Three core values of community pharmacy are fundamental to a healthy future 

NHS England’s consultation on ‘Improving health and patient care through community pharmacy’ in December 2013 gave every indication it would reform the community pharmacy contract along more clinical lines. 

The discussion document published at the time described a future for community pharmacy, in which it would provide “a range of clinical and public health services that will deliver improved health and consistently high quality” and play “a stronger role in the management of long-term conditions”​[1]​.

The associated consultation document included a series of patient stories provided by the Royal Pharmaceutical Society (RPS), illustrating how community pharmacists were unsung heroes, busily preventing hospitalisations​[2]​.

The profession engaged eagerly with the consultation, which NHS England said received a “hugely positive response”​[3]​.

However, before any of the consultation’s recommendations were enacted, the NHS appeared to make a U-turn on its views. In January 2016, former pharmacy minister Alistair Burt informed the all-party pharmacy group that an NHS-imposed cut to community pharmacy funding could force up to 3,000 local pharmacies to close​[4]​. 

Since then, pharmacy funding has been frozen at £2.59bn, amounting to a cumulative loss of £790m over the past five years, allowing for the effects of inflation​[5]​. It is a small wonder that the entire community pharmacy sector is on the verge of collapse today.

Fast forward to 2024 and we have a new NHS chief executive office and chief pharmaceutical officer for England, whose rhetoric is now warmer towards community pharmacy. 

But questions still remain around whether community pharmacy is viewed as an expendable cost to the NHS or as an invaluable service to patients and the public, which merits support and investment.

Effects of COVID-19

The COVID-19 pandemic has thrown the NHS into the depths of a crisis. In 2024, waiting lists for routine hospital treatment are projected to reach unprecedented levels of 8 million people​[6]​.

Yet a modest investment by the NHS in community pharmacy could provide a huge return, providing  both increased capacity and additional capability to NHS services. A report published by the Company Chemists’ Association (CCA) in February 2023 estimated that community pharmacies could release more than 42 million appointments from general practice and reduce hospital re-admissions by 65,000 annually​[7]​.

Taking these data into account, the financial case for investment is compelling, which begs the question — what will it take for the NHS to see community pharmacy as an investable solution and allocate more funding from the NHS’s £168.8bn budget​[8]​?

Community pharmacy has three central values — clinical services, social capital and public health — which provide a unique offer to the NHS, but these have not been effectively conveyed or thoroughly considered by commissioners.

Clinical services

In recent years, pharmacists have taken on increasingly clinical roles. From the launch of the NHS Urgent Medicine Supply Advanced Service in 2019 to the NHS Pharmacy First service, which launched at the end of January 2024, pharmacists have been remunerated for the provision of medicines to patients, in addition to our growing dispensing responsibilities​[9]​. The current iteration of the community pharmacy contract is full of perverse incentives leading us to compete against one another for ever more prescriptions.

While procurement, dispensing and safe supply will always be a core aspect of pharmacy’s role, we should be incentivised for deprescribing over dispensing and de-couple the community pharmacy budgeting process from the NHS drugs budget. 

The NHS acknowledges that overprescribing is widespread, systemic and cultural in origin, amounting to at least 10% of primary care prescribing. The number of prescriptions per head of population doubled from 10 per head in 1996 to 20 in 2016, and adverse drug reactions are responsible for as many as 20% of hospitalisations​[10]​.

Instead of moving pharmacy services in a direction that supports endeavours to deprescribe, medicines use reviews were decommissioned in 2021 while the new medicine service was retained. This could be rectified by enabling community pharmacists to conduct structured medication reviews, which are currently only taking place in general practice.  

Social capital

Community pharmacy has a significant part to play in the reduction of health inequalities and endeavours to increase in the number of healthy years of life.

Timely access to healthcare is crucially important. It is impossible to pick up a newspaper without seeing a headline reporting the difficulty many people face in accessing their GP, especially if a face-to-face appointment is desired​[11]​. Spend a day behind my pharmacy counter and you will be shocked by the frustration my patients experience. To counter this, community pharmacists should be empowered to fast-track patients into appropriate parts of the health and care system based on red flags and in cooperation with local integrated care systems.

Significantly too, community pharmacies defy the inverse care law, which was suggested by Julian Tudor Hart in a paper for The Lancet in 1971 to describe an inverse relationship between the need for healthcare and its actual utilisation​[12]​. In other words, those who most need medical care in areas of high deprivation are least likely to receive it. Conversely, those with least need of healthcare in areas of low deprivation tend to use health services more and more effectively.

Community pharmacies, however, are well-distributed in the so-called “under-doctored” areas of high deprivation​[13]​. The potential for pharmacy services here is obvious, particularly around referrals to social prescribing services. 

Having tried and failed to engage with the local social prescribing team, which refuses to work with non-GPs, it is clear that social prescribing services should be introduced into our national contract as a logical extension of Healthy Living Pharmacy​[14,15]​.

Public health

The most significant of community pharmacy’s three values is its contribution to public health concerns. 

Pharmacies have already demonstrated their value in this area through the NHS Community Pharmacy Smoking Cessation Service, which launched in March 2022. Smoking is one of the biggest avoidable causes of disease and premature death in the UK putting a considerable strain on NHS resources​[16]​. In 2015/2016, there were 474,000 hospital admissions and 79,000 deaths caused by smoking, which cost the NHS £2.5bn​[17]​. According to the latest NHS statistics, 41% of patients who set a quit date in their pharmacy, successfully stopped smoking following treatment​[18]​.

However, there is more that pharmacies can be commissioned to do to support public health aims.

The government said in January 2023 that since 1993 the proportion of adults in England who are overweight or obese has risen from 52.9% to 64.3%, and the proportion who are obese has risen from 14.9% to 28.0%​[19]​.

The prevalence of obesity or being overweight is particularly prevalent in the most deprived areas in England, where the proportion is 14 percentage points higher than in the least deprived areas. A report by the National Institute for Health and Care Excellence published in February 2023 noted that “price and affordability of food is a key component in the inequalities seen”​[20]​.

This leads to an increase in heart disease and diabetes among these populations, adding further strain on the NHS. While community pharmacies have taken on responsibility for aiding the identification of patients with heart disease, if patients were encouraged and supported to eat healthier, they would use fewer NHS resources. 

There are already resources available to support community pharmacists, including a Centre for Pharmacy Postgraduate Education resource on ‘Nutrition, medicines and myths: evolution of pharmacy practice’​[21]​. This could also be part of an extension of the Healthy Living Pharmacy portfolio of services, with payment made per intervention.  

The availability of healthy food should not be limited to those who can afford it. As a trustee of the Public Health Collaboration, a UK-based charity dedicated to improving the nation’s metabolic health, we provide a fantastic free resource for patients and the public promoting “real food on a budget”​[22]​. 

By investing in community pharmacy and making the most of what the sector has to offer under these three value areas, commissioners and the NHS could create a real paradigm shift towards healthy living for all patients in the future.

Graham Phillips, director and superintendent pharmacist, Manor Pharmacy Group