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The Company Chemists’ Association claims a pharmacy diabetes screening service could save the NHS £50m. How would such a service work in practice, and are pharmacies geared up to provide it? By Saša Janković

Type 2 diabetes (T2D) is one of the most common chronic diseases in the UK and its prevalence is on the rise. Already, more than four million people have been diagnosed with the condition and another two million are considered at high risk of developing it. 

In addition to lifelong disease, diabetes also impacts a person’s whole health leading to stress, anxiety, and depression. Around 30 per cent of people with T2D have cardiovascular disease, increasing their risk of suffering heart attacks and strokes, one in three adults with diabetes will suffer with kidney disease, and people with diabetes are 25 times more likely than the general population to become blind. 

In September 2024 the Company Chemists’ Association (CCA) called for a pharmacy diabetes screening service along the lines of the hypertension case-finding initiative, which it claimed could save the NHS £50m a year by catching people with diabetes before serious complications develop. 

CCA data shows that each T2D patient costs the NHS an estimated £3,000 per year through direct costs alone, while avoidable complications from the disease cost the NHS over £6.2bn a year – which it says could be saved with better treatment and prevention.

Screening in pharmacy

The CCA report says a T2D screening service would create a clear national patient pathway for diabetes detection and prevention. CCA modelling shows this could screen 1.5m adults and identify 180,000 prediabetics and 45,000 undiagnosed diabetics, preventing almost 7,000 heart attacks and strokes and stopping nearly 15,000 people developing severe-sight loss over the course of their lifetime.

So how would a community pharmacy diabetes screening service work in practice? Professor Claire Anderson, president of the Royal Pharmaceutical Society, believes it could follow the model of the previously mentioned NHS hypertension case-finding service.

“It could identify at-risk patients by carrying out blood tests and referring those with high results to their GP for further checks and treatment,” she says.

Nick Thayer, CCA head of policy, says using this kind of model would mean the service would be familiar to patients and pharmacy teams and therefore quickly scalable.

“Patients could come to pharmacies and complete a questionnaire and a finger prick blood test, and depending on their results, a pharmacist could either give advice, support them with lifestyle change underpinned by continued point of care testing (PoCT), or refer them to their GP – and in the future, we would expect any initiation of treatment to begin via a prescribing pharmacist,” he says. 

One example of a PoCT is a service led by BHR Biosynex using its MoRem (Motivating Remission) behavioural support process, which enables pharmacies to combine levels of glucose to hemoglobin (HbA1c) measurements with lifestyle coaching, plus the necessary support to enable behavioural changes that potentially reverse the condition.

According to the CCA report, results from initial small-scale trials using MoRem and glucose testing showed a reduction in patients’ Hb1Ac readings, with an average reduction of 12 per cent (6mmol/mol) over three months. 

Similarly, 96 per cent of patients recorded a reduction in their waist measurements, with an average of a five centimetre reduction over three months, following three-months of pharmacy-led support as a private service.

GLP-1 receptor agonist shortages 

Another tool in the diabetes treatment arsenal are GLP-1 receptor agonists such as semaglutide (aka Wegovy/Ozempic) and others.

These have become better known in recent months due to a surge in off-label prescriptions of semaglutide as part of private weight loss services – causing nationwide shortages of the injectable medicines and creating supply issues for prescribers managing blood glucose levels in T2D patients.

According to data from charity Diabetes UK, stocks were resupplied at the end of December 2024 and the issue has now been reported as resolved, but Graham Phillips – director and superintendent pharmacist of iHeart Pharmacy Group, and founder of the ProLongevity diabetes reversal service – warns: “We can’t Wegovy our way out of the diabesity crisis.”

As a trustee of the Public Health Collaboration (PHC, PHCuk.org) – a charity dedicated to helping people achieve sustainable lifestyle changes – Phillips says: “The MHRA has linked Wegovy injections to 10 deaths and is now closely monitoring adverse effects, urging caution around the drug’s use.

