German island pharmacies struggle under 24/7 emergency duty pressures

On the North Sea island of Föhr, just two pharmacies handle all emergency services—24 hours a day, every day of the year. One of them, the Insel-Apotheke in Wyk, has shouldered the burden alone for scheduled periods like March 2026. Meanwhile, a planned reform aims to raise emergency fees, offering some relief to struggling owners like Christian Daegel, who calls the duty a personal obligation despite financial losses.

Christian Daegel, owner of the Insel-Apotheke, views emergency shifts as a duty rather than a choice. Even with his daughter expecting a baby soon, he cannot take time off due to the round-the-clock service. The current fee of €535 per shift leaves him with a net loss of €253, based on last year's figures where a pharmacy earned €871 but spent more to stay open. Doubling the fee to €1,070 would help, though not fully, while a proposed flat-rate increase to €1,112 could turn that loss into a small surplus of €227.

Elsewhere, Thorsten Knoke shut his own pharmacy to join Rebekka Lehmann's team, creating a 50-50 split of emergency shifts between their two pharmacies. This rare cooperation contrasts with broader trends: in many regions, fewer pharmacies now offer emergency services, especially in rural areas where a single location may cover nights and holidays alone. Urban areas fare slightly better, with roughly one in ten pharmacies sharing the load.

Knoke supports the planned fee hike, arguing it could stabilise staffing and keep essential services running. Daegel, however, highlights the toll of constant planning and lost spontaneity, calling the system unsustainable without better support.

The reform could ease financial strain by lifting emergency fees to €1,112 per shift. For Daegel and others like him, this change might mean fewer losses and a more stable service. Yet even with adjustments, the pressure remains—especially in remote areas where a handful of pharmacies bear the full weight of 24/7 care.