Between July 2017 and July 2023, the number of operating pharmacies in England fell by 914 from 11,723 to 10,809.

Deprived communities, where the need is greatest, have seen the biggest decline. More than one in ten pharmacies have been lost in the poorest 20% of areas in the last six years.

That accounts for 40% of losses in that period.

Dr Leyla Hannbeck CEO of the Association of Independent Multiple Pharmacies says the situation is "awful, terrible" and "the worst it has been in years and years".

It's been caused by a combination of government funding cuts, rising rents and costs, staff shortages and supply problems, as well as increased patient demand.

The result is that pharmacists like Reena Barai in Sutton are wondering how long they can stay open.

"Currently, we're in what I describe as a survival of the fittest," she says. "Within community pharmacy, the majority of my colleagues really do feel like we're on a sinking ship."

"We want to be that front door to the NHS because we know that people go to the GPs or A&E unnecessarily for minor illnesses and they should be coming to the pharmacy. We really want to be that first port of call, but we're struggling."

Impact of big chain closures

The bulk of closures so far has been driven by big companies like LloydsPharmacy and Boots. LloydsPharmacy has lost three quarters of its branches (1,087 out of 1,442) since 2017 and around two thirds (629 out of 984) in the past year.

Boots, which lost 40 branches in the last year, has also just announced a further 300 closures over the next 12 months.

The loss of these bigger pharmacies has increased the burden on those that remain, many of them smaller, independent businesses, which must pick up the workload without extra funding.

An analysis by The Pharmaceutical Journal in February suggested the impact of this year's closures could displace nearly one million prescriptions each month to surrounding pharmacies.

Dr Hannbeck says: "Pharmacies are drowning because the workload from those other pharmacies (that have closed) is landing on them."

Deprived areas are the worst affected

Sky News analysis suggests the increased burden is being felt most acutely in England's poorest neighbourhoods where people are more likely to depend on their services.

Richard Murray, CEO of the Kings Fund says in deprived areas "there are higher levels of ill health. They'll probably be a lot more walk ins going into the pharmacy asking for advice, more people going in to collect their medicines, and probably more people struggling with their medicines too".

Pharmacies in the most deprived 20% of areas are now serving a 13% more people than a decade ago, compared to just 3% more in the least deprived.

On average all pharmacies are dispensing more items, with the number of items dispensed per pharmacy up 17% since 2017.

And poorer areas have seen the greatest increase, dispensing a sixth more than those in the least deprived areas.

"The job can be harder in deprived areas," says Richard Murray.

"The workforce crises that we see across the profession are often localised, deprived areas may suffer a bit on that front," he added.

"Pharmacists do generate money from selling other things but at a time of cost-of-living crisis, it just might be harder for other parts of the business to prop up community pharmacy and rather easier in areas that are richer, where people have got more money to spend."

Pharmacy First and funding cuts

It's in this context that NHS England recently said it would invest £645m into a Pharmacy First scheme, allowing pharmacists to prescribe medicines for seven common conditions including sinusitis and shingles. The aim is to reduce the footfall at GP surgeries, saving a potential 10 million appointments each year.

But Leyla Hannbeck and Reena Barai both believe the funding gap that already exists needs to be addressed before pharmacists can take on new responsibilities.

"The funding is absolutely not fit for purpose," says Hannbeck. "If government really cares about patient care, accessibility to care, and people not landing in GP surgeries or A&E then they have to take pharmacy seriously. And we need an immediate cash injection."

Cuts introduced in 2016, followed by a five-year funding deal in 2019, that didn't take account of inflation has shrunk the value of the pharmacy contract in real terms by 30% from £2.8bn to £2.15bn since 2015.

The figures were revealed in a written parliamentary answer in January and amount to an annual shortfall of around £67,000 per pharmacy in England.

A recent National Pharmacy Association report - authored by Professor David Taylor of University College London and Dr Panos Kanavos from the London School of Economics and Political Science - found in England in 2022, community pharmacy accounted for a lower percentage of total health spending than at any point since 1948.

It means Reena Barai is questioning whether she can afford to be involved in Pharmacy First.

"I really want to take part in it (Pharmacy First) because I've got the skills, the training, the clinical confidence to do these things. But to do that, I also need to improve my infrastructure to expand the premises."

"The government will say 'we've just announced x million for Pharmacy First', but that will be to provide a service. We will also have to train our team, make sure we've got the adequate numbers of staff. We'll need new IT systems."

Fluctuating medication costs

Increased medication costs have added to the funding gap, with some leading pharmacists saying they aren't fully reimbursed by the NHS.

Ms Barai said: "It gets really difficult when suddenly the price of a bread-and-butter drug that was say 50p goes up to £5 and you're having to buy the same volume of the drug but an increased cost, that's what really affects pharmacies a lot, their cash flow.

"We're not even guaranteed that we'll be reimbursed, for example one of the drugs that I'm buying, Atorvastatin, I'm buying it above the cost that the government said that they'll reimburse us. So, we're actually out of pocket," she added.

Staff shortages and burnout

The cash flow crisis and overwhelming workload have made it tougher for community pharmacies to recruit and retain their staff.

Half of pharmacies responding to the Community Pharmacy Workforce Survey 2022 said they were finding it "very difficult" to fill vacancies. The survey also suggested 16% of pharmacist and 20% of technician roles were unfilled.

Mr Murray explains that many have opted to work in GP pharmacies instead: "NHS England has run a big recruitment campaign to take pharmacists into general practice to work alongside the GP teams and that's ratcheted up the shortages."

Being short-staffed while dealing with increased demand and coping with rising costs makes Reena worry for her own wellbeing.

"It's exhausting. It's never-ending," she says. "Even if you take time off, you can't put on your out of office and say sorry, you've always got to find staff to cover. So, it's a really all-consuming job. I think I just have to be careful that I don't burn out and that my team don't burn out."

A spokesperson for the Department of Health and Social Care said: "We are carefully monitoring access to pharmaceutical services, but good access remains.

"We have announced £645m in additional funding in the Primary Care Recovery Plan and thousands more training places for pharmacists as part of the Long-Term Workforce Plan, on top of the £2.6bn we provide every year to the sector."

Methodology: To get the number of active pharmacies we looked at the number active on a given date, in this case, the last day of July for every year since 2017. We looked at each pharmacy's open and close dates to determine if it's open on the given date. If a pharmacy's open date is on or before the specified date and it doesn't have a close date or its close date is after the specified date it's counted as active.

The Data and Forensics team is a multi-skilled unit dedicated to providing transparent journalism from Sky News. We gather, analyse and visualise data to tell data-driven stories. We combine traditional reporting skills with advanced analysis of satellite images, social media and other open source information. Through multimedia storytelling we aim to better explain the world while also showing how our journalism is done.