It’s that time of year when pharmacies across the UK gear up for flu vaccination season: ordering supplies, double-checking resources, training staff as needed and updating protocols.
This ‘business-as-usual’ service raises wider questions about the government’s proposed neighbourhood health service. Can it work within current funding setups without creating competition between healthcare providers?
There is a clear desire for pharmacies to provide more clinical services — and the success of the flu vaccination service is a case in point. During the 2024/2025 season, pharmacies delivered more than 4 million flu vaccines — a record in the past decade since the flu vaccination programme was introduced in pharmacies, outside the COVID-19 pandemic. The rise reflects growing public trust in pharmacists and the accessibility of community pharmacy, which helps to ease pressure on GP surgeries during the winter months.
In February 2025, Amanda Pritchard, former chief executive of NHS England, described community pharmacies as a “key opportunity” to increase flu vaccine uptake among children and young people. Since then, Community Pharmacy England confirmed that community pharmacies in England will be able to provide flu vaccinations to children aged 2–3 years from 1 October 2025 under a new NHS England advanced service.
When GPs tell patients to avoid getting their vaccinations at pharmacies — it’s actively discouraging the public to seek protection in any way they can
However, current funding models for the service can create competition between providers. Right now, general practices and pharmacies purchase flu vaccines at their own risk. This is a careful balance between ordering enough for patients while avoiding wastage, all while protecting margins and serving their communities. For pharmacies, competition between each other to secure and deliver enough vaccines is almost inevitable. But with GPs, the dynamic is different: pharmacies depend on them for prescriptions to keep their business going, including Pharmacy First referrals.
When GPs tell groups of patients to avoid getting their vaccinations at pharmacies, that’s not just professional competition — it’s actively discouraging the public to seek protection in any way they can. GPs are businesses too, of course, but this approach puts public health and prevention at serious risk, undermining the idea of a neighbourhood health service. This tension is ultimately fuelled by financial pressures, competition within the NHS, and a lack of incentives for GPs and pharmacists to work together to improve local care.
Our Pharmacy First infographic visualises how GP referrals are a bottleneck to the service’s success — using data to illustrate how insufficient GP engagement is slowing uptake, undermining Pharmacy First’s potential to relieve pressure on primary care and impacting patient care.
Resistance to community pharmacy involvement in flu vaccination programmes has always existed. Thankfully, it has eased in recent years, particularly since COVID-19 drove a rise in vaccine uptake. We are no longer seeing outright objections to a pharmacy-led flu vaccination programme that emerged when they were first introduced in 2014.
Speaking to The Pharmaceutical Journal, Raj Matharu, chief executive of Community Pharmacy South East London LPC, describes this as a “friction in the system”. He hopes that it will ease with the arrival of a new cohort of independent prescribers in 2026 and the gradual shift towards more clinical services — another goal of the NHS ten-year plan.
Matharu notes that if the shift to more clinical services happens, GPs will have to relinquish some of that to community pharmacy. It will also rely on both GPs and other healthcare professionals recognising the skills of the pharmacy profession. The government’s ambition to move to a single patient record will also help. If given access, pharmacies will inevitably become less reliant on general practices.
While GPs have their premises costs, such as rent and utilities, covered by the NHS, pharmacies must pay these overheads out of their own budgets
A different procurement model could help too. In November 2024, NHS England sought evidence on the benefits and challenges of a centralised procurement model, aiming to improve the effectiveness of flu vaccination programme delivery. Currently, the UK Health Security Agency (UKHSA) manages the procurement and supply of all other vaccines, including the children’s flu vaccine. If central procurement of the adult flu vaccine is implemented, the UKHSA would also take on the purchase and supply of this vaccine.
However, some want reform to go further. Dervis Alkan Gurol, director of the Independent Pharmacy Contractors Network and Sussex Pharmacies, argues that it isn’t really a competition when it’s not a level playing field. He points out that general practices get far more financial support than community pharmacies, which can be justifiable in some cases — but stresses that the two models cannot be compared directly. While GPs have their premises costs, such as rent and utilities, covered by the NHS, pharmacies must pay these overheads out of their own budgets.
Perhaps calling it ‘competition’ at all is part of the problem. It reduces a public health service to a turf war, missing the bigger picture. Vaccination — and healthcare more broadly — should be about convenience, accessibility and patient choice. It should not be about ‘winning’ patients. At a time when ‘vaccine fatigue’ is on the rise, all healthcare professionals have a duty to promote vaccination wherever it is provided to combat hesitancy and mistrust for the benefit of all.
If the budget for pharmacies and general practices were pooled — with both paid for activity and purchase — could this move us closer to truly integrated neighbourhood teams? There would be challenges, but the potential benefits of improved coordination and system efficiency could make it a plausible strategy for integrated neighbourhood teams. Nevertheless, it would require careful planning on a local level to come to fruition.
However it is achieved, it is clear that true collaboration between GPs and pharmacies is essential if we are to protect the entire population efficiently and fairly. PJ
