Community Pharmacy And Neighbourhood Renewal

Community pharmacists have always played a role in promoting, maintaining and improving the health of communities. This is primarily because they are situated in the heart of communities and provide local employment as well as local services. A report by the Department of Health (Improving shopping access for people living in deprived neighbourhoods, DH 1999) identified that in small communities, three core businesses make the difference between a viable business community and one that fails:

• a health centre
• a pharmacy, and
• a source of cash (most often provided by a post office).

Where these three are present, business communities are stable and grow.  If any is absent, the business community declines with an associated reduction in health and well-being for local people through reduced access to services.  For example, the Countryside Agency has estimated that each post office closure results in an estimated 15% drop in trade for local shops in rural areas – and local traders report similar reductions in trade when a bank closes.

The relocation of a GP surgery and the subsequent closure of the local pharmacy may have a significant impact on local shopping access. The New Health Economic Foundation – an independent think tank – published a report Ghost Town Britain: a lethal prescription (available at www.neweconomics.org) calling for the government to recognise the role of pharmacies in supporting local services. This report followed an earlier publication which highlighted the speed with which local services were disappearing – especially in villages and market towns.

The New Health Economics Foundation’s argument stated that when the number of local retail outlets falls below a critical mass, the quantity of money circulating in the local economy falls as people find it difficult to do a full shop locally and therefore go elsewhere. This is a finely tuned mechanism – as soon as people have to go elsewhere for one service, they tend to go elsewhere for them all, leading to local food and finance deserts. The social and economic impact of this may be significant, with those least able to access alternatives - notably older people, single parents and those without private transport - being most affected.  High street pharmacies can be a crucial lifeline in many communities and an essential service for those who do not have access to a car. If pharmacies close when, for example a GP surgery relocates, then local neighbourhoods are in danger of becoming health facility deserts. In addition, areas without a vibrant local economy tend to be less attractive to live in with a resulting reduction in social cohesion.

Socially disadvantaged areas are particularly vulnerable to such decline – with associated public health consequences. Levels of illness in a community are influenced by wealth, which in turn is influenced by the economic viability or potential of the local community.

Ironically, people living in socially disadvantaged areas are more likely to use primary care services than those in higher socio-economic groups. The Office of National Statistics has shown that low income households make twice the number of visits to their GP as high income professional groups. It is also likely that they visit the pharmacy more often. Therefore the provision of local health services is particularly important in socially disadvantaged areas.