COMMUNITY pharmacies across Wales are being forced to sell some medicines at a loss because of an outdated NHS funding system that no longer reflects real-world costs, owners have warned.

Under current rules, pharmacists must dispense prescriptions at prices set nationally, even when those prices are lower than what they paid wholesalers — leaving them out of pocket on everyday items such as aspirin.

The situation has led to mounting debts, emergency loans and, in some cases, owners remortgaging their homes simply to keep their doors open.

Figures from the National Pharmacy Association suggest four in ten Welsh pharmacies were not profitable last year, with many described as “clinging on by their fingertips”.

Selling at a loss

Unlike normal retailers, pharmacies cannot set their own prices or refuse to stock products.

They are contracted to the NHS through the Welsh Government’s Community Pharmacy Contractual Framework, which fixes reimbursement rates for prescription medicines.

But wholesalers’ prices have risen sharply due to inflation, supply shortages and higher manufacturing costs.

That means the maths often no longer adds up.

In one example shared by pharmacists, a packet of 75mg aspirin costs £3.75 to buy but is reimbursed at just £3.05 — a loss of 70p each time it is dispensed.

Multiply that across hundreds of packs a month and dozens of other medicines, and small losses quickly turn into thousands of pounds.

One west Wales pharmacy owner told The Herald: “You wouldn’t run a corner shop selling bread for less than you paid for it. But that’s effectively what we’re told to do every day.”

‘Averaging out’ no longer works

The government’s model assumes that losses on some drugs will be balanced by profits on others.

But pharmacists say that system — once workable — has broken down.

Generic medicines that previously provided modest margins are now also rising in price, while reimbursement rates lag weeks or months behind market costs.

At the same time, running costs have surged.

Energy bills, staff wages, National Insurance contributions, fuel for deliveries and regulatory costs have all increased, while core NHS funding has remained largely flat in real terms for nearly a decade.

Owners say they are now busier than ever too, as GP surgeries redirect patients to pharmacies for minor ailments, vaccinations and clinical advice — work that takes time and staff but often brings little additional income.

Debt and closures

The result is growing financial pressure.

Some pharmacists report taking out short-term loans just to cover monthly payroll, while others have dipped into pensions or personal savings.

Across the UK, hundreds of community pharmacies have closed in recent years, with rural and small-town chemists particularly vulnerable.

Health campaigners warn that if closures continue, patients could lose easy access to prescriptions, advice and walk-in care — pushing more pressure back onto already stretched GP practices and hospitals.

Government response

The Welsh Government says it recognises pharmacies are an essential part of primary care and points to increased investment, including additional stability payments and grants for premises improvements.

A spokesperson said reimbursement prices are set using supplier data and that “while some medicines may be reimbursed below cost on occasions, this is offset by the profits pharmacies make on most of the medicines they dispense”.

But pharmacists argue that assumption no longer reflects reality.

A simple question

At the heart of the row is a basic principle.

If the NHS commissions a service, pharmacists say, it should at least cover the cost of providing it.

As one owner put it: “No business can survive by selling stock at a loss and hoping it balances out. Eventually the numbers catch up with you.”

Unless the funding formula changes, many fear more local chemists could disappear from Welsh high streets — and with them one of the most accessible parts of the health service.

Photo caption: Community pharmacies say fixed NHS prices are forcing them to dispense some medicines below cost (Pic: stock).

DECISIONS on the future of nine frontline hospital services across west Wales will be made later this month when Hywel Dda University Health Board holds a special two-day Board meeting.

The Extraordinary Board will meet on Wednesday (Feb 18) and Thursday (Feb 19) to determine the next steps for critical care, dermatology, emergency general surgery, endoscopy, ophthalmology, orthopaedics, stroke, radiology and urology services.

Health chiefs say the proposed changes are aimed at tackling staffing shortages, improving clinical standards and cutting waiting times for diagnosis and treatment.

More than 4,000 people responded to a public consultation on the plans. Feedback was gathered through questionnaires, public meetings, staff sessions and discussions with stakeholder groups.

An independent consultation report compiled by Opinion Research Services will form part of the evidence considered by Board members. It will sit alongside updated data on workforce pressures, estate condition, clinical standards and how services link together across hospitals.

All documents to be considered by the Board have now been published online ahead of the meeting.

Alternative ideas assessed

During the consultation, communities also submitted 190 alternative proposals.

Each idea was tested against “hurdle criteria” to check whether it was safe, practical and capable of delivery before being taken forward.

Of those, 22 met the criteria and have been developed into full options. These will be considered alongside the Health Board’s original proposals.

Board members will assess whether each option is clinically sustainable, deliverable, accessible to patients, aligned with the Health Board’s long-term strategy and financially viable. They will also decide whether further engagement or evidence is needed before any final changes are introduced.

Some changes, if approved, could be phased in over time.

Dr Neil Wooding, Chair of the Health Board, said: “At our meeting next week, the Board will carefully consider the consultation feedback alongside the latest clinical evidence, workforce insights, updated impact assessments and the alternative options that were put forward during the consultation.

“Our responsibility is to consider the full range of evidence and ensure we make decisions that ensure that our services are sustainable for the future. No decisions have been made ahead of the Board. We are committed to a thorough and transparent process, ensuring each option and alternative options are considered in the round, and focused on improving services for the people who rely on them.”

KIDNEY RESEARCH UK has launched a new dedicated online forum specially created to give people living with kidney disease and the families and carers who support them a safe and supportive space to talk, learn from each other and share experiences. 

Shaped with help from Welsh patients, the forum offers a dedicated community space for the more than 377,000 people in Wales thought to be living with kidney disease. 

Free to use, the new forum, called Kidney Community, creates a single, safe space where people can connect with others who understand their experiences, ask questions, share practical advice and find support, no matter what stage of the kidney disease journey they are at. 

Kidney Community is open to kidney patients at all stages of the disease, people with a higher risk of developing it, and anyone affected by a diagnosis in their family or friendship groups. 

The forum will be continually supported by Kidney Research UK’s team, helping to ensure discussions are informed, respectful and grounded in trusted information. It has been co-developed with kidney patients and carers to ensure it reflects real needs, concerns and priorities. 

Darren Daniel from Ammanford in southwest Wales helped with the forum’s development. Diagnosed with kidney disease in 2017, Darren has used social media, including TikTok, to raise awareness of kidney health and the realities of living with long-term illness. His experience of connecting with others helped inform the development of the forum. 

Darren said: “When I started sharing my kidney journey online, I saw just how many people were desperate for somewhere to talk honestly about what they were going through. Helping shape this forum felt like a natural next step – making sure it’s real, accessible and driven by the questions people actually ask, not medical jargon.” 

“This forum takes that sense of community and gives it a safe home, backed by Kidney Research UK. It means people don’t have to scroll endlessly or rely on misinformation. Whether you’re newly diagnosed or years into treatment, there’s power in knowing others understand your day-to-day reality, and that support is only a conversation away.” 

Sandra Currie, chief executive of Kidney Research UK, said: “Many people affected by kidney disease tell us they feel unsure where to turn for support. This forum brings patients and carers together in one place, so they can feel heard as part of a community, with access to information and shared experience at every stage of kidney disease. We are providing a safe, welcoming space where every question and every story matters.” 

The launch builds on Kidney Research UK’s long-standing commitment to ensuring the voices of patients and families help shape research, services and support. Existing supporters, volunteers and members of the charity’s Kidney Voices for Research network were among the first invited to join. 

The forum is now live and free to access at kidneycommunity.kidneyresearchuk.org