Positive Pharmacy Care Law Revisited: an area-level analysis of the relationship between community pharmacy distribution, urbanity and deprivation in England
What did we do?
In collaboration with the Northern Health Science Alliance (NHSA) and Health Equity North, this research project explored the relationship between access to, and the availability of, community pharmacies between 2014 and 2023, to:
- look at geographical access to community pharmacy in England,
- explore the relationship between access to community pharmacy and how built-up or deprived an area is, and
- understand any changes in access over time.
Why is it important?
Community pharmacies are an important part of healthcare systems around the world and deliver a range of public health and clinical services to the general public.
In previous work from 2014, we found that, in England, community pharmacies followed a ‘positive pharmacy care law’ which meant the availability of community pharmacies was greatest in the most deprived communities.
This was interesting, as it was the opposite of the well-established ‘inverse care law’ for other healthcare services, both in England and internationally. ‘Inverse care law’ means there is less provision in the most deprived areas, even though they have the highest health needs.
In related analysis, it was found that more people lived within a 20-minute walk of community pharmacies than other primary care providers, including general practice.
The ‘positive pharmacy care law’ supported the idea of using community pharmacies as a way to promote health and wellbeing interventions to local communities. But, since the discovery of the ‘positive pharmacy care law’ ten years ago, there have been funding cuts which have led to community pharmacy closures.
Because of these changes to the community pharmacy network, we wanted to explore if the ‘positive pharmacy care law’ is still in operation, as this could influence how future services are commissioned.
How did we do it?
We used a range of data to identify Ordnance Survey Points of Interest datasets to find the locations of community pharmacies, in September of each year, from 2014 to 2023.
We used three measures to assess how easy it is for someone to access a community pharmacy:
- Community pharmacy availability per 10,000 people
- Community pharmacy access: whether or not the straight-line distance is within a 20-minute walk
- Community Pharmacy change over time: whether or not a community has lost a pharmacy between 2014 and 2023.
Findings
- In 2014, 91.3% of people lived within a 20-minute walk of a community pharmacy. By 2023, this number increased to 91.7%.
- There was a positive relationship between geographical community pharmacy access and living in a built-up area, and geographical community pharmacy access and living in a deprived area. This means there were more pharmacies in built-up and deprived areas.
- We found that the median number of community pharmacies available (per 10,000 people) had decreased from 1.60 in 2014 to 1.51 in 2023.
- The most deprived areas were more likely to lose a pharmacy, compared to the least deprived areas.
Overall, we found that there is still high access to community pharmacies in England, with access to a community pharmacy greatest in the most deprived areas, showing that the ‘positive pharmacy care law’ remains.
However, the ‘positive pharmacy care law’ is eroding as the availability of community pharmacies has reduced over time – particularly in deprived areas – with more people reliant on each community pharmacy.
Downloadable resources
Who we worked with
- Newcastle University
- The University of Manchester
- The Northern Health Science Alliance
- Health Equity North
More information
Mike Spence
Senior Programme Lead
mike.spence@healthinnovationmanchester.com