The NHS ten-year plan has missed the role of pharmacy professionals in community health services

The government’s ten-year plan for the NHS in England, published in July 2025, outlines three key shifts: from analogue to digital, from illness to prevention and from hospital to community^​1​.  

Official responses from pharmacy and healthcare organisations, including the Royal Pharmaceutical Society (RPS) and General Pharmaceutical Council, to the plan have been published; however, there is not enough emphasis placed on the vital role of pharmacy within community health services.  

Community health services support people from birth to the end of their lives. Services are mainly delivered in people’s homes, including care homes, but also in community hospitals, intermediate care facilities, clinics and schools by different types of organisations across the country, such as NHS trusts, community interest companies, social enterprises, local authorities and independent providers. Many patients being seen in their home are housebound and may only see a primary care clinician when they are acutely unwell during a home visit. They also may not see a pharmacy professional if they have their medicines delivered by a community pharmacy or have someone collect a prescription on their behalf. A lot of prescribing and administration of medicines occurs within community health services, where pharmacy professionals provide expertise on the safe use in these settings.

Prevention — one of the three shifts in the NHS ten-year plan — is central to the role of all pharmacy professionals. Prevention activities include but are not limited to preventing drug interactions, medication incidents, medication-associated falls and hospital admissions. A 2024 World Health Organization (WHO) systematic review of preventable medication-related harm highlighted that the highest prevalence rates were observed in older people units and the need to focus on prevention activities^​2​.  

Medicines are the biggest intervention in the NHS — £19.9bn was spent in England on medicines alone in 2023/2024^​3​. Therefore it is crucial to ensure that all medicines are optimised and that patients understand why they are taking them and how to take them effectively. Much of this is supported through shared decision-making but also through the investment of dedicated time and expertise from a pharmacy professional. 

Walking into a patient’s home is a privilege. By conducting medication reviews in this setting, pharmacy professionals can see exactly how patients take their medicines, identify issues with obtaining and storing medicines, as well as how they are being administered and address any patient concerns. Deprescribing and reducing the tablet burden in these patients is an important priority, as is empowering them to manage their medicines safely at home. With around 5–20% of hospital admissions and readmissions attributed to medication — and with almost half of these being preventable^​4​ — timely and effective interventions by pharmacy professionals reduce the risks of falls and hospital admissions owing to medication issues.

Complex medication regimens — along with environmental and logistical challenges while working in a home environment — mean that problem-solving skills are required to work in this sector. I have been involved in many multidisciplinary team discussions where pharmacy has enabled patients to be treated at home despite being on complex drug regimens or where the home environment (e.g. a hostel) was not a usual setting. I provided expert advice on how to obtain medicines, how to store them at home and how to administer — along with different options for administration — so that these patients could have their treatment in their preferred setting safely. This individualised care also involved consideration of legal and professional guidance of high-risk medicines. 

According to the results of a survey conducted by Marie Curie in 2024, nearly two-thirds (62%; n=730) of people spent their last three months of life at home, while just under one-quarter (23%; n=273) spent this time in a nursing or residential home^​5​. More than half (53%; n=629) of respondents reported that patients had contact with a district or community nurse in their last three months and one in three (31%; n=370) of people died in a private home^​4​. Caring for patients at the end of their life often requires complex medication regimens, while pharmacy professionals, embedded into the multidisciplinary community teams, provide expert advice to ensure medicines are prescribed, supplied and administered safely. However, palliative and end-of-life care is overlooked, given that it is only mentioned once within the NHS ten-year plan.

The RPS’s ‘Interim professional standards for hospital at home, including virtual wards, pharmacy services’, published in September 2023, states: “Hospital at home services require a trained pharmacy team with appropriate levels of staff available to deliver a safe and high-quality service by utilising the skill-mix of pharmacy team members, supervised by a senior pharmacy lead.^​6​

“Pharmacy professionals should be involved in patient reviews, multidisciplinary team meetings and board rounds,” the guidance adds.

These services provide acute-level care and patients are having complex medication interventions in their own home. This high level of acuity requires expert medicines input from pharmacy professionals. Medicines reconciliation should take place within 24 hours of admission in acute settings^​7​. While not acute settings, community hospitals and ‘hospital at home’ services should also aim to complete medicines reconciliation as soon as possible, as transferring from one setting to another is known to be high risk with respect to medicines. Pharmacy professionals working in community hospitals or rehabilitation units support medicines optimisation through medicines reconciliation and medicines review, as well as ensure safe discharge home or alternative places. Patients who are undergoing rehabilitation can stay in hospital longer than in an acute hospital, which is a fantastic opportunity to complete a full medication review by a pharmacy professional and discuss with the patient how they take their medication and whether any changes could be made. Many patients in rehabilitation units have had falls or fractures and polypharmacy reviews are crucial to prevent further events.

The NHS ten-year plan provides significant opportunities for the healthcare system but needs to be adequately resourced with the right healthcare professionals in the right services. Community pharmacies are specifically mentioned and must be included in all neighbourhood team discussions; however, more pharmacy professionals should be embedded within multidisciplinary teams in community health services to provide the clinical expertise in medicines needed by patients in their home as part of an improved community-based service model. There is complexity for anyone working in the home environment and pharmacy professionals are required to support the safe and effective use of medicines by completing risk assessments and providing advice to all professionals working in this sector. Pharmacy leadership is also required in both commissioning and provider services to ensure that these important roles are included in future workforce models. It is, therefore, essential that pharmacy roles within community health services are listed within the government’s workforce plan, which is due to be published in 2026. 

This article is brought to you as part of a collaboration with the UK Clinical Pharmacy Association (UKCPA).

The views expressed in this article are those of the author and are not attributed to any organisation.

The UKCPA is a member association for clinical pharmacy practitioners that encourages, supports and promotes advanced practice in pharmacy. 

To discover expert-led training, resources for clinical pharmacy practice and access ongoing support from our community of practicing clinical experts visit the UKCPA website or contact via email.