Fermanagh pharmacists speak out about the crisis in pharmacy

For many, such a pharmacy is the front door of the health service, as it is the pharmacist who dispenses their prescriptions, who administers vaccines, and who provides an all-important listening ear, day in, and day out.

Now, Community Pharmacists say they are in a crisis. Pharmacists are under pressure, whether that is from the increase in the price of drugs, getting paid less than their counterparts in the UK as well as being underfunded.

One pharmacist has revealed he is working 60 to 70 hours a week trying to juggle the service so that patients do not feel the effects of the struggles the sector is facing.

Joe McAleer, Fermanagh/Western representative for Community Pharmacy NI, described the service as being at “breaking point”.

Noting the impact of the current situation on staff, he said: “It is a very stressful and unrewarding environment that is at breaking point.

“We have absorbed the cuts and cost rises as much as we can, but we are at breaking point.

"The increases in the National Living Wage last year and this year have pushed all pharmacies over the edge.

“The very basis of a pharmacy – the safe supply of medicines to patients in a timely manner – is at risk."

Mr. McAleer, who owns Erne Pharmacy in Enniskillen and Belcoo Pharmacy, says that he is dispensing medicines at a loss as the Department of Health reimbursement is less than what pharmacists are purchasing drugs for.

He detailed some of the shocking price changes. “We had morphine for palliative patients which cost us twice what we got paid for it; paracetamol liquid for patients with swallowing difficulties – [that] cost us over £50; Ulcerative Colitis treatment – that cost us £150 more than we got paid for it.

“Many times, over the last 16-18 months, our wholesaler bills at the end of the month are more than we have been paid by the Department for the drugs we purchased.

"The drugs have cost more than we have been paid.

“We have had to extend our loans, increase our overdrafts, maxed out our credit cards, introduced private funds, cut back our staff level – all while seeing our operating profit margin decrease while our activity through prescriptions and services increase.”

Patients are also missing out on all the services provided by pharmacies in the rest of the UK as they are not funded here.

Mr. McAleer concluded: “[The] Pharmacy [sector] can see the problems in other parts of the NHS, but we are in crisis ourselves, and on the brink of collapse.

"With fair funding, we could play a big role in freeing up other parts of the health service, and keeping patients out of GP practices and hospitals.”

These changes have been seen right across the board, with pharmacist Siobhan McNulty of Melvin Pharmacy also saying that the figures are not adding up for pharmacists.

“The last few months, we have noticed – most contractors will have noticed – that every month when we get our payment or reimbursement, it hasn't been adding up.

“I would look at my invoices, and then I would look at my reimbursement, and I would be like, 'I must have been paid wrong. because I don't think I have enough to cover my bills'.”

She says many pharmacists were operating under a "wall of silence" where they were afraid to speak up about cost concerns.

“Everybody has been afraid to say. It is the big elephant in the room; we're finding it really hard to cover our bills, because our reimbursement isn't enough to match our outgoings.”

Mrs. McNulty explained: "We've been underfunded for years; our dispensing fee hasn't changed in 20 years.

"In fact, it was reduced five or six years ago, and then this year, they brought it back up to where it had been.”

The main dispensing fee for pharmacists was £1.04 in 2011/12. This was later reduced to 98p in the intervening years, before being increased back to £1.04 in 2023/24.

This figure does not change for pharmacists, no matter how many hoops they have to jump through to dispense the drugs, whether that be ringing a GP, contacting a hospital, or delivering the prescription.

“It's not in comparison to in the South, where they get five euro for every item they dispense,” claimed Mrs. McNulty.

“Every month, pharmacy contractors [owners] have to decide which wholesaler they can pay this month, and which wholesaler can wait for another month, as the reimbursement is covering the drug costs.

“This ultimately means that we reduce our ability to give patients their medications in a timely manner.

“Many pharmacy owners are putting their own money back into the business, so they are effectively propping up the NHS.”

Across Northern Ireland, pharmacies have closed and there is a fear that more pharmacies will close.

Mrs. McNulty continued: “It really is an unsustainable situation, and there will be more closures.

"When you paint this against a background of GP closures, and packed Emergency Departments, it really is a bleak picture, yet there is a workforce of pharmacists ready to take on some of the pressures of the NHS, if funded properly.”

Another issue is that staff wages, utility bills and running costs have increased, yet pharmacy funding is not matching these outgoings.

Last week, the Department of Health published a strategic plan for Community Pharmacy.

The strategy outlines a vision where community pharmacies can offer more clinical services that utilise the skills of their teams to offer the public safe, convenient, and faster access to care.

The Department states that funding for community pharmacies in Northern Ireland has increased in recent years.

“The year-start investment total for community pharmacy services was £104million in 2018/19.

"By 2023/24, it was £128million, and in April of this year, it stood at £147million.

"There has therefore been a £43million (41 per cent) increase in six years.”

Data from Community Pharmacy NI (CPNI) shows that £147million in 2024/25 is below the £152million provided during the pandemic years of 2020/21 and 2021/22.

The data shows that the £147million in 2024/25 does not take account of the steep rise in costs incurred by pharmacy owners since the pandemic, many of whom have told CPNI they are putting their own money in to prop up their businesses, struggling to pay medicine wholesalers, and are essentially subsidising the health service from their own savings and pension funds.

CPNI is calling for a number of interventions, including further investment in the community pharmacy network to stabilise the service, and to maintain medicines' supplies to pharmacies and patients. They say this is “urgently needed”.

In addition, there are calls for the urgent implementation of an agreed community pharmacy contract and funding arrangements that support the strategic community pharmacy vision and implementation plan.

Finally, CPNI is calling for “immediate policy changes to put in place a Drug Tariff specific to Northern Ireland that recognises unique Northern Ireland factors and which underpins stabilised and fair pharmacy contract and funding arrangements”.

Throughout Fermanagh, pharmacists are collecting signatures and providing information on the Fair Funding for Pharmacy campaign organised by CPNI, and are calling for the public's support.