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As closures continue to shrink the pharmacy network across England, the contractors left behind face mounting workloads, cash flow strain, and service pressures – all while trying to maintain safe, effective care. Saša Janković hears from those on the frontline about how they’re coping, and what needs to change

Last year saw 222 permanent pharmacy closures in England, comparatively less dire than the 436-strong wave of shutdowns the previous year but still the second worst on record, mostly driven by the exit of Lloydspharmacy and strategic closures and consolidations by other national and regional multiples.

This leaves the current number of bricks and mortar pharmacies at 9,986 – according to official NHS Business Services Authority data on community pharmacy ownership for May 2025. That figures is 1,963 fewer than a decade ago when the numbers peaked at around 11,950 due mainly to the control of entry exemptions put in place in 2005. 

Logistical demands

In a sector struggling to make ends meet it could be easy to think that when one business closes it open up opportunities for those which remain, but the reality is much more challenging.

“When a pharmacy closes, that doesn’t mean the needs of people in that community have gone away”, says National Pharmacy Association (NPA) director of corporate affairs, Gareth Jones. “The remaining pharmacy in that area – if there is one – may find itself under immense workload pressure and also encounter stock issues and cash flow problems.”

Mark Burdon, pharmacist at Burdon Pharmacy Group in Newcastle-upon-Tyne, has experienced this first hand and says: “It can be chaos. We had a closure near one of our pharmacies and we saw an 11 per cent increase in the prescription volume overnight as the town went from having four to three pharmacies. And you might think brilliant, you get more business, but actually, to normalise that is really difficult. 

“For starters you’ve got to invest upfront for the medications and it’s not until some months down the line that the payments catch up so there’s a push on cash flow.” 

As pharmacies in the vicinity brace themselves for increased demand, they may also have to bring in coping mechanisms such as working outside usual opening hours to catch up on admin or dispensing; requiring appointments for services; and only answering the phones at certain times of the day.

“This won’t help their existing capacity struggles,” says Gordon Hockey, director, legal at Community Pharmacy England (CPE). “Pharmacy owners must also consider the health and wellbeing of their pharmacy staff, as well as their own.”

Richard Hough, pharmacist and partner at law firm Brabners LLP, points out another issue for contractors: “The contractual framework does not provide for additional emergency resources, leaving teams to manage increased volume and complexity with the same or fewer tools.

"This not only threatens the quality and timeliness of the care that patients receive, but also significantly heightens the risk of burnout among pharmacy professionals.”

In January, NPA analysis showed the highest rate of closures in council areas per head of population in the last two years was in West Berkshire, followed by Plymouth and Liverpool.

Matt Harvey, superintendent pharmacist and director at Green Lane Pharmacy in Liverpool, felt the impact of this when three nearby Boots pharmacies closed in March last year.

“It was absolute carnage,” he says. “It was impossible to know how many patients would transfer their nominations to us, what medicines they would need, and how much extra staff or stock we would need.”

Prescription volumes surged from around 17,000 to a peak of 25,000 items per month which, along with cashflow issues, resulted in repeated pharmacy reconfigurations and immense pressure on staff. “We’ve had to absorb a whole other pharmacy’s work without any help from anyone, apart from us trying to manage it ourselves,” says Harvey.

“There’s been lots of sleepless nights and staff stress, not to mention being on the receiving end of a lot of negative reviews from dissatisfied patients who didn’t understand why they were experiencing delays in getting their prescriptions dispensed.” 

Administrative burdens

Beyond the increased clinical workload, there are substantial administrative burdens that remaining pharmacy businesses have to tackle.

“Pharmacies must update NHS systems, manage the redirection of prescriptions, and liaise with GP practices to ensure the continuity of care for displaced patients,”says Hough. “This is time-consuming and resource-intensive, often diverting attention from frontline service delivery.” 

In addition, service specifications, regulations and funding processes do not change with this increase in workload. 

“This must all be adhered to, to ensure safety and patient experience is maintained,”says Michael Holden, managing director of consultancy firm MH Associates. He advises that pharmacies look at processes to work smarter, suggesting: “Embrace technologies including their PMR and, if appropriate, hardware including robots and automated collection points.

