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Community pharmacy staff are generally very motivated to perform clinical services to help people within the communities they serve, and to make the most of their qualifications, says a report by Rand Europe, which was commissioned in February 2024 by NHS England to conduct a qualitative evaluation of CPCF clinical services.

However, the report says community pharmacies are under extreme financial pressures, influenced by historic levels of inflation, and many pharmacists felt remuneration for clinical services was insufficient and impacted their ability to deliver them.

Issues with physical and digital infrastructure persist. Many other healthcare practitioners do not use the same IT systems used in community pharmacies, and pharmacists lack access to full medical records.

Integration with other healthcare providers remains an ongoing challenge, the report says, influenced by complicated referral pathways, competing incentive structures and limited awareness about the services pharmacies offer.

Service users are motivated by the convenience and timeliness of clinical services offered at community pharmacies compared to other healthcare settings. Existing relationships and high levels of trust with pharmacy staff are also key drivers for service. However, limited public awareness of the services pharmacies offer remains a challenge.

The report looked at the outcome of 76 interviews  conducted between July and October 2024 with pharmacy staff (n=48); other HCPs, their support staff, and wider health system stakeholders (n=18); and pharmacy service users (n=10).

The report makes several recommendations, including increasing remuneration for CPCF clinical services based on the complexity of the service and the need to purchase supplies and equipment, as well as broader financial pressures.

It suggests formal referrals for certain CPCF clinical services are required and whether alternative pathways, such as informal referrals, signposting or walk ins, could help to improve service user engagement.

The report says ways to minimise variation in the quality of CPCF clinical service delivery should be considered, which might be achieved through optimising quality assurance processes, or enhanced regulation of services.

Ways to raise public awareness about CPCF clinical services should be considered, including eligibility criteria, and which pharmacies offer specific services. This could be achieved through national advertising campaigns and optimisation of the nhs.uk website so that service users can easily find pharmacies that provide the nationally commissioned services they need.

To minimise competition and promote collaboration between community pharmacies and other HCPs the report suggests joint commissioning structures and incentive schemes that promote a focus on service user outcomes and experiences.

IT infrastructure should be interoperable between pharmacies and other HCPs to facilitate referrals, communication and visibility of summary care records, the report says.

Service user awareness of CPCF clinical services, and what they entail, is generally poor, with the exception of the influenza vaccination service, the report notes. “Poor awareness of services can, in part, be attributed to lack of advertisements or promotion of services within pharmacies, language barriers and limited national efforts to educate the public.”

The CPCF five-year deal was established in 2019, within a very different economic landscape than today, the report says. “Future commissioning of clinical services in community pharmacies must consider this new economic landscape, the evolving professional role of pharmacists, and the NHS 10-Year Health Plan, which aims to shift healthcare focus from hospitals to communities, from sickness to prevention, and from analogue to digital,” it concludes.

“The potential for community pharmacies to help to shape the future delivery of clinical services in England will depend on how these services are commissioned moving forward.”