Many pharmacies in England, Wales and Northern Ireland could cut their opening hours in protest over government funding, if a “work-to-rule” ballot passes.

The National Pharmacy Association says its unprecedented ballot of members could mean chemists keeping strictly to the 40 hours a week they are required to open in the government contract.

The NPA, which represents about half UK community pharmacies, some 6,000, says 1,500 have closed since 2016 because of workloads and budget cuts.

The Department of Health in England said the previous government had neglected pharmacies for years.

The NPA says core government pharmacy funding in England has fallen by 40% after adjusting for inflation, since 2015-16.

It has called for an annual £1.3bn funding increase to plug the “financial hole”.

And pharmacists have argued for some time the drug tariff, which covers payments for services and medicines, is failing to cover their costs.

NPA chief executive Paul Rees said pharmacies were “being pushed to the brink” by a decade of real-terms cuts.

“Pharmacies are routinely required to dispense NHS medicines at a loss – 1,500 have been forced to close in the past decade, while others have had to cut hours to try and make ends meet,” he said. And it was hitting patients hard.

Despite pay rises for junior doctors and train drivers since the election, there was no sign of an end to cuts putting pharmacies out of business, Mr Rees added.

Members of the NPA, which is not a trade union, will be balloted over six weeks and, if there is a vote in favour, there could be action before Christmas.

They will be asked if they support stopping providing services not covered by the central government contract.

These include some emergency contraception, substance-misuse services and free medicine delivery, which are commissioned by local authorities.

The government contract, which pharmacies are obliged to observe, includes medicine dispensing, some consultations and flu or Covid vaccinations.

The Pharmacy First service, launched in January in England, extended the range of services chemists can provide, including treatment of sinusitis, earache and shingles.

Members were not being asked to pull out of the scheme, the NPA said, but a reduction in opening hours to 40 per week would affect it.

Another pharmacy group takes a different view on the current situation.

Leyla Hannbeck, chief executive of the Independent Pharmacies Association said: “Our members are deeply embedded in their local communities and for them the idea of prematurely punishing patients by any type of strike action is unconscionable.”

Ms Hannbeck said the focus should be on engaging with the new ministers “in as constructive a way as possible”.

Health is a devolved issue and pharmacists in Wales and Northern Ireland are being surveyed separately, because of similar concerns about funding.

But there is no discussion about protest action in Scotland, where the NPA says financial support is more adequate.

A Department of Health official covering England said: “Pharmacies are key to making healthcare fit for the future as we shift the focus of the NHS out of hospitals and into the community.

“We will make better use of pharmacists’ skills, including accelerating the rollout of independent prescribing to improve access to care.”