How many pharmacies does a city have? The question sounds simple. The answer, it turns out, depends on what you count.

The NHS England dispensing contractor register is the authoritative source for community pharmacy locations in England. It lists every contractor that holds an NHS pharmaceutical services contract. Local authorities, researchers, health planners, and organisations like PharmSee use it as the denominator in pharmacy density calculations. But across 13 English cities analysed by PharmSee, between 15% and 27% of registered pharmacies show no dispensing activity in the most recent NHSBSA quarterly dataset.

These entries inflate headline pharmacy counts and depress GP-to-pharmacy ratios — sometimes significantly.

The Scale of the Problem

PharmSee has measured the zero-revenue rate across 13 English cities using the same methodology: a three-mile radius from a city-centre postcode, cross-referencing the contractor register against the most recent NHSBSA dispensing data.

All data from PharmSee's aggregation of NHS England dispensing contractor records and NHSBSA dispensing data. "Effective ratio" excludes zero-revenue branches from the pharmacy count. GP figures remain unchanged.

What Causes Zero-Revenue Entries

Several factors contribute to the gap between registered and actively dispensing branches:

NHSBSA reporting lag. Dispensing data is published with approximately one quarter's delay. A pharmacy that opened last month would appear on the contractor register but show zero dispensing until the next quarterly data release. Conversely, a pharmacy that closed recently may still show dispensing from its final active quarter.

Estate restructuring. The most visible contributor to the current gap is the 2023 national restructuring of a major pharmacy chain estate, which resulted in hundreds of contractor codes remaining on the NHS register after the associated branches ceased dispensing. In several cities — Stoke (nine entries), Newcastle (seven entries), Norwich (five entries) — these unpruned register entries account for a majority of the zero-revenue count.

Specialist contractors. The NHS register includes appliance contractors, homecare providers, and distance-selling pharmacies that may not dispense traditional prescriptions. Entries from organisations such as B Braun Medical, Fittleworth Medical, or Amcare Ltd appear in some city registers and are legitimate NHS contractors but do not operate walk-in community pharmacies.

Genuine closures. Some zero-revenue entries represent pharmacies that have closed but whose contractor codes have not yet been removed from the register. The register is not updated in real time.

Why It Matters

The practical consequence is that any density figure based solely on the contractor register overstates the number of accessible community pharmacies. In Sunderland, the headline ratio of 0.78:1 suggests a well-supplied market. The effective ratio of 1.08:1 — after removing 15 branches that show no dispensing — tells a different story: roughly one active pharmacy per GP practice, which is closer to balanced than abundant.

The gap matters for several constituencies:

Health planners and ICBs use pharmacy density data in commissioning decisions. A city that appears well-served on paper may in practice have fewer accessible dispensing sites than the register implies.

Pharmacy owners and investors assessing local competition need to distinguish between registered and actively dispensing competitors. In Stoke, the headline figure of 74 pharmacies drops to 60 active branches — a 19% reduction in the apparent competitive field.

Professionals considering a move to a new area benefit from understanding that a city with a seemingly low ratio (more pharmacies than GPs) may in fact have a tighter effective market.

The Range Is Wide

What is perhaps most notable is the variation. Coventry's zero-revenue rate is just 8.6%, while Sunderland's is 27.3% — a threefold difference. Cities that experienced large-scale chain withdrawals in 2023 tend to have higher rates, but the pattern is not uniform: Sunderland's gap is broadly distributed across multiple operators, while Stoke's is concentrated in a single chain's former sites.

Oxford and Cambridge, with the lowest zero-revenue rates (4.9% and 12.9% respectively), are also the cities with the lowest GP-to-pharmacy ratios. Their effective ratios remain below 1.0:1 — genuinely well-supplied markets even after adjustment.

A Note on Methodology

PharmSee uses the three-mile urban radius as its standard comparison unit for city-level analysis. This captures the core urban area but excludes suburban hinterland. All ratios compare GP practices (from NHS Digital's Organisation Data Service) with community pharmacy contractors (from the NHS England contractor register), cross-referenced with NHSBSA dispensing data for revenue activity.

A branch showing zero dispensing revenue is not necessarily closed. It may be in a data-reporting gap, undergoing a change of ownership, or operating as a specialist contractor. PharmSee reports this figure as a data-quality indicator, not as a definitive closure count.

For researchers and planners, the effective ratio — excluding zero-revenue entries — may be a more useful planning metric than the headline register count. PharmSee's pharmacy search tool allows users to filter by dispensing activity and compare branches across any English postcode.

Data sources: NHSBSA dispensing data via PharmSee, NHS Digital GP practice list, NHS England dispensing contractor register. All figures based on three-mile radius queries at city-centre postcodes. Snapshot date: April 2026.