A qualitative evaluation exploring how CPCF clinical services are implemented in England's community pharmacies. Pharmacies found to offer accessible, trusted care but face financial strain, limited integration, and low public awareness. Future commissioning must reflect the evolving role of pharmacists and today's economic and policy landscape.

A qualitative evaluation of clinical services under the Community Pharmacy Contractual Framework

Saoirse Moriarty, Maggie Bradford, Stephanie Stockwell, Frances Wu, Avery Adams, Manon Richard-Sheridan, Hampton Toole, Lizzie Mills, Jennifer Newbould, Robert J. Romanelli

ResearchPublished Jul 14, 2025

Cover: A qualitative evaluation of clinical services under the Community Pharmacy Contractual Framework
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Includes Executive summary

Community pharmacies in England are an integral part of the healthcare system. In February 2024, RAND Europe was commissioned by NHS England to conduct a qualitative evaluation of some clinical services provided in community pharmacies under the Community Pharmacy Contractual Framework (CPCF) five-year deal (2019-2024). The purpose of this qualitative evaluation was to understand the implementation of CPCF clinical services and to inform future planning and rollout of these services. The evaluation included the voices of more than 100 stakeholders, from diverse areas of England, representing community pharmacies, integrated care boards, primary care networks, local pharmaceutical committees, and members of the public. This evaluation identified various factors that influence the delivery of CPCF clinical services, including those related to services specifications, pharmacy staff and pharmacy characteristics, service users, relationships with other healthcare professionals, and lastly, the wider health system and national policies. The CPCF five-year deal was established in 2019, within a very different economic landscape than today. Future commissioning of clinical services in community pharmacies must consider this new economic landscape, the evolving professional role of pharmacists, and the NHS 10-Year Health Plan, which aims to shift healthcare focus from hospitals to communities, from sickness to prevention, and from analogue to digital. The potential for community pharmacies to help to shape the future delivery of clinical services in England will depend on how these services are commissioned moving forward.

Key Findings

  • 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 other 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 healthcare providers 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.

Recommendation

  • The CPCF five-year deal was established in 2019, within a very different economic landscape than today. Future commissioning of clinical services in community pharmacies must consider this new economic landscape, the evolving professional role of pharmacists, and the NHS 10-Year Health Plan, which aims to shift healthcare focus from hospitals to communities, from sickness to prevention, and from analogue to digital. The potential for community pharmacies to help to shape the future delivery of clinical services in England will depend on how these services are commissioned moving forward.

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Moriarty, Saoirse, Maggie Bradford, Stephanie Stockwell, Frances Wu, Avery Adams, Manon Richard-Sheridan, Hampton Toole, Lizzie Mills, Jennifer Newbould, and Robert J. Romanelli, A qualitative evaluation of clinical services under the Community Pharmacy Contractual Framework. Santa Monica, CA: RAND Corporation, 2025. https://www.rand.org/pubs/research_reports/RRA3570-1.html.
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The research described in this report was prepared for NHS England and conducted by RAND Europe.

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