The latest scandal in British politics is the long running tragedy of sub-postmasters. Over the decades the scandal has gone on the number of post offices in the UK has more than halved from 22,500 under Thatcher to around 11,500 now. 99% of all UK post offices are operated by franchise partners or sub-postmasters, who are independent business people.
While we are watching this another scandal is developing.
The UK has around 11,000 community pharmacies. Just like post offices they are provided by the private sector, either as independent businesses, or as part of large chains like Boots. Just like post offices the number of pharmacies is in decline, and has been for several years, despite dispensing more prescriptions than ever. The decline has become much more severe since the Government implemented the new Pharmacy contact in 2019.
Some people won’t have noticed the decline of community pharmacy yet – most of us live within 30mins walk of a pharmacy. The closures are concentrated in deprived areas with lots of health needs, following the same pattern as the closure of post offices. More than one in ten pharmacies have been lost in the poorest 20% of areas in the last six years.
But it’s not just smalll locally owned pharmacies shutting down. Sainsburys have closed all 246 Pharmacies, operated in partnership with Lloyds. Lloyds themselves have have sold or closed 90% of it’s non-Sainsbury’s pharmacies. Tesco are closing some of theirs too. Boots are in the process of closing 300 stores.
Part of the problem is falling Government funding, in particular since the 2019 contract. Community Pharmacy England quotes a 25% real terms cut in funding since 2015. At the same time pharmacies face rising costs, particularly rents, and staffing. Since the Brexit vote the UK has found it harder and harder to recruit skilled professionals in areas like healthcare; shortage of staff, means more locums, and higher costs.
But the most serious problem is getting hold of drugs. There have been supply chain problems across Europe for particular medicines, however Boris’s Brexit deal means that the UK is suffering from them more than any other country.
Shortages of HRT treatments have made the news, along with shortages of medicines for Diabetes and ADHD. In fact shortages of medicines have doubled in the last 18 months, with problems getting hold of medication for Epilepsy, Schizophrenia and Breast Cancer.
There is also tension between the Government and the Pharmaceutical industry. Successive governments have tried to increase the use of unbranded (generic) prescribing to save money. Back when I ran a PCT we had the highest generic prescribing rate in England for a couple of years. Government policy to limit NHS spending on branded drugs is having an effect on the pharmaceutical industry’s willingness to invest in supplying the UK.
There is a cap on the total allowed sales value of branded medicines to the NHS each year, which grows at an agreed rate of 2% per annum. Any medicine sales above the cap are paid back to the government via a levy charged on companies’ sales revenues. A scheme with a 4% cap has been introduced for the next five years after consultations with the pharmaceutical industry.
At the same time mistakes in Boris’s Brexit deal meant that the EU does not recognise UK-produced generics. Generics manufacturers can’t compete with EU rivals, and while the EU had invested £20bn in generics manufacturing since Brexit, the UK had invested nothing.
The EU is seeking to safeguard its supplies by switching to a system in which its 27 members work together to secure reliable supplies of 200 commonly used medications, such as antibiotics, painkillers and vaccines. But the bloc’s move to insulate itself from growing drug shortages is exacerbating the scarcity of medicines in the UK, posing serious problems for Doctors and Pharmacists.
These are all of the complex, often technical, reasons why pharmacy is in crisis. But none of these problems were unknown, people in senior positions have known that community pharmacy is falling down, they just don’t do anything about it.
I could have written the same blog about the collapse of General Practice, or the disappearance of NHS Dentistry. I could have written about failings in HMRC, or the way that DWP has become bloated with civil servants paid to do nothing but bully the poor and the vulnerable. In another era each of these stories would have been front pages news, like the collapse of the CSA under John Major. But public services have been so diminished by austerity, Brexit, Covid, and the chaos of Boris, Liz and Rishi that we have come to accept that the public sphere is dysfunctional, bureaucratic and authoritarian.
What all of these scandals have in common is contempt for the little people – not just the patients or the benefit claimants but the small business people who run pharmacies, GP surgeries, NHS dentists, sub-post offices. A sneary snobbish contempt for ordinary hard working people, and a belief that their wealth and power puts them above accountability.
Mr Bates vs the Post Office isn’t the last story we are going to watch over the next few years, as we come to terms with an era in which the state turned it’s back on ordinary people. We had an era of scandals in the UK financial services sector that lasted a decade, and we might find another 10 years of scandals about how badly the state has treated it’s citizens.
If I were in charge of Primary Care at DH or small business tax at HMRC I would be wondering who would be playing them in the TV adaptation.
https://researchbriefings.files.parliament.uk/documents/CBP-9854/CBP-9854.pdf