"That’s why PHC advocates for addressing the underlying causes of diabesity [diabetes and obesity] rather than merely supressing the symptoms with drugs. 

“The challenge lies in balancing modern life with healthy choices. Wegovy might help temporarily, but clinical trials show that weight tends to return if underlying habits aren’t changed. Without a shift in lifestyle, the results are fleeting at best.”

The challenge of cost

While pharmacies may well be geared up to provide these services, the cost of providing – and patients accessing – screening creates challenges. 

From a patient point of view, deprivation is known to correlate to disease prevalence, yet many of the people who would benefit from screening are unable to due to the barrier of cost. This is why a publicly funded solution is urgently needed.

From community pharmacy’s perspective, Thayer stresses that if pharmacies are commissioned to administer more services, additional funding would be imperative.

And Anderson says the NHS “should also ensure pharmacies have the time and resources to integrate screening into their daily practice effectively”.

Satyan Kotecha is a pharmacist working in general practice in Leicester, running diabetes clinics two days a week, as well as holding multiple roles including vice chair of Community Pharmacy(CP) Leicestershire, as a member of CP Arden, and a clinical champion with Diabetes UK. 

He says a key element of any screening service is ensuring accessible and practical testing methods, and advocates the use of point-of-care HbA1c testing in pharmacies. “Yes, point-of-care HbA1c tests are more expensive,” he acknowledges.

“But they allow pharmacists to identify at-risk patients immediately and refer them appropriately, rather than relying on traditional venous blood samples, which create unnecessary barriers. This isn’t about pharmacists making more money; it’s about buying time to deliver high-quality care.”

A team-based approach

Nick Kaye, National Pharmacy Association chair, agrees that pharmacies could easily provide HbA1c testing. “The team-based approach within pharmacies works well for screening, with technicians and dispensers carrying out blood tests, and pharmacists interpreting the results, offering advice, and referring patients to GPs if needed,” he says.

A public health outreach programme in Cornwall where community pharmacists have been sent to engage with groups who often don’t engage with traditional NHS services – such as fishermen, farmers and Romany gypsies – has demonstrated success in such a service.

“In these outreach efforts pharmacists inform people about existing community pharmacy services while also carrying out on-the-spot blood pressure and HbA1c testing,” he says. 

“The response has been overwhelmingly positive, demonstrating that pharmacists can bridge gaps in care for underserved groups, and that community pharmacies can reach people who might never attend a hospital-led screening clinic.”

GP collaboration

If a diabetes screening service was to be rolled out in community pharmacy, Anderson says a strong collaboration with GPs would be essential to ensure smooth referrals and follow-ups. “Seamless data sharing and clear referral criteria are also necessary for success,” she maintains.

In addition, Kaye suggests: “Diabetes screening would be a natural extension of Pharmacy First, reducing pressure on GPs and ensuring early intervention before costly complications arise.”

And while some GPs were initially resistant to Pharmacy First, Kotecha believes diabetes care is different. “I already work closely with my local community pharmacists,” he says.

”For example, when I prescribe diabetes medications I tell patients ‘expect your community pharmacist to provide the New Medicine Service to reinforce what I’ve told you and follow up in a couple of weeks’, which helps patients understand the pharmacist’s role, and ensures they receive consistent education and support.”

Further pharmacy advice

Phillips says that many patients with T2D are not routinely monitoring their blood glucose levels, often due to outdated healthcare advice or lack of access to testing equipment, and believes pharmacies can bridge this gap by encouraging self-monitoring, helping patients interpret their readings, and providing access to the latest monitoring technology such as continuous glucose monitors.

Beyond medication, Phillips is a keen advocate for lifestyle intervention as the primary method of managing type 2 diabetes. “Pharmacists should be trained to offer meaningful dietary and lifestyle guidance, rather than just focusing on dispensing medication”, he says.

“We should also be recognised as key players in managing and preventing diabetes complications, ensuring patients receive continuous, personalised support rather than just medication.”