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The pharmacy cuts – a personal reflection on patient impact


MY mum won’t be putting any Christmas decorations up this year.


Last year my mum trimmed the house up as usual for the Christmas period – admittedly ‘less is more’ is not a mantra she follows so every free surface gets sparkly treatment of one sort or another.

My dad has dementia and couldn’t cope with the alteration to his surroundings. He became unsettled and more aggressive than usual, until my mum twigged what was affecting him and took the decorations down again.

My dad finds it difficult to cope with any changes to his routine now. Even if it’s something simple like us all getting together for a family meal. He gets agitated and although he can’t remember the finer details of what is happening, he knows that something is different to normal and that causes him to become anxious and aggressive.

He’s always been an angry person, but dementia has made his mood more unpredictable as he struggles to deal with the challenges it causes.

I’m not talking about physical aggression here, I am meaning verbal aggression. The sort of aggression that makes you scared to speak in case you have a torrent of abuse thrown at you. My mum is constantly walking a fine line between offering help that is gratefully received, or viciously rejected, never knowing which response to expect. A difficult situation to cope with that is helped by maintaining a constant environment and limiting change.

But my dad is not the only person with dementia that is affected by a change in routine.

Much more than medicines
In my role as community pharmacist I see patients living with dementia every day. As their condition progresses my pharmacy team become more and more involved in their care, providing support and a safe place for them to come when they have a problem. Not just about medication. They know that they can trust us and when they get letters they don’t understand, or the fridge stops working, or there’s a hole in the pavement outside their house, they come to us, and we do what we can to help.

Quite often we will find ourselves providing weekly dosette boxes to dementia patients to enable them, or their carers, to manage their medication at home. It is not unusual for us to receive telephone calls from dementia patients about their medication, either worrying that they can’t find their tablets, or thinking they’ve not got any tablets for this morning’s dose when they’ve already taken them.

The frequency of these telephone calls tends to increase quite noticeably when there is a change to the patient’s routine. When the relative or carer who normally looks after them is on holiday we will see an increase in telephone calls. Even when our delivery driver is on holiday and a different driver drops the dosette box off the patient will be unsettled and more anxious and we will get more calls.

Unintended consequences
But what’s the point of me writing all of this down?

I am deeply concerned about the effect that the proposed pharmacy cuts will have on dementia patients and carers. The government has said that it wants about 3,000 pharmacies to close. Each of those pharmacies will be supporting several patients and carers who are living with dementia, and who have built up trusting relationships with their pharmacy over many years – years that cannot be reclaimed.

How does a person with dementia forge a new relationship with a new pharmacy, in a new location, with new staff? If even a slight change to their routine causes such a profound effect on them, then what effect will a complete change of pharmacy have? And let’s not forget the carers who are having to deal with the fall out at home.

I would urge the government to think about all the patients who depend on their local pharmacy, but dementia patients in particular, before forging ahead with their plans to close pharmacies. We are a vital resource to many, and the relationships we build with our patients should not be underestimated. When the rest of the healthcare system is under such pressure, it seems madness to reduce funding to pharmacies to force them to close.

Please, please, think again.

The author of this blog wishes to remain anonymous

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