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The DHSC’s promise of shortage-busting ‘flexibilities’ is a sticking plaster over deeper problems, writes Outsider 

The Department of Health and Social Care (DHSC) has announced it is to consult on “pharmacist flexibilities”. While it may sound as though we are being invited to a yoga class, the only thing that will be bending will be the rules of medicines supply as the department finally tries to deliver a long overdue Brexit benefit. 

The basic proposition is clear enough: patients are struggling to get their medicines, shortages are biting harder every week, and community pharmacies are left to deal with the fallout.

So the government wants to know how far pharmacists can, or should, exercise discretion in making supply decisions when the prescribed brand, strength or formulation is not available. 

Is this a common-sense approach or is it a tacit admission that the supply chain is cracked wide open, and that ministers would rather shift responsibility than fix the system? 

Shortages, once the exception, have become the everyday soundtrack of pharmacy life. Conversations that should last 30 seconds – “Here’s your prescription” – now drag on as staff explain why the usual pack is nowhere to be found, why a substitute costs ten times the Drug Tariff price, and why the patient has to come back tomorrow, or next week, or never.  

Pharmacies juggle wholesalers, emergency supplies, and apologetic phone calls to GPs, all while being hammered on reimbursement. 

‘Flexibility’ sounds generous until you realise it’s the equivalent of being asked to build a house from Lego, blindfolded, and then blamed when the roof caves in. 

Of course, this all lands in the middle of the sector’s most challenging financial climate in decades.

Pharmacies continue to close, some due to the relentless grind of underfunding, others through the kind of poor management that might make you wonder how they stayed open in the first place.   

Either way, the effect is the same: patients left without local access, other services needing to do what pharmacies once did for “free”, and politicians shrugging as if gravity itself were at fault. 

The government points to its Community Pharmacy Contractual Framework (CPCF) as proof that the sector is being supported.

Pharmacy First is the shiny new toy, and yes, five million consultations in its first year is impressive. But that doesn’t come close to making up for the income lost from Medicine Use Reviews and establishment payments. 

It’s also only a fraction of the £645 million promised. Any actual funding uplift in 2025-2026 is already spent in advance, swallowed by inflation, staffing costs and stock. Meanwhile, the notion of ‘service bundling’ creeps in, threatening access to that much touted uplift.   

In Whitehall this sounds efficient; but it’s only efficient if that funding gets spent and spent in the right places. At the moment it just looks broken. That is the context into which these promised flexibilities are arriving.  

Pharmacists are already expert improvisers, though not always by choice.  They make clinical calls every day under conditions that few outside the dispensary understand. What is galling is the suggestion that this new flexibility is a gift. 

It isn’t. It’s a belated recognition of the impossible conditions under which community pharmacy has been operating for years.

And unless the contractual framework starts to deliver real finding, it won’t be enough to keep more doors from closing. 

The uncomfortable truth is that many pharmacies are now only as stable as the personal savings of their owners. Surveys show countless contractors dipping into overdrafts, skipping salaries, or remortgaging to keep the lights on. 

Locums are still chasing overdue payments from chains that should know better. Against this backdrop, flexibilities begin to look less like liberation and more like the state asking for one more unpaid favour. 

Of course, there is an argument that greater autonomy could professionalise pharmacy further, lifting it away from the image of pill-counting and into the realm of problem-solving clinicians. 

That may be true, but it ignores the reality that autonomy without resources is just another word for liability. Imagine being told you can now legally juggle substitutions, off-licence strengths and creative pack splits – but your IT systems are out of date, your staff hours are cut, and you’re already explaining for the third time today why the patient’s metformin looks different again. 

Flexibility should not be confused with resilience.

Pharmacists are resilient because they have no choice; they are flexible because the system is brittle. To consult on flexibilities without addressing shortages, funding, and workforce realities is like repainting the walls while the foundations crack. 

So yes, let’s have flexibilities. But let’s not kid ourselves they are a cure-all. Unless the sector is funded to stand tall, every new responsibility simply adds weight to shoulders already stooped. 

At some point, even the most flexible spine can only bend so far. 

And while pharmacists are good at many things, bending over backwards was never supposed to be part of the service specification. 

Outsider is a community pharmacy commentator