The GP-to-pharmacy ratio is one of the most commonly cited metrics in pharmacy planning. Integrated Care Boards use it to assess whether an area needs more pharmacies. Planning consultants cite it in market entry applications. Policy researchers use it to map access to pharmaceutical services.
But the metric has a systematic flaw: it counts every pharmacy on the NHSBSA contractor register, including branches that have not dispensed a single item in the most recent quarter. PharmSee's analysis of 13 English cities shows this distortion is large enough to change planning conclusions.
Headline vs effective ratios across 13 cities
| City | Headline ratio | Active pharmacies | Effective ratio | Shift |
|---|---|---|---|---|
| Exeter | 1.42:1 | 18 of 26 | 2.06:1 | +45% |
| Liverpool | 1.42:1 | 87 of 106 | 1.72:1 | +21% |
| Birmingham | 1.26:1 | 82 of 96 | 1.48:1 | +17% |
| Bath | 1.22:1 | 22 of 27 | 1.50:1 | +23% |
| Sheffield | 0.78:1 | 79 of 100 | 0.99:1 | +27% |
| Manchester | 0.93:1 | 91 of 108 | 1.10:1 | +18% |
| Stoke-on-Trent | 0.89:1 | 60 of 74 | 1.10:1 | +24% |
| Norwich | 0.88:1 | 32 of 40 | 1.09:1 | +24% |
| Sunderland | 0.78:1 | 40 of 55 | 1.08:1 | +38% |
| Newcastle | 0.79:1 | 63 of 85 | 1.06:1 | +34% |
| Oxford | 0.66:1 | 28 of 41 | 0.96:1 | +45% |
| Coventry | ~0.90:1 | est. | ~1.10:1 | ~22% |
| Cambridge | ~0.85:1 | est. | ~1.05:1 | ~24% |
Source: PharmSee analysis of NHSBSA dispensing data and NHS Digital register, 3-mile radius from city centre. "Effective ratio" counts only pharmacies with recorded dispensing activity in the most recent NHSBSA quarter. Zero-revenue entries may reflect data-reporting lag rather than permanent closure, meaning the effective ratio is a conservative estimate. Coventry and Cambridge figures are approximate from earlier measurement cycles.
The planning threshold problem
Many pharmaceutical needs assessments use a GP-to-pharmacy ratio of 1.0:1 as an informal threshold: below 1.0 suggests adequate pharmacy supply, above 1.0 suggests potential need. If this threshold is applied to headline ratios, only four of the thirteen cities appear to need additional pharmacy capacity (Exeter, Liverpool, Birmingham, Bath).
Applied to effective ratios — counting only pharmacies that are actually dispensing — ten of thirteen cities cross the 1.0:1 line. Sheffield moves from 0.78 (well-supplied) to 0.99 (borderline). Oxford moves from 0.66 (over-supplied) to 0.96 (approaching threshold). The picture of English pharmacy supply shifts substantially.
Why the distortion varies
The shift from headline to effective ratio ranges from 17% (Birmingham) to 45% (Exeter and Oxford). The variation depends on two factors:
Zero-revenue rate. Cities with more inactive register entries show larger shifts. Sunderland (27% zero-revenue) and Sheffield (21%) see bigger corrections than Manchester (16%).
Absolute pharmacy count. In smaller markets, each inactive entry has a proportionally larger effect. Exeter's shift is amplified by having only 26 total pharmacies — removing 8 zero-revenue entries reduces the denominator by 31%.
The Lloyds factor
A substantial share of zero-revenue entries across these cities carry Lloyds contractor codes — remnants of the chain's 2023 market exit. In Sheffield, 11 of 21 zero-revenue entries are Lloyds. In Exeter, 5 of 8. In Birmingham, 10 of 14.
This is not a small-sample anomaly. It is a known, documented, large-scale market exit whose effects have not yet been fully reflected in the contractor register. Until ICBs complete the deregistration process for these codes, every density calculation using the register as-is will overstate pharmacy supply in affected areas.
What should change
PharmSee's data supports a simple reform: the NHSBSA should publish a "dispensing status" flag alongside each contractor code, indicating whether the pharmacy submitted dispensing data in the most recent quarter. This would allow planners to calculate both headline and active ratios without needing to cross-reference dispensing datasets manually.
In the meantime, any pharmaceutical needs assessment, market entry application, or policy paper that cites GP-to-pharmacy ratios should report both versions — and explain the difference.
Explore headline and active pharmacy counts for any English postcode using PharmSee's location analysis tool. Compare specific pharmacies using the pharmacy search.
Methodology
GP-to-pharmacy ratios calculated within a 3-mile radius of each city's central postcode using PharmSee's database of NHSBSA dispensing contractor records and NHS Digital GP practice data. "Active" pharmacies are those with any recorded dispensing revenue in the most recent NHSBSA quarterly dataset. Zero-revenue entries may include pharmacies with reporting delays; effective ratios should therefore be treated as upper bounds on access scarcity. Data snapshot: April 2026.
Data: NHSBSA dispensing contractor records, NHS Digital ODS register.