• Electronic prescribing leads to a proliferation of online players grabbing market share and becoming the dominant pharmacy players. Online pharmacies useautomated prescription factories to drive efficiency. Patients who got used to using remote technology during the pandemic for services never come back
• More palliative care at home leads to more medicines bypassing pharmacy as pharma goes direct to patients
• The recession leads to a squeeze in NHS funding and further cuts in pharmacy remuneration. The resulting market consolidation reduces the number of independent pharmacies, a problem exacerbated by the enforced closure of small pharmacies by the Government. Pharmacy goodwill values collapse
• Government drives a free market in enhanced services. Professional ‘services only’ companies grow, taking business from traditional pharmacies
• National and regional multiples install central fill hubs, creating an unlevel playing field. Regulatory changes facilitate smaller scale robots in GP practices or in other public spaces, allowing patients to pick up medicines within minutes of consultations, bypassing pharmacy.

When developing scenarios, it is important to ‘suspend disbelief’. The future is neither predetermined nor predictable. I think we all recognise that the pandemic will create effects years into the future, maybe even a different sort of world. Our knowledge is about the past, but our decisions are very much about the future.