The Darzi report, an independent investigation of NHS England, recently highlighted the accessibility of community pharmacies as “one of the great strengths” of the NHS, while Labour's 2024 manifesto identified “community pharmacy prescribing services” as a new route to relieving pressure on the NHS. With wait times for routine services growing and patient satisfaction at an all-time low, can community pharmacies offer a solution to the NHS's growing challenges?
Whilst community pharmacists' roles have historically been limited to dispensing and providing advice on medications, in recent years, training and funding for community pharmacies has expanded community pharmacists' scope of practice to now include delivering clinical services and prescribing certain medicines. These changes have been met with strong public support. An IPSOS survey from 2022 found that 90 percent of the public in England would feel comfortable consulting a pharmacist for a minor illness after speaking with a GP receptionist.
Presently, community pharmacies offer a range of clinical services that might otherwise be provided by a GP, such as contraception services, vaccinations, and consultations for minor illnesses, including the supply of some antibiotics. Community pharmacists also play an active role in preventive health care, through initiatives like Healthy Living Pharmacies and opportunistic blood pressure checks, which help identify individuals with undiagnosed hypertension.
The role of community pharmacists as a provider of clinical services is likely to further expand.
The role of community pharmacists as a provider of clinical services is likely to further expand. Beginning September 2026, all newly qualified pharmacists will be independent prescribers, able to prescribe a wide variety of medications that, currently, only a doctor can prescribe.
Expanding the delivery of clinical services in community pharmacies across England—especially services that would be typically done by a GP—has several potential benefits:
First, community pharmacies could help to alleviate the demand on GP practices. Approximately 1.6 million people in England are waiting over a month for a GP appointment, and burnout and other pressures in the profession have resulted in a decrease in the workforce by over 1,500 full-time equivalent staff since 2015. Expanding access to clinical services within community pharmacies could help to shorten waiting lists and promote more timely access to care.
Second, pharmacies are geographically well placed to offer clinical services. The Darzi report highlighted the importance of the physical accessibility of pharmacies, citing that “more than 85 percent of people live within one mile of a community pharmacy.” Positioned on high streets and within shopping centres, pharmacies are often more accessible than other health care providers.
Third,community pharmacies can offer patients more convenience and anonymity than GP practices. Pharmacies generally offer walk-in services, making same-day access readily available. Unlike GPs, pharmacies typically do not require patient registration and are therefore able to provide more anonymous care. The convenience of walk-in appointments, coupled with limited collection of personal data for some clinical services, could encourage people to access services who might not otherwise engage with the health care system.
Despite these potential benefits and the increasing political interest in community pharmacies delivering clinical services, opportunities to expand the role of community pharmacists have been met with considerable challenges.
Community pharmacies themselves are under increasing pressure and are closing in record numbers. In 2023, 436 pharmacies permanently closed. According to Community Pharmacy England (PDF), a representative body for pharmacy owners across England, since 2015 pharmacies have experienced a 25 percent cut in funding and a 70 percent increase in staffing costs. Shifting some services from one part of the system to another (that is, from GP practices to community pharmacies) may not be a sustainable solution without a more holistic approach to alleviating system pressures.
The expansion of clinical services offered by community pharmacies has unintentionally put them in competition with GPs for some services and, consequently, NHS remuneration. Such competition may limit incentives for working together, and GPs may be reluctant to refer patients to pharmacies, which for some services is required for pharmacies to receive remuneration. The reluctance by GPs to refer their patients to pharmacies, coupled with a lack of patient information sharing between community pharmacies and primary- and secondary-care providers, reinforces a health system in which patient care is not very well integrated, potentially contributing to system waste and inefficiencies.
Remuneration for clinical services is complex, and can be perceived as insufficient. Where remuneration is provided, the administrative requirements (PDF) can be time consuming, and online systems can be difficult to navigate. Some pharmacists feel that compensation for discrete clinical services falls short of the full scope of work that pharmacists do. This became particularly evident during the COVID-19 pandemic. Although pharmacists are remunerated for providing COVID-19 jabs, they have reported that the time and resources to procure ultra-low temperature freezers to store the initial vaccines, and the time to field general questions from customers about COVID-19 symptoms, vaccinations, and treatments represents uncompensated 'hidden work'. It is possible that these factors could influence whether certain clinical services are financially viable and whether pharmacists will offer them.
There is a lack of awareness amongst the general public about what clinical services community pharmacies provide, if they are eligible to receive these services, and how to access them.
Finally, despite high levels of support, there is a lack of awareness amongst the general public about what clinical services community pharmacies provide, if they are eligible to receive these services, and how to access them.
RAND Europe has been commissioned by NHS England to conduct an independent evaluation of certain community pharmacy clinical services. While the analysis is still ongoing, important lessons are emerging about how to best support pharmacists, the public, and the wider health care landscape in fully benefiting from the delivery of clinical services within community pharmacies. A report will be publicly available in early 2025.
With a recent change of government and particular focus on health care in light of the Darzi report, this could be a pivotal moment to re-examine the expanding role of community pharmacists in the provision of clinical services and easing pressures on the NHS. However, significant barriers exist. Overcoming these challenges requires greater cooperation between health care professionals, enhancing data sharing, reconsidering remuneration models that align incentives, and generating more public awareness of pharmacy services.
