The government’s ten-year-plan for the future of the NHS in England, subtitled ‘Fit for the future’, has promised three “radical” shifts in how the NHS will work.
It said new technology will be used to cut administrative work for healthcare staff and give patients greater access to their care data; the health service would work to move the emphasis from sickness to prevention; and there will be a shift of care from hospital to community.
The latter of these three aims will mean “more care will be available on people’s doorsteps and in their homes”, the plan says.
As part of this move to bring care closer to patients, the government has promised the creation of neighbourhood health teams. And which type of provider sits in those neighbourhoods? Community pharmacies.
More than 80% of England’s population live within a 20-minute walk of their nearest community pharmacy, and the government says that pharmacy will have a “vital role” in the new neighbourhood health service.
Detail on the proposal is scarce and, at this early stage, it is difficult to tell how pharmacists will be integrated with the service, but Janet Morrison, chief executive of Community Pharmacy England, is optimistic about their involvement in both developing the neighbourhood health teams and achieving the government’s aims.
“Pharmacies adapt well to change — just look at their efforts during the pandemic and in getting Pharmacy First up and running — and many are already taking innovative approaches to healthcare provision,” she says.
There’s no clear strategy to prevent a drain from community pharmacies into these new centres, which could destabilise existing services
Jay Badenhorst, director of pharmacy at the Pharmacists’ Defence Association
“These neighbourhood health services should be harnessing the valuable skills and expertise of community pharmacy professionals, as well as making the most of our sector’s network of accessible locations.”
Jay Badenhorst, director of pharmacy at the Pharmacists’ Defence Association, is slightly less positive about the idea. Referring to the reported plan for 250–300 multidisciplinary neighbourhood health centres by 2035, bearing in mind the pharmacy workforce crisis, he asks: “Where will the pharmacists come from?”
“There’s no clear strategy to prevent a drain from community pharmacies into these new centres, which could destabilise existing services and contribute to workforce pressures.”
Badenhorst also notes that there is a risk of pharmacists being “subsumed under medical hierarchies” in these centres, limiting their abilities. He says they should be involved in the design of the plan, rather than being left to “pick up the pieces”.
So what could pharmacy’s involvement in neighbourhood healthcare look like in practice, and what is needed for this planned shift from hospital to the community?
Clinical services to address the chronic disease burden
As part of the ten-year plan, the government says that it will transition community pharmacy over the next five years from “being focused largely on dispensing medicines to becoming integral to the neighbourhood health service, offering more clinical services”.
As pharmacists will increasingly be able to independently prescribe — the first cohort of pharmacy students are due to qualify as independent prescribers in 2026 — the plan highlights that pharmacists will take on an increased role “in the management of long-term conditions, complex medication regimes, and treatment of obesity, high blood pressure and high cholesterol”.
Danny Bartlett, a primary care pharmacist, says this should have always been the case. “Community pharmacists treating UTIs and coughs and colds — I don’t think that’s the best use of their skills.
“It’s very transactional, whereas now we’ve got such a big prevention and chronic disease burden. Imagine if … instead of Pharmacy First for UTIs, it was Pharmacy First for blood pressure, diabetes and asthma reviews.”
In the ten-year plan, the government references Canada’s pharmacy care clinics, which provide services for chronic disease management, as a model England can learn from.
For example, the clinics provide full diabetes care, from carrying out blood glucose tests and cholesterol checks, to medication reviews and diabetes care consultations.
Raj Matharu, chief executive of Community Pharmacy South East London, says he thinks the additional offering from pharmacies in England could be diagnostic services.
“Phlebotomy is one that a number of pharmacies do for private phlebotomy services that could easily be converted, or you could use the flu model,” he says.
He explains that, when the community pharmacy flu vaccination service was trialled in London in 2015, it was adapted from private providers’ patient group directions (PGDs).
“We said … ‘why don’t we do a service level agreement that says, if you’ve got a provider PGD, that’s good enough for us — provide it’. That’s gone from strength to strength and now it’s a national service, so that can be replicated.”
The community pharmacy flu vaccination service launched in 2015, with pharmacies having administered more than 4 million flu vaccines in the 2024/2025 winter flu season.
On 24 July 2025, Community Pharmacy England (CPE) announced that community pharmacies in England will be able to provide flu vaccinations to children aged two to three years from 1 October 2025, as part of a trial commissioned for the 2025/2026 winter season.
I think community pharmacy will run better if they do less services better, as opposed to more services diluted
Danny Bartlett, primary care pharmacist
Alastair Buxton, director of NHS services at CPE, said at the time: “We are confident that pharmacy teams will be able to increase vaccination rates by providing a convenient and accessible service to parents and their eligible children.”
Bartlett argues against pharmacies offering more services and says they should instead concentrate on improving what they already do well.
“I think community pharmacy will run better if they do less services better, as opposed to more services diluted,” he says.
