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The National Cancer Plan for England identifies roles for community pharmacy in delivering world class cancer, but exactly what avenues will this open up for pharmacy, and for patients? By Saša Janković

Community pharmacies are set to play an “expanded role” in cancer diagnosis, according to the Government’s new National Cancer Plan for England, which includes offering “first-line tests” for possible cancer symptoms to enable patients to access early test appointments. 

The plan sets a target of 75 per cent of patients diagnosed from 2035 to be cancer-free or living well after five years – an increase from the current level of 60 per cent – alongside offering an individual cancer plan and a personal needs assessment to every patient.

Detailing his own experience of recovering from kidney cancer, Secretary of State for Health Wes Streeting says in the introduction to the Plan that it sets out “how we will fight cancer on all fronts so that more people become cancer-free like me and fewer people get cancer in the first place”. 

Streeting adds: “The NHS will continue to partner with manufacturers and retailers to increase knowledge of the signs and symptoms of cancer and encourage people to get checked. 

“The British Oncology Pharmacy Association’s Let’s Communicate Cancer programme will continue to help community pharmacists to identify people with concerning signs – such as being regular buyers of cough medicines or indigestion relief – and signpost them for checks.”

Action plans for pharmacy

In fact, the Plan contains three specific 'Actions' that relate to pharmacy, including:

Action 11: Work with community pharmacy to partner on new heartburn tests - using the capsule sponge: a simple, non-endoscopic test for early oesophageal cancer and the pre-cancerous condition, Barrett’s Oesophagus. 

Cancer of the oesophagus is more common in older people, and men are more likely to have the cancer compared to women. Smoking, drinking alcohol and obesity are all factors that increase risk of the disease.

Of almost 10,000 patients diagnosed with oesophageal cancer in the UK each year, 80 per cent of patients are diagnosed at a late stage, where only 20 per cent of patients survive the year, according to data from NHS England. 

Currently used in hospitals and Community Diagnostic Centres to help reduce the need for invasive endoscopies and free up appointments for those at high risk of cancer, the test involves patients swallowing a small pill on a thread, which expands into a penny-sized sponge when it reaches the stomach. After a few minutes, it is safely pulled out to collect cells from the lining of the oesophagus, which are tested for pre-cancerous changes in the lab.

Pharmacists can spot patients who are regularly using over-the-counter medications to ease their heartburn or reflux symptoms but haven’t come forward to their GP, with participating pharmacies able to refer patients who meet certain criteria directly into secondary care for further investigation.

Action 27: Partner with the pharmaceutical industry and digital weight loss providers to accelerate the uptake of GLP-1 medicines.

Overweight and obesity is the biggest cause of cancer in the UK after smoking, according to Cancer Research UK, which is funding research at Bristol Medical School comparing different weight-loss methods such as reducing calories, gastric bypass surgery and GLP-1 weight loss injections to see if the different methods affect exactly how fat is lost and how this impacts cancer risk.

However, “it’s actually not been explicitly proven that [GLP-1] drugs reduce cancer risk”, says Richard Martin, Professor of Clinical Epidemiology at Bristol Medical School explains, adding: “It’s assumed because of the extent of weight loss many people experience using these drugs [but] we don’t know the exact mechanism by which these drugs would reverse someone’s cancer risk.

“It’s important to have a biological understanding of what you’re doing to someone in order to reduce their risk, but also to potentially help guide us to develop new and better targeted weight loss tools, especially when it comes to cancer prevention.”

The third action point involves targeting young people who missed out on the HPV vaccination at school to have it administered at their local pharmacy. 

Action 29: Public health, school immunisation teams, primary care and Cancer Alliances will collaborate on tailored campaigns to increase take-up of the HPV vaccine among boys and girls, particularly in underserved populations. 

From 2026, they will promote new schemes to enable young people who missed out on the HPV vaccination at school to have it administered at their local pharmacy. 

Opportunities for pharmacy, and for patients

NPA chief executive Henry Gregg welcomed the mentions of community pharmacy in the plan, saying the sector is a “massive untapped resource” to help detect serious illnesses such as cancer early on, “which we know greatly improves survival rates for many cancers”.

Nick Thayer, head of policy at the Company Chemists’ Association (CCA), also praised the expanded role for pharmacies: “Pharmacies already deliver many NHS vaccines, so commissioning them to provide HPV catch-up vaccinations will make access easier for young people who missed vaccination at school and support the goal of eliminating cervical cancer by 2040.

“Community pharmacy is also well placed provide wraparound support for people using GLP-1 medicines safely, including advice, monitoring and signposting where appropriate. The combination of online services and pharmacies in communities across the country offers the ideal route to accelerate uptake of GLP-1 medicines.”

However, he warns: “With core-funding for pharmacies already increasingly stretched, any additional services must come with sustainable funding to ensure they can be delivered consistently and effectively.”

BOPA involvement

The British Oncology Pharmacy Association (BOPA) is also keen that the Plan explicitly recognises the role of pharmacy and says it “strongly supports this ambition”. 

However, it emphasises that “success will rely on the leadership, expertise and professionalism of cancer pharmacy professionals, who are essential to delivering safe, effective and personalised cancer care across the UK.”

To deliver the ambition of the National Cancer Plan, BOPA is urging the government and NHS England to:

• Fully integrate cancer pharmacy professionals into national workforce planning, recognising their vital role in systemic anticancer therapy, diagnosis, personalised medicine, genomics and advancing pharmacy practice
• Support national standardisation across Systemic anti-cancer therapy (SACT) protocols, prescribing competencies and capacity planning tools.
• Invest in pharmacy education, genomic literacy, pharmacy research and credentialling practice frameworks to ensure the workforce is equipped for increasingly complex care.

Johnny Ashton-Barnett and Conor Corbett – co-chairs of BOPA’s Community & Primary Care Pharmacy (CPCP) Subcommittee – are confident that the Plan will open up a range of opportunities for community pharmacy.

“The National Cancer Plan recognises something the pharmacy profession has long understood: community pharmacy is an essential front door to the NHS, particularly for people who may not otherwise engage with healthcare services”, they say, “and the actions outlined in the Plan create meaningful opportunities for pharmacy teams to play a more proactive role in cancer prevention, early detection, and risk reduction.”

The continued support for BOPA’s Let’s Communicate Cancer programme is especially welcome, with Ashton-Barnett saying it “reinforces the value of upskilling the entire pharmacy workforce so they feel confident identifying red‑flag symptoms, having sensitive conversations, and signposting effectively. This is already happening at scale, and the Plan gives it further legitimacy and momentum.” 

Corbett says the proposed introduction of capsule sponge testing in community pharmacy is also significant step. 

“If implemented well, it could expand access to early oesophageal cancer detection, particularly for people who may not seek help through traditional routes”, he says, “and, similarly, pharmacy involvement in HPV catch‑up vaccination and the wider use of GLP‑1 medicines for weight management positions pharmacy is a key partner in cancer prevention strategies.”

When it comes to benefits for patients, Ashton-Barnett and Corbett say they are substantial: “Community pharmacies are accessible, trusted, and embedded in local communities, so earlier conversations about symptoms, easier access to testing, and more opportunities for preventative interventions all contribute to earlier diagnosis and improved outcomes. 

“For underserved populations in particular, community pharmacy involvement can help close gaps in engagement and health equality.”

And while acknowledging that the Plan represents “real progress” they believe further action is still needed, saying: “The actions relating to pharmacy are promising, yet remain relatively narrow in scope”.  

To fully realise the potential of the sector, Ashton-Barnett and Corbett say they would like to see:

• Clear implementation frameworks for how these initiatives will be delivered, funded, and supported in practice
• Investment in workforce development, ensuring pharmacy teams have protected time and resources to build the skills required
• Integration with primary care and Cancer Alliances, so pharmacy activity is not siloed but forms part of a coherent early‑diagnosis pathway at national level
• Expansion of structured referral mechanisms, enabling pharmacists to refer directly into appropriate diagnostic services where clinically appropriate
• Ongoing evaluation, so we can understand what works, where the impact is greatest, and how to scale successful models.

“Community pharmacy has enormous untapped potential in cancer care”, they add, “and the plan acknowledges this, but the next phase must focus on operationalising these ambitions and ensuring pharmacies are equipped and empowered to deliver them.”