There’s a polite fiction at the heart of community pharmacy policy; that we can keep asking more of the sector while paying, structurally, for something smaller.
That fiction is now unravelling.
The three issues facing community pharmacy in England aren’t complicated, they’re just uncomfortable. I faced the same a few years back when I was the Minister.
First, the money doesn’t match the mission. We can argue about the precise real-terms decline, but the direction of travel is obvious to anyone who runs community pharmacy.
Costs have surged; funding has not kept pace. Ministers point to a £3bn envelope; contractors point to balance sheets that no longer balance. The result is a slow attrition of the network, shorter hours, fewer staff, quiet (and occasionally not so quiet) closures.
Read more: ‘Deeply troubling’: Council reveals effect of pharmacy closures
Not dramatic enough to dominate a news cycle, especially one that has seemingly given up any domestic stories, but cumulatively corrosive.
Second, we are running the system hot - and pretending that’s efficiency. Community pharmacy has become the NHS’s overflow valve; managing medicines shortages, picking up minor illness, steadying patients who can’t get a GP appointment.
Let’s be clear, this is precisely the direction of travel we want. But you cannot run a front door service permanently at full tilt without consequences.
Workforce strain, falling morale, and rising patient frustration are not side effects - they are signals. Ministers speak of this very same dynamic elsewhere in the NHS workforce but seek to tolerate it among community pharmacists.
Read more: NPA calls for ‘emergency’ £52m payment for pharmacies
Third, we still haven’t decided what pharmacy is for. Every strategy document (and I was guilty of this too) gestures toward a more clinical future - prevention, case-finding, long-term condition support. Yet the contract remains rooted in dispensing volume. We are, in effect, paying for yesterday while asking for tomorrow. That is not reform; it is wishful thinking.
Which brings us to the current negotiations with Community Pharmacy England.
Talks are ongoing (with the usual and understandable - yet hobbling - lack of real time commentary) and, of course, have slipped beyond the start of the financial year. Plus ça change!
That is never a good sign in my experience. Publicly, the sector is asking for sustainability and a credible long-term deal; the government is signalling fiscal constraint and incremental reform. Neither position is surprising. But the gap between them is potentially lethal.
Read more: Nearly 8% of brick-and-mortar pharmacies closed in five years
And for me, here lies the political choice.
If pharmacy is a marginal cost centre, then we will continue with short-term fixes: a tweak to margin here, a service add-on there, and a gradual thinning of the network that we only notice when access finally gives way.
If, however, pharmacy is a core part of the NHS front door (I believe it’s now called ‘Neighbourhood Health’), then the contract must say so - clearly and unambiguously. That means multi-year certainty, a decisive shift toward funding clinical activity, and honest recognition of the costs required to deliver it.
When I was a minister, we talked often about “unlocking” the potential of community pharmacy. The truth is that the door is already unlocked and has been ajar for years.
Read more: Wes Streeting: ‘Sunak says he wants to put pharmacies first, but he’s left the sector to rot’
The sector has stepped up - again and again. The question now is whether government is prepared to follow through.
Wes Streeting while he remains Secretary of State (and change could be coming) has to back up the fact he said the NHS was ‘broken’ with radical change alongside thoughtful ten year plans.
Right now he’s perhaps the physician who tells the patient they’ve had a heart attack and prescribes paracetamol.
It’s very simple; if we don’t align the contract with the rhetoric this time, we won’t just miss an opportunity. We will lose capacity we cannot easily rebuild and with it, one of the most accessible parts of the NHS valued by patient as one they can truly rely on.
Steve Brine is a consultant, podcaster, trustee and former MP for Winchester & Chair of the Health Select Committee