Leela Barham argues that we need to know more about how the public values community pharmacy, including the trade-offs that are needed in these difficult times, to improve policymaking

Advocacy by community pharmacy for the sector is routine. But if people, be they current or future patients, are at the heart of community pharmacy, don’t we need to hear more from them? Not just what they want, but also what they are willing to give up in order to have a sustainable sector in the future.

If you want to find out what the profession wants for the future of community pharmacy in the UK, there’s plenty to draw upon. There are a lot of professional bodies who regularly advocate for the sector: the Royal Pharmaceutical Society (RPS), the Independent Pharmacies Association (IPA), the Company Chemists’ Association (CCA), the National Pharmacy Association (NPA) and more.

Plus, Community Pharmacy England (CPE) and its devolved nation counterparts negotiate with government on behalf of the sector. Sometimes they work together too: CPE, the CCA, NPA and the RPS have a manifesto for community pharmacy in readiness for the general election.

It’s implicit that these groups will not only set out what they want, but through CPE and their counterparts in Wales, Scotland and Northern Ireland, also what they are willing to trade off to reach an agreement with government on a contract for the sector in each country of the UK.

The views of people in the community are less easily identified than those of the plethora of bodies representing the professional interests of community pharmacy.

As an example, of 69 written submissions to the most recent health and social care committee inquiry into pharmacy published in May this year, just seven were from those who can be considered to reflect people’s views – ranging from Healthwatches to charities.

Arguably, the charities aren’t speaking for the public in general terms but for the specific patients whose interests they represent, so that would come down to just two if you take Healthwatches as speaking for Joe Public. Healthwatch England also released its self-described “deep dive into the state of pharmacy services, opportunities and challenges” in April this year.

This sets out what people want from a pharmacy, based upon a survey of 1,650 adults in England plus interviews conducted by local Healthwatch staff. Recommendations range from better communication of Pharmacy First to more support for pharmacy teams and better IT. Other recent surveys have tapped into people’s views.

An Ipsos survey, commissioned by NHS England, captured the views of 2,082 people in the UK and was published in January 2024. The survey covered use, the impact of closures, services on offer, confidence and satisfaction, as well as comfort with new pharmacy services.

A YouGov poll of 1,774 adults in England, commissioned by the PSNC (as was) and published in March 2023 found most respondents (78 per cent) thought services from community