He argues that rather than offering ad hoc services for acute conditions, such as Pharmacy First or minor ailment services, it would make more sense to channel energy into preventative services for conditions, such as hypertension, “where you’re not waiting for people to come through the door with a UTI or opportunistic referral from the GP surgery that might be inappropriate”.
Community pharmacy should be marketed where these needs are, “rather than trying to shoehorn acute need when you’ve got people like paramedics and advanced clinical practitioners that can help with that acute burden”, he adds.
“It’s the chronic burden that we need so much more help with.”
However, Bartlett acknowledges that pharmacies may be providing lots of services, “because the funding is not there”.
Funding reforms needed
It is evident that if pharmacies are to transition towards more preventative work, there must be improved funding.
“The vast amount of our income is from dispensing and if they want us to shift to clinical services, I need to see that bridge from supply to clinical and that support they provide us. I don’t see any meaningful frameworks coming forward with transitional funds to help us to do that,” Matharu says.
He points out that only 43% of pharmacies in South East London are meeting the Pharmacy First targets for payment for each of the seven clinical conditions. “That’s a lot of money that we’re losing.”
In April 2025, an estimated 182 pharmacies in the region fell short of the threshold, equating to £182,000 in missed payments.
“I would love to drop the way that we have to always get referrals from other providers into community pharmacy, because that simply just doesn’t work. The fact that we’ve got a universal target of 20 or 30 Pharmacy First consultations, irrespective of how many prescriptions you do or where you’re based — I’d like to drop that if I could,” he says.
There is no mention of pharmacy funding in the ten-year plan, just as there was no mention of it in the government’s spending review for 2025. However, a spokesperson from the Department of Health and Social Care told The Pharmaceutical Journal in June 2025 that pharmacies remain a “priority” as it rebuilds the health service.
In response to the spending review, a joint statement published on 16 June 2025 by several primary care bodies, including CPE, said there was “little capacity to deliver the reforms needed, and improve the care people receive closer to home, without further investment in primary care”.
Speaking in Parliament on 17 June 2025, health minister Stephen Kinnock told MPs he was “working on” reforms to Pharmacy First to “get the allocation of funding right” for the service.
How do I make sure that there are sufficient community pharmacists in leadership positions at all levels?
Raj Matharu, chief executive of Community Pharmacy South East London
Bartlett says funding for the neighbourhood health service should be based on performance and priorities. He gives an example of a neighbourhood team that sees a lot of patients with frailty. “Their key performance indicators should be: we want to deprescribe medication; we want to prevent the amount of falls or reduce them; and we want to reduce the amount of hospital admissions.
“I think the funding model has to fit with what [neighbourhood teams are] wanting to achieve, but also make sure they achieve it,” he adds.
Pharmacy leadership
Matharu points out the need for funding for pharmacy leadership in the neighbourhood health service. “How do I make sure that there are sufficient community pharmacists in leadership positions at all levels? That’s the challenge for me, and I haven’t seen that addressed anywhere within the NHS ten-year plan.”
He says neighbourhood leadership has already been attempted with South East London Integrated Care System’s (ICS’s) community pharmacy neighbourhood leads programme.
Developed in 2023, the programme supports community pharmacists to become neighbourhood leads for their respective localities. It followed a pilot in Lambeth, south London, which led to a 300% increase in referral activity for the community pharmacy consultation service, which pre-dated Pharmacy First, and which the ICS says freed up appointments at GP surgeries — something that aligns with the ten-year plan.
Matharu says that Community Pharmacy South East London plans to recruit local pharmaceutical committee (LPC) staff to become the community pharmacy neighbourhood leads.
“We’ll start off with a small number and see how that develops as they make those interventions at a neighbourhood level,” he adds.
Bartlett says it’s “essential” that pharmacists practising at an advanced level step into neighbourhood leadership roles.
“My ultimate dream is that there would be a consultant pharmacist post that sits maybe in each integrated neighbourhood team (INT) or maybe across a couple of INTS, because then they’re going to be that fountain of all knowledge in primary care that can help disseminate the services and also help lift up those other junior pharmacists as well.”
Matharu also notes that pharmacy leadership will encourage relationships between different care sectors. “Let’s get some community pharmacies in these positions of leadership and I can start developing those relationships, breaking down some of the barriers, because that’s when they will start to build trust and confidence with secondary care and general practice.
“Once that happens, hopefully it would be an era of collaboration.”
Developing the plan
Morrison says that CPE is “keen to work closely with the Department [of Health and Social Care] to ensure that community pharmacies are enabled and have the capacity to fully contribute to neighbourhood health services as they develop”.
“We are supporting LPCs to work with the NHS and local authorities, making sure they are aware of the value of pharmacy teams whilst also being mindful of the need for investment. With the right support, pharmacies can develop new ways of working across primary care and provide an even wider range of clinical services that benefit patients, communities and the NHS,” she adds.
There is huge potential for pharmacists to be an integral part of the neighbourhood health service; however, as Morrison’s comments highlight, clarity is needed on how their involvement will be funded, as well as the need for pharmacists to feel empowered to take on leadership roles to help shape the service.