40%+ of pharmacy closures in last seven years have occurred in the 20% most deprived parts of England

Research by the Company Chemists’ Association (CCA) has found that between 2015 and 2022, over 40% of permanent community pharmacy closures took place in the 20% most deprived parts of England.

The long-term trend of closures runs contrary to the Department of Health and Social Care’s desire for pharmacies to do more with the Department currently reviewing¹ how pharmacists can play a ‘bigger role’ in supporting local communities.

Reduced accessibility to pharmacies could impede the Government’s flagship ‘levelling up’ policy and the NHS’ efforts to reduce health inequalities. The Government’s own Levelling Up White Paper² (February 2022) acknowledged that the “pandemic has seen disparities in access to healthcare widen in the most deprived areas”.

The CCA’s analysis of NHS data found that between 2015 and 2022, 808 pharmacies closed permanently in England. In that period, only 138 new pharmacies opened – a net loss of 670 community pharmacies.

Analysis of permanent closures only provides half of the picture. The CCA examined where permanent closures had taken place. 41% of net permanent closures had taken place in the top 20% most deprived areas in England. Meanwhile, only 9% of net permanent closures took place in the top 20% least deprived areas.

Although the latest figures for 2021/22 suggest that the overall rate of closures may be slowing down, the proportion of pharmacies permanently shutting in more deprived areas has only increased. An even larger share of pharmacies that permanently shut in 2021/22 occurred in the most deprived areas compared with the previous fiscal year: 44% of net closures took place within the bottom two IMD deciles.

Although a national problem, the North and West Midlands were found to have shouldered a heavy burden of closures in most deprived areas. 63% of closures in the most deprived areas were concentrated in the Northwest, West Midlands, and Yorkshire and Humber. A regional breakdown of permanent net closures in England including the proportion taking place in deprived areas is outlined below:

Table 1: Breakdown of permanent net closures by region in England

^a Total net closures per region – A breakdown of all the permanent net pharmacy closures that took place per region between the financial years 2015/16 to 2021/22.

^b Total net closures in most deprived areas per region – A breakdown of the permanent net pharmacy closures that took place in the most deprived areas per region between the FY 2015/16 to 2021/22. Deprivation is defined and calculated according to the Index of Multiple Deprivation 2019, where “most deprived” refers to areas experiencing the 20% highest levels of deprivation.

^c Proportion of closures in deprived areas – These figures present the proportion of net losses in deprived areas out of the total net losses for each region.

The CCA is concerned that permanent closures will undermine healthcare accessibility in deprived areas, where access tends to be more limited despite greater need (the ‘inverse care law’). The reverse is true for community pharmacy – 89.2%³ of the population is estimated to have access to a community pharmacy within a 20-minute walk, and crucially in areas of highest deprivation access is significantly higher (99.8%) – otherwise known as the ‘positive pharmacy care law’. Moreover, ‘underserved’ communities may be more likely to visit their local pharmacy, according to NICE guidelines⁴.

NHS England has devised ‘Core20PLUS5’⁵, a national and Integrated Care System-level approach to reducing health inequalities in the top 20% most deprived populations by focusing on five areas of clinical focus such as chronic respiratory disease and hypertension case-finding. The early detection of high blood pressure, otherwise known as hypertension, is crucial. Those in the most deprived 10% of the population are almost twice as likely to die because of cardiovascular disease⁶ and residents of the most deprived areas are 30% more likely to have high blood pressure compared to those in the least deprived areas⁷.

In October 2021, the Community Pharmacy Blood Pressure Check Service⁸ commenced and has delivered over 210,000 checks in community pharmacies so far. CCA analysis finds that nearly half of these (45%)⁹ have taken place in areas of deprivation.

Malcolm Harrison, Chief Executive of the CCA said: “Research shows that population health is greatly affected by standards of nutrition, housing, working environment and education.  Therefore, access to healthcare needs to be greater in areas of higher deprivation.  Unfortunately, the opposite is true, with access to general practice often better in more affluent areas. However, we know that there is greater access to community pharmacies in deprived areas.

Pharmacies continue to close disproportionately in areas of deprivation at a concerning rate. Closures will only worsen the health of deprived communities. The CCA is concerned that individuals may not be able to visit pharmacies at all to either get the medicines and advice they need or to be referred into other parts of the system.

The current funding model for community pharmacy is broken. The pharmacy network is no longer economically viable. The Government must face the facts and stop pharmacy closures by providing a sustainable level of funding. Without action, the country is sleepwalking towards an ever-worsening crisis in primary care – which threatens the entire ‘levelling up’ agenda for people in the most deprived communities.”

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NOTES TO EDITORS

• Years are calculated according to fiscal years i.e. 2015-16 to 2021-22.
• Deprivation is defined and calculated according to the government’s 2019 Index of Multiple Deprivation (IMD). The Index of Multiple Deprivation (IMD) is the official measure of relative deprivation for small areas in England. It is the most widely used of the Indices of Deprivation (IoD). The IMD ranks every small area in England from 1 (most deprived area) to 10 (least deprived area). Further information available here (see page 4).
• The ‘most deprived’ areas, refers to the bottom two IMD deciles.

METHODOLOGY

• The CCA used the pharmacy data (downloaded as the eDispensary files) from NHS Digital’s Organisation Data Service (latest update 27 May 2022) to analyse the permanent pharmacy closures, brand new pharmacy openings and overall net changes between 2015 to 2022. Available here.
• A ‘permanent’ pharmacy closure refers to bricks and mortar pharmacies that have closed for the last time at a given address and have not since reopened, been sold, or moved. (See column L of the NHS Digital eDispensary spreadsheet which can be accessed here).
• A ‘true new’ or ‘brand new’ pharmacy opening refers to bricks and mortar pharmacies that have opened for the first time at a given address and are not the result of a reopening, a sale or a move. (see column K of the eDispensary file).
• The General Pharmaceutical Society (GPhC) pharmacy register, and the NHS Find a Service list were used where further confirmation was needed to determine the status of a pharmacy.
• The postcodes of the resulting data were then cross-checked against their deprivation status. The CCA matched the postcodes by deprivation decile on a scale of 1 to 10, with 1 = the most deprived, and 10 = the least deprived.

REFERENCES

1 – Then Health Secretary Sajid Javid speaking before the Health and Social Care Committee, 7 June 2022, transcript available here – see answer to Q365.

2 – ‘Levelling Up the United Kingdom, published 2 February 2022 – see bottom of page 201, available here.

3 – Todd et al, ‘The positive pharmacy care law: an area-level analysis of the relationship between community pharmacy distribution, urbanity and social deprivation in England’, BMJ Open, 2014, available here

4 – ‘Community pharmacies: promoting health and wellbeing’. NICE guideline [NG102], 2 August 2018, available here.

5 – CORE20PLUS5 is a national NHS England and NHS Improvement approach to support the reduction of health inequalities at both national and system level. ‘Core20’ correspond to the most deprived 20% of the national population as identified by the national Index of Multiple Deprivation (IMD). ‘PLUS’ corresponds to ICS-determined population groups experiencing poorer than average health access, experience and/or outcomes but not captured in the ‘Core20’ alone. The ‘5’ sets out five clinical areas of focus – maternity, severe mental illness, chronic respiratory disease, early cancer diagnosis, and hypertension case-finding. More detail available here.

6 – NHS England, ‘Cardiovascular disease (CVD)’ webpage. Available online here.

7 – Public Health England, ‘Tackling high blood pressure: from evidence into action’, November 2014. Available online here (see page 5)

8 – NHS England, ‘NHS Community Pharmacy Blood Pressure Check Service’. See more information here.

9 – Based on the CCA’s analysis of NHS BSA dispensing contactor data (October 2021 to May 2022 – available here.) and cross-referenced against IMD 2019 deciles.