Kolia has been forced to employ security staff at some of his branches.

‘One, in Cardiff, had a particularly bad abuse problem but, as soon as the security staff appeared, incidents dropped from daily to zero,’ he says. ‘Obviously, we have to pay for that.

‘As a large chain with some 1,000 employees, we can manage. But smaller chains and family-run pharmacies clearly can’t.’

This comes as the Government looks to community pharmacists to take on more work from GPs to help with the NHS crisis.

Last week, Secretary of State for Health and Social Care, Steve Barclay, told MPs the Government wants pharmacies to offer NHS services, such as prescribing the contraceptive pill, taking patients referred from A&E and providing advice for conditions such as skin infections, cystitis and allergies.

The extra responsibility is ‘welcome’, says Leyla Hannbeck, yet many can’t afford to be involved.

Community pharmacists — in particular small, independent businesses that are often family run — are already under pressure from soaring drug costs and drastic government underfunding, which means many are closing down, says pharmacist Mohammed Kolia, who is director of the Knights Pharmacy chain

In a letter last week to the Health Secretary, Leyla Hannbeck and other community pharmacist representatives described the sector as at ‘a fork in the road’.

‘The long-term attrition of 30 per cent real-term funding cuts over the past seven years,’ could, they said, rapidly lead to ‘many permanent closures,’ with ‘serious consequences for the millions of people who rely on dispensed prescriptions every year.’

As the Mail has highlighted, independent community pharmacists are being crushed by a financial crisis. About a third of them face closure by 2024, an analysis by Ernst & Young shows.

Their basic funding deal from the Government, last negotiated in 2015, froze funding at £1.27 per prescription item, but now it actually costs more like £2 in costs such as staff, heating and IT for a pharmacist to prescribe.

The Mail is campaigning for proper government funding to save independent community pharmacies, a lifeline for the old and vulnerable in particular.

The pharmacies’ position is becoming increasingly untenable — last week, the Company Chemists’ Association (CCA) revealed that the shortfall in funding amounts to more than £67,000 per pharmacy every year in England.

On top of all this, independent High Street chemists are now beset by a wave of abuse from customers. In December alone, Mohammed Kolia had four cases of staff being physically attacked. ‘I’m dealing with incidents on a daily basis across our 96 pharmacies,’ he says. ‘In previous years, I’d have four cases of abuse a year at most. When I started this role in 2016 it was almost unheard of for a pharmacist to be abused.

‘Following that incident captured on video in Wales, we had another where a pharmacist at our Rugby branch was headbutted by a patient because their GP had not sent a prescription and we therefore could not dispense it,’ he adds. ‘The pharmacist suffered a head wound.’

And perhaps more shocking, Mohammed Kolia says these incidents are carried out not by vulnerable individuals but ‘day-to-day, usual members of society’.

He says: ‘At a Birmingham pharmacy in December a raging customer threw a cash till at staff.

‘The customer had no psychiatric issues. The pharmacist was simply very busy, and the customer was frustrated at having to wait for their prescription.’

He believes that ever-increasing frustration at accessing GP appointments — and difficulties getting medicines once they’ve obtained a prescription — is driving the abuse.

Supply problems caused by Covid, inflation and other pressures are leading to shortages at drug wholesalers, adds Suraj Shah, drug tariff and reimbursement manager at the independent chemists’ representative, the Pharmaceutical Services Negotiating Committee (PSNC). Even when scarce drugs are available, their prices can rise so high that pharmacists find them unaffordable. The Government sets a tariff for each drug, although that is often 10 to 20 per cent lower than what pharmacies have to pay, according to the PSNC.

Moreover shortages and high prices mean that the costs of about 200 medicines are far above what the Government says they are on the tariff, Suraj Shah explains.

If the drugs are unavailable, or an independent pharmacy just doesn’t have the funds to pay, the patient may have to go without.

This problem is exacerbated by what Mohammed Kolia calls ‘misinformation’ from the Department of Health and Social Care (DHSC).

‘With the Strep A outbreak, antibiotic shortages meant pharmacists could either not obtain the right drugs or they were available at unaffordable prices — having risen by 400 per cent,’ he says.

‘But the DHSC initially said there was no problem with supplies. As a consequence, people believe that shortages are the community pharmacies’ fault, so they become abusive and violent. Now the same thing is happening with shortages of over-the-counter cold and flu medicines.’

An epidemic of abuse is the result, says Leyla Hannbeck.

‘We are right at the frontline, we have the doors open and people are taking their frustrations out on us,’ she says.

‘We are now getting reports that abusive people are waiting outside pharmacies for staff members to come out after work so they can continue their abuse.

‘We have had pharmacists threatened that their homes will be burnt down and their families harmed. It is very scary.’

Yet the health department refuses to fund security for pharmacists, though it does pay to protect other NHS community services. As part of NHS England’s GP Winter Access Fund, doctors’ surgeries can access a £5 million kitty for security enhancements.

‘The Government needs to be fair’ says Leyla Hannbeck. ‘We can’t put pharmacy staff in situations where they are frightened, stressed, crying and questioning whether to carry on with this job.’

Mohammed Kolia says that after the Birmingham attack, ‘staff members were unable to return to work the next day because they were so shaken up’.

‘Generally speaking the police have been very supportive,’ he adds. ‘We can’t fault them. In Rugby, for example, they issued a banning order to an attacker who headbutted our pharmacist and the case is ongoing.’

With proper funding, pharmacists could not only afford to protect themselves better against the violence, it could help defuse the factors fuelling the frustration.

It would make them better able to meet soaring prices of scarce medications and to afford staff to keep chemist shops open for longer.

As PSNC chief executive, Janet Morrison told Good Health: ‘The Government must decide whether it wants to fund a community pharmacy sector that could continue to deliver huge value to patients while doing more to ease wider NHS pressures.

‘Or does it want to continue to degrade our sector and the services that so many people rely on?’

A DHSC spokesperson said: ‘Deliberate violence or abuse directed at healthcare staff, who continue to work tirelessly to provide care, is unacceptable.

‘All staff, including pharmacists and their teams, deserve to work in a safe and secure environment.’

The DHSC adds, however, that, ‘Community pharmacies are private contractors and while the NHS and Government can support the health and safety of employees, security is a matter for employers’.