Finances and integration a challenge for pharmacies expanding clinical services

Community pharmacies in England are facing significant financial pressures and persistent integration challenges as they expand their clinical services, an independent evaluation commissioned by NHS England has found.

The review, carried out by Rand Europe, examined the delivery of care provided under the Community Pharmacy Contractual Framework (CPCF) five-year deal (2019-2024), which saw pharmacies expand their clinical offering with services such as contraception consultations, blood pressure checks, medication support for long-term conditions, influenza vaccinations, smoking cessation support and assistance with medications after hospital discharge.

Researchers consulted over 100 stakeholders across diverse areas of England, including community pharmacies, healthcare professionals, integrated care boards, primary care networks, local pharmaceutical committees and members of the public.

The report found that pharmacy staff remain highly motivated to deliver clinical services and are uniquely well-placed to support the shift of care into the community.

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Pharmacies are often well integrated into their local communities, with staff speaking the languages of local residents and building levels of trust not always observed with other healthcare professionals – factors that could be crucial for reaching diverse populations and improving health equity, the study found.

However, respondents in the pharmacy sector highlighted ‘extreme financial pressure’s – worsened by historic levels of inflation – with many pharmacy staff citing insufficient remuneration as a major barrier to sustainable service delivery.

The study also revealed physical and digital infrastructure issues, with community pharmacists lacking access to full medical records and many healthcare professionals working on incompatible IT systems.

Integration with other healthcare professionals remains a challenge, the report found, with complex referral pathways, competing incentives and limited awareness about the full range of pharmacy services available.

While convenience and existing relationships with pharmacy staff are key reasons patients access clinical services in community pharmacy, the evaluation found limited public awareness is still restricting wider uptake of expanded services.

The report concludes that, if properly supported, community pharmacies could play a pivotal role in supporting the NHS 10-year health plan for England, which aims to shift healthcare focus from hospitals to communities, from sickness to prevention, and from analogue to digital care.

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The evaluation recommends that future commissioning of clinical services must consider the current economic landscape and the evolving professional role of pharmacists if community pharmacy is to fulfil its potential as an accessible, trusted part of the NHS that can help build a health service fit for the future.

The report also notes that the introduction of Pharmacy First has made it more important than ever for community pharmacies to realise their potential in expanding access to clinical services.

Commenting on the findings, Malcolm Harrison, chief executive of the Company Chemists' Association, emphasised that pharmacy teams and patients alike welcomed the vision of an increasingly clinical future for community pharmacy.

However, he warned that future services must be based on ‘firm foundations’, with both NHS services and dispensing sustainably funded.

He said: ‘Significant progress has been made already and access to community pharmacy care through the NHS has been transformed.

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‘Over three 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 [but] the sector continues to need additional investment.

‘Additional funding will allow pharmacy businesses to invest further in their technology, workforce and premises.’