Evaluation of Clinical Services in Community Pharmacy

What is the issue?

Community pharmacies are an integral part of the healthcare system in England. While traditionally centred on medicine procurement and dispensing, over time their services have expanded to include more clinical services.¹

As the strain on healthcare services in the UK rises, the potential for pharmacies to help improve access to clinical services is becoming more important. The recent rollout of Pharmacy First signifies greater involvement of pharmacies in delivering clinical services.²

In 2019, NHS England and community pharmacies entered into a 5-year deal (2019-2024) as part of the Community Pharmacy Contractual Framework (CPCF), which is an agreement between NHS England and community pharmacies to provide specific clinical services to the public. Some of these services include: contraception (birth-control or oral contraception/the ‘pill’) consultation service; blood pressure checks; support with using newly prescribed medications for a long-term condition (e.g. asthma); support with using medications after hospital discharge; stop smoking support after hospital discharge; and influenza vaccinations.

How did we help?

We were commissioned by NHS England to evaluate some clinical services provided under the CPCF 5-year deal. The evaluation included consultations with more than 100 stakeholders across diverse areas of England, representing community pharmacies, other healthcare professionals (HCPs), integrated care boards (ICBs), primary care networks (PCNs), local pharmaceutical committees (LPCs), and members of the public.

The goals of the evaluation were to understand:

1. How are CPCF clinical services working, how have they progressed, and what are the successes, opportunities, and challenges in providing these services?
2. What are the key factors that impact on service delivery related to commissioning/contract arrangements?
3. How do CPCF clinical services, if at all, meet the needs of diverse populations? How can services be modified to better support service-users access, engagement and health equity?

What did we find?

• Community pharmacy staff are generally very motivated to perform CPCF clinical services to help people within the communities they serve and to make the most of their qualifications.
• Community pharmacies are under extreme financial pressures, influenced by historic levels of inflation. Many pharmacy staff felt remuneration for these clinical services was insufficient and impacted their ability to deliver them.
• Issues with physical and digital infrastructure persist. Many HCPs do not use the same clinical IT systems used in community pharmacies, and community pharmacists lack access to full medical records.
• Integration with other HCPs remains an ongoing challenge, influenced by complicated referral pathways, competing incentive structures and limited awareness about the services pharmacies offer.
• Service users are motivated by the convenience and timeliness of clinical services offered at community pharmacies compared to other healthcare settings. Existing relationships and high levels of trust with pharmacy staff are also key drivers for service users to engage with these services. However, limited public awareness remains a challenge.
• Most community pharmacies offer a convenient and accessible form of care for a lot of people, which can be particularly important to people who may not seek care otherwise. Often pharmacies are well integrated into their local communities, with staff speaking the languages of local residents, which helps to build levels of trust that are not observed with some other HCPs. If supported to deliver clinical services, pharmacies could play an important role in moving care to the community.

What can be done?

Future commissioning of clinical services in community pharmacies must consider the new economic landscape, the evolving professional role of pharmacists and the NHS 10-Year Health Plan for England, which aims to shift healthcare focus from hospitals to communities, from sickness to prevention, and from analogue to digital. Community pharmacies can play a pivotal role in supporting these shifts and building a health service that is ‘fit for the future’.

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Additional project team members

• Frances Wu
• Lizzie Mills – Independent subcontractor
• Beccy Biard – The King’s Fund, subcontractor
• Maggie Bradford
• Saoirse Moriarty