As it attempts to slow the spread of coronavirus, the United Kingdom is learning what a “shutdown” means in day-to-day life. Chiefly, that the only shops to remain open are food stores and pharmacies.
The latter high-street stalwarts have received less attention than their supermarket neighbours, with the media focused on food shoppers’ behaviour.
Yet with GP surgeries warning patients to stay away, and hospitals rushing to prioritise beds and care for coronavirus sufferers, pharmacies are essentially the only place left for sick people to go without prior notice or permission.
This represents a lot of public spaces – accessible amid the shutdown – for individuals potentially infected with the virus to gather. As of January 2016 there were 11,189 pharmacies in the UK, from community pharmacists in high street chemists and supermarkets to those serving hospitals, prisons, university campuses, military bases, and anywhere else where medicine is prescribed.
“Community pharmacies are the main centre of primary care where people can just rock up at the counter with no appointment. You don’t know what sort of condition they’re in, how stable they are, everything like that. It’s getting quite dangerous,” says Oscar*, 50, from Manchester, who has been working as a community pharmacist for 25 years.
“Someone could be asking about verrucas and the next person could be a potential case of Covid-19,” he says. “They could either have a chesty cough or it could be Covid-19, right?”
Oscar works at a large supermarket in north-west England but prefers not to give his real name, or the name of the store, for fear of losing his job.
The past few weeks have been “very, very stressful” for him and his colleagues, as they put themselves “under huge levels of risk” by coping with a surge of customers.
They have no hand sanitiser gel for their staff, and have only just been issued with masks and gloves – but of “minimal quantity” with instructions “not to wear them unless we have a suspected case”.
Every day, he and his colleagues are exposed to potentially infected people. “The government are handling the communication of it really badly,” he says. “People are going out panic-buying anything – over-the-counter medication, paracetamol, co-codamol, Calpol, painkillers.”
Describing a “major run on products like paracetamol and hand sanitiser”, Oscar says that “customers come in and demand things, you haven’t got it, and they start to get very emotional – there’s a heightened atmosphere, a tense situation. I’ve been personally verbally threatened, I have nearly been attacked recently as well, by people who are just panicking.”
There has been a 30 per cent increase in footfall in some UK pharmacies since coronavirus began spreading across the country, according to Paul Day, director of the Pharmacists’ Defence Association (PDA), a union which represents 30,000 members.
“Those pharmacists are working flat-out, and are at risk because people are coming in with all sorts of conditions, which could include coronavirus,” he says. “And of course they also face the same sort of challenges that you’ve seen over the weekend in the media, at Tesco or wherever else, of people not comprehending how serious this is.”
In some European pharmacies, there are protective measures in place, such as tape on the floor marking two-metre points to aid social distancing, one-in-one-out policies, plastic sheets guarding the counters and contactless hatches where prescriptions go in and medication comes out.
“We’re nowhere near that level of protection for the pharmacy staff in this country,” Day reveals.
An urgent issue for pharmacies fighting coronavirus is a lack of adequate protective gear, according to the PDA.
“The particular concern of community pharmacists that there is no personal protection equipment issued,” says Day. “Pharmacists are human beings, they’re as likely to have asthma or anything else that you and I might have, so there’s their personal risk, but there’s also the risk – as with the rest of the NHS – if they’re ill, they can’t then keep working.
“We’d like to see testing [staff for the virus] and greater protection and the provision of personal protection equipment.”
Indeed, the supermarket pharmacist I speak to is concerned about illness affecting “the pharmaceutical chain” which keeps supplies of medication coming into the pharmacy from wholesalers. “If people start becoming ill, it means the wholesalers can’t handle the orders, drivers can’t deliver the medication, and patients can’t get the items”.
Coronavirus has created a “perfect storm” for an already stretched sector, he says. In common with other UK services whose limited resources have been exposed by this pandemic, pharmacies have undergone deep cuts since December 2015, when the government announced it would slash the sector’s funding by 6 per cent. Then months later, ministers finalised the cuts as 12 per cent from December 2016-March 2017, with a further 7.4 per cent drop in the next financial year, according to Chemist and Druggist.
A new deal was announced in July 2019, “committing” £13bn to the sector with the aim of expanding its role in an attempt to relieve pressure on GPs and A&E. Yet this still meant funding for pharmacies would remain flat in cash terms, at £2.59bn, over the following five years – a real-terms 9 per cent budget cut, plus the expectation of taking on more services.
These pressures have impacted pharmacists’ ability to afford and maintain a steady flow of medicines. When I reported on this issue last summer, a community pharmacist in the north-west called Thorrun Govind told me, “if you cut the funding for pharmacy, that impacts on staffing levels, and part of that is you can’t hold a load of stock on your shelves as well… As well as doing free social care work, like putting medication into blister packs and trays, pharmacies are also being forced to pick up the slack elsewhere.”
“Pharmacy for years now has been under a huge level of stress from the government, pharmacies are closing down, so basically there is no elasticity within the pharmacy profession at the moment”, Oscar says. “For years, they’ve been just about managing, and for something like this [coronavirus] to come along is going to create huge pressures on community pharmacies.”
On 23 March, NHS England announced that “millions more items of personal protective equipment (PPE) for frontline staff have been delivered to NHS services across the country”, including pharmacists in its lists of services receiving additional supplies. It has been contacted for comment on this story.