Community pharmacies are mentioned as part of the government's recently released 10-Year Health Plan, which aims to build an NHS in England that is “fit for the future.” The plan describes shifting from treating to preventing illnesses and from acute to community-based care—two areas that community pharmacies are well poised to support.
In fact, most of the approximately 10,000 pharmacies in England already provide various types of community-based and preventive health services. These include: providing lifestyle advice and support for healthy eating and exercise; support for individuals with substance use issues; and clinical services historically delivered by a GP, such as advice for and access to contraception, support for smoking cessation, influenza vaccinations, blood pressure checks, and consultations for common minor ailments that might require prescription-only medicines.
According to the 10-Year Health Plan, community pharmacies will be integral members of so-called “Neighbourhood Health Services” and will play a larger role in the management of long-term conditions and providing additional health services, including prevention and vaccinations. But how can this be achieved?
A new evaluation by RAND Europe published last month explores how community pharmacies have delivered clinical services in England under the Community Pharmacy Contractual Framework's “five-year deal (2019–2024).” Commissioned by NHS England, this independent evaluation draws on the voices of more than 100 stakeholders from diverse regions of England, representing community pharmacies, GP surgeries, integrated care boards, primary care networks, local pharmaceutical committees, and members of the public. The findings offer clear lessons for future commissioning.
Community pharmacies are under extreme pressure, which increasingly affects their ability to provide the services currently on offer.
First, community pharmacies are under extreme pressure, which increasingly affects their ability to provide the services currently on offer. Over time, community pharmacies have been asked to provide a wider range of health services, while continuing their core role in dispensing medicines. This is happening against a backdrop of historic rises in inflation, workforce shortages, and medicines supply issues, factors which have led to record numbers of pharmacy closures and growing burnout among pharmacists, many of whom are considering leaving the profession.
Second, real and perceived competition between community pharmacies and GP surgeries hinders healthcare professionals working together. Community pharmacies and GP surgeries are each contracted to deliver health services for the NHS. These contracts, however, do not promote collaboration. In fact, at times, they foster competition and have caused tension between community pharmacies and GP surgeries.
While services such as influenza vaccinations and other health services for patients with less complex health conditions have been made available in community pharmacies to ease the pressure on GPs, this has not always had the desired effect. Some GPs view the increasing role of pharmacists as an infringement on their professional jurisdiction, whilst others believe that moving services for patients with fewer complex health needs into community pharmacies will actually increase a GP's work burden.
Third, digital infrastructure—allowing pharmacy staff to receive referrals, book and manage appointments, record encounters, communicate with a patient's care team, and see a summary of a patient's medical records—is key to delivering health services in community pharmacies. However, many health care providers do not use the same IT systems as community pharmacies, complicating workflows and referral pathways. In some cases, GPs have switched off digital infrastructure—namely GP Connect, which allows data sharing—complicating efforts for joined-up care and further contributing to tensions. When a community pharmacist can see a patient's summary record, it is often an incomplete picture of their medical history and, at times, insufficient to make informed clinical decisions.
Finally, the public is often unaware of the range of health services that community pharmacies can provide, and they hold mixed views about where they prefer to receive care. Many people are open to receiving health services in community pharmacies, valuing the convenience of walk-in appointments, the timeliness of care, and trusted relationships with pharmacy staff. But awareness of available services—beyond influenza vaccinations—remains low, especially as the specific services offered across pharmacies vary.
As pharmacies adapt to manage growing demand, there is a risk that some of the features that patients value most, such as walk-in access and low digital barriers, could be lost.
Moreover, as pharmacies adapt to manage growing demand (through tools such as online booking systems), there is a risk that some of the features that patients value most, such as walk-in access and low digital barriers, could be lost. Whilst many people are open to or even prefer to receive certain services in community pharmacies, others, particularly those with more complex health needs, prefer services from other health care providers.
Community pharmacies have great potential to support the government in achieving its goals under the 10-Year Health Plan. Unfortunately, realising this potential is not as simple as transferring more services from other parts of the system into pharmacies. This will only risk adding pressure to a sector already stretched by its current responsibilities.
Without addressing the underlying structural issues, even well-designed services will struggle to succeed. Rather, a more systemic approach will be needed: one that addresses pharmacy workforce and funding constraints, strengthens collaboration with other health care providers, builds the necessary digital infrastructure, and involves patients in shaping how and where they receive care.