“Since the use of a hub for prescription assembly is not an option until October 2025, a pharmacy needs to ensure that, whatever their choice, service levels, safety and financial viability must work for them and their patients.”

Exacerbating inequalities 

For patients, particularly those who are elderly, disabled, or managing chronic health conditions, the closure of a local pharmacy can be deeply disruptive. It may mean longer travel distances, increased dependence on family members or carers, or, in some cases, missed doses of essential medication.

Hough warns: “These are not just operational challenges; they are direct threats to patient safety and health equity.”

Worryingly, some locations, particularly rural and deprived areas, have been left devoid of pharmaceutical services following closures, with Holden pointing a finger at “the current control of entry based on outdated Pharmaceutical Needs Assessments that often do not reflect the current distribution of pharmacies.”

Thorrun Govind, pharmacist and solicitor at Brabners, says: “Communities must understand the value of their local pharmacy, not just as a convenience but as a cornerstone of local healthcare infrastructure. As pharmacy owner-operators have consistently warned, without urgent intervention, more closures will follow.

"When they do, the consequences will be felt most acutely by those who are already underserved: the elderly, the isolated, and those living with complex health needs.”

Local is the future 

With England experiencing the largest decline in life expectancy improvement in Europe – according to recent research published in the Lancet – could unchecked closures exacerbate health inequalities and threaten Wes Streeting’s vision for neighbourhood-based care?

“It’s positive that the government has an ambition to shift healthcare from hospital to community, and a sustainable community pharmacy network could be at the heart of that shift,” says Zoe Long, director of communications, corporate and public affairs at Community Pharmacy England (CPE).

“The shift will be very difficult to achieve with a shrinking pharmacy network that is struggling to keep its doors open. Patients are already beginning to feel the effects as pharmacy owners are forced to cut back on services and opening hours, so the upcoming NHS 10 Year Health Plan must set a more positive path for community pharmacy with much-needed investment to match whatever is asked of the sector.”

With pharmacists and pharmacy teams under increasing pressure from rising prescription volumes and expanding clinical service expectations, Alison Jones, director of policy and communications at the Pharmacists’ Defence Assocation (PDA), says pharmacies could be commissioned differently.

“A contractual framework that genuinely supports pharmacists, ensures safe patient care, and guarantees the long-term sustainability of community pharmacy would be likely to benefit all communities, and particularly those areas of high health inequality or deprivation,” she says. 

“We want to ensure that the workforce has its voice heard as part of the solution and therefore we call for the PDA’s inclusion in future discussions around commissioning and service development.”

Holden says there is also still more to be done to maximise the impact of the Healthy Living Pharmacy (HLP) model. “The Community Pharmacy Contractual Framework is necessary to stop a postcode lottery for core pharmaceutical services,” he says.

“Local is the future of healthcare provision, which requires engagement, partnership working and negotiation by local pharmaceutical committees and local collaboration between pharmacies. 

"The HLP model was designed to ensure that the shift towards services, local collaboration, community engagement and turning interactions into intervention (service) opportunities. The need was clear in 2009 when we created it but it took 10 years to be embedded in the CPCF and has yet to be fully embraced or leveraged.” 

Pharmacy bodies are clear that significantly more public investment is needed to stabilise the network and develop clinical care that addresses the nation’s ever-growing health needs.

Enhanced prescribing service

“The pandemic showed that a resilient community pharmacy network is a crucial part of the health service and I would urge the government and NHS to closely monitor the potential impact and location of closures, so that patients can continue to access the care they need,” says Elen Jones, Royal Pharmaceutical Society’s director of pharmacy.

“We have seen some welcome progress with Pharmacy First and, with the right support and investment, an enhanced community pharmacist prescribing service will help deliver the government’s ambition to deliver more care in the community, but the conversations to make this a success need to happen sooner rather than later.

"Pharmacists are crucial to supporting the best use of medicines across the system and ahead of the 10 Year Health Plan, the government and NHS should reflect on how this is prioritised across primary care.”

Long stresses that “the viability of all pharmacy businesses” remains CPE’s “critical concern”, stressing that “it is imperative that the government fulfils its commitment to work with us to develop a sustainable funding and operational model for community pharmacy”. She says CPE is preparing to have those discussions with policymakers “as soon as possible” and has been working “on an ongoing basis” to influence Government Spending Review and policy processes in favour of community pharmacy.

Hough believes “coordinated and decisive action is essential” to prevent further closures and protect the health and wellbeing of communities. “Our clients continue to report that the current contractual and funding model does not reflect the true cost of delivering modern pharmacy services, particularly as the scope of pharmacy practice continues to expand,” he says. “We consider that a revised funding framework is urgently needed, that recognises the full value of the clinical, preventative, and advisory services that pharmacies provide.”

As a result, Hough says NHS England and the Department of Health and Social Care “must formally acknowledge the strategic role of community pharmacies in delivering primary care and public health”, and he calls on integrated care boards and local authorities to be “empowered and resourced to commission services that reflect the specific needs of their populations, with pharmacies positioned as central delivery partners for those commissioned services”.

Clear communications

In the shorter term, Burdon says that contractors facing the impact of mopping up a competitor’s closure are going to remain on the back foot.

“If we knew that in three years’ time there was going to be X number of pharmacies closed, or there was going to be a reshaping of the market, and we were able to plan and it wasn’t disorderly, then we could do something about it,” he says.

“The difficulty we have is that all of these things just hit us without any warning, in some cases where a pharmacy down the road goes bust and closes down. 

"We’re the people who are left pick up the pieces, and even if you might be prepared, their customers won’t be and suddenly they’re panicking and turning up and trying to give nominations to you. It’s always a difficult situation to manage because more often than not when it happens it’s just, boom, there you go, get on with it.” 

In the meantime, Harvey’s advice to other contractors facing the prospect of nearby pharmacy closures is clear: “Hold on tight, persevere, and you will get there.”

He agrees with Burdon that while it’s almost always impossible to predict how many patients or prescriptions will come your way, or what stock and staffing levels you’ll need, contractors need to “just take it as it comes and deal with it when it happens”. 

A further mitigating strategy Harvey recommends is to be proactive in communicating with patients once the details of nearby pharmacy closures are known.

“Customer awareness is key to managing the fallout from this,” he says. “You can put up notices to explain why patients might experience increased queues and prescription processing times, and make them aware of why the situation is happening, and that you and your staff are doing everything you can to make sure the transition goes as smoothly as possible for everyone involved. 

And for those contractors who are in a position to take on extra staff to manage the increased workloads he also suggests considering hiring an apprentice – and do it early. 

“They are affordable and attract training grants, helping to bolster your staff capacity without significant upfront costs until it becomes clear how much demand will increase,” he says. 

Ultimately, Harvey underscores the importance of perseverance and transparency with patients and staff: “While any transition is likely to be extremely challenging, most of your customers will be very thankful and sympathetic to your plight if you keep them informed. There really isn’t a lot of preparation you can do – you’ve just got to just suck it and see, and that’s the problem.” 

Sector shrinkage?

Health economist Leela Barham suggests the real objective of the new Community Pharmacy Contractual Framework is a downsized sector, pointing to the results of Frontier and IQVIA’s recent economic review of the sector, which compares the full economic cost of NHS pharmaceutical services to available funding and gives a central estimate that these costs exceeded funding in 2023/24 by £2.308 billion. 

The report concludes that: “NHS pharmaceutical services (taken in total) are already not currently sustainable in the short-run for a large proportion of pharmacies and for a greater proportion when taking a long-run view. The likely consequences – absent of intervention – include the risk of pharmacy closures, shorter opening hours, and pharmacies choosing to offer a reduced range of services.” 

Barham says: “It is hard to believe that the government could really think that the network can continue to be sustainable as it stands. It’s much more believable that the policy ambition is for a smaller network.” 

Meanwhile, Mike Holden believes what’s needed is a new model of modern community pharmacy practice that meets the current and future needs of the health system and patients.

He says:  “Owners of independent pharmacies must focus their energies on matters in their control, not national negotiations, lobbying, legislation or regulation, which includes their premises, their team, their services and the use of technology to improve efficiency and patient engagement.

"There has never been a more important time to work on their business as well as in it.”