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Pharmacies are under “extreme financial pressures, influenced by historic levels of inflation”, according to an NHS England-commissioned review of community pharmacy clinical services in England.
The independent review, published on 14 July 2025, recommended that this “new economic landscape” should be considered in any future commissioning of clinical services in community pharmacies.
The review, which analysed clinical services provided under the ‘Community pharmacy contractual framework’ (CPCF) for 2019–2024, highlighted challenges around physical and digital infrastructure, including access to patient records, as well as integration with other healthcare professionals.
However, it noted that pharmacy teams “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 pharmacy teams’ “relationships with members of the local community can help to facilitate access to clinical services among more diverse populations”, the review added.
The evaluation of the CPCF for 2019–2024 clinical services was commissioned by NHS England in 2024 following a tender process and undertaken by think tank and research institute RAND Europe.
It made several recommendations, including that commissioners consider:
- Increasing remuneration for CPCF clinical services “based on the complexity of the service and the need to purchase supplies and equipment to run the services, as well as broader financial pressures”;
- Whether formal referrals for certain CPCF clinical services are required and “whether alternative pathways, such as informal referrals, signposting or walk ins, could help to improve service user engagement and outcomes for those able to access care”;
- Ways to minimise competition and promote collaboration between community pharmacies and other healthcare professionals.
RAND Europe used interviews with pharmacy staff and other healthcare professionals between July and October 2024, as well as focus groups and ethnographic site visits and observations to conduct a qualitative evaluation.
The review did not cover clinical services introduced as part of Pharmacy First.
Since it was conducted, a new CPCF was agreed for 2025/2026 that included increased fees for Pharmacy First and contraception services, antidepressants added to the new medicine service, an increase in the single activity dispensing fee of £0.19 to £1.46 per item and an increase in the margin allowance for community pharmacy from £800m to £900m per year.
Commenting on the report’s findings, Elen Jones, director of pharmacy at the Royal Pharmaceutical Society, said: “With the right investment and support, community pharmacy teams will play a transformative role in improving population health, boosting prevention and enabling better care across the NHS.”
An expanded clinical role for pharmacists “must be backed by sustainable funding, a supported and skilled workforce and investment in IT and digital infrastructure”, she added.
Malcolm Harrison, chief executive of the Company Chemists’ Association said: “We envisage an increasingly clinical future for community pharmacy, and a growing role in tackling some of the key challenges the NHS faces. We know that pharmacy teams and patients alike welcome this direction of travel.
“Significant progress has been made already and access to community pharmacy care through the NHS has been transformed. Over 3 million Pharmacy First consultations in the service’s first year and the highest number of flu vaccinations administered outside of the pandemic years is testament to this.
“It is imperative that future services are based on firm foundations – with both NHS services and dispensing sustainably funded. For this to happen, the sector continues to need additional investment.”
Alison Jones, director of policy and communication at the Pharmacists’ Defence Association (PDA), said: “Feedback to the PDA from community pharmacy members is that in general they support the development of more clinical roles and proposals for an expansion of these in the future; however, the reality is that the sheer volume of services being delivered in community pharmacies currently without the necessary investment in the workforce is taking its toll — in terms of workplace pressure and burnout.
“Some tell us that target setting in relation to clinical pharmacy services is now commonplace, where they are pressured into meeting numbers of consultations or activities to meet payment thresholds, despite recent guidance from the General Pharmaceutical Council. It is therefore unsurprising that the daily challenges that are experienced by pharmacists on the frontline trying to juggle multiple demands were observed as part of the study.”
