Fewer pharmacies could be open in the evenings and at weekends from the New Year after pharmacy owners voted in favour of collective action for the first time in their history.
Some could also withdraw from providing emergency contraception and stop smoking services.
The National Pharmacy Association (NPA) said its members “have been forced into an untenable position by a decade of underfunding”.
The trade association warned that pharmacists “don’t want to reduce services” but “will be left with no option” if there is not an adequate response from the Government on funding in the coming weeks.
Some 3,339 independent community pharmacies in England, Wales and Northern Ireland took part in the unprecedented ballot, a turnout of 64%.
The ballot result overwhelmingly shows the sheer anger and frustration of pharmacy owners at a decade of cuts that is forcing dedicated health professionals to shut their doors for good
Of those who voted, 97.8% said they would serve notice on opening hours above the minimum required by their contract, meaning fewer will be open at evenings and weekends.
According to the NPA, pharmacies are contracted to open for 40 hours a week minimum, although most are open for 50 hours a week on average.
Elsewhere, some 96.1% voted to withdraw from locally commissioned services such as emergency contraception, addiction support and stop smoking services, while 96.8% voted to stop supplying medicine packs that the NHS do not pay pharmacies to provide, other than those covered by the Disability Discrimination Act.
Almost all (99.2%) voted to refuse to co-operate with certain data requests above those required for patient safety and contractual minimums.
NPA chairman Nick Kaye said: “Pharmacies desperately want to support their local communities with access to medicines and advice but have been forced into an untenable position by a decade of underfunding which has led to a record number of closures.
“As a third-generation pharmacist, I deeply care about my patients, as do pharmacy teams across the country, but I have never experienced a situation as desperate as this.
“Pharmacy owners are not a radical bunch, we have never proposed action like this before, but after a decade of underfunding and record closures, something simply has got to give.”
The NPA estimates about 700 pharmacies have shut in England in the last two years, with more than 1,250 closing in the last decade.
Mr Kaye added: “Pharmacies don’t want to reduce services but we will be left with no option but to suggest that pharmacy owners should consider acting on the clear ballot results if government does not act to protect this vital and much-loved part of our health service.”
Mr Kaye said last month’s Budget has “intensified” issues, and while the NPA agrees with the Government’s aim to shift more care from hospitals into the community as part of its 10-year plan, he warned the sector must be properly funded.
“The sense of anger among pharmacy owners has been intensified exponentially by the Budget – with its hike in National Insurance employers’ contributions and the unfunded National Living Wage increase – which has tipped even more pharmacies to the brink,” he said.
“The ballot result overwhelmingly shows the sheer anger and frustration of pharmacy owners at a decade of cuts that is forcing dedicated health professionals to shut their doors for good.
“We strongly agree with the new Government’s ambition to boost community health care and hope to meet with them to discuss a new funding deal for pharmacies and modernisation of pharmacies to increase the number of clinical services they deliver, as long as they are properly funded.”
We are awaiting a settlement and the results of that settlement will determine the next steps
Dr Leyla Hannbeck, chief executive of the Independent Pharmacies Association, added: “Community pharmacy sector is in an escalating crisis with £1.7 billion shortfall in its funding.
“This has got worse by the hike in the employer NI resulting in £12,000 extra costs annually for our members.
“As healthcare professionals, we believe that patients must not be caused suffering by any withdrawals of our members’ valuable and vital professional services.
“The government must urgently raise pharmacy funding to prevent further closures of community pharmacies. We are awaiting a settlement and the results of that settlement will determine the next steps.”
The NPA ballot comes amid collective action by GPs in England.
In August, the British Medical Association (BMA) issued a list of 10 actions for surgeries to consider, including limiting patients to 25 a day or refusing to carry out work GPs are not formally contracted to do.
The move is part of a row over the new GP contract, which will give services a 1.9% funding increase for 2024/25 – a move the BMA claims will leave many surgeries struggling financially.
GPs launched a formal dispute over the issue in April after a referendum carried out by the union found 99% of 19,000 GPs rejected the contract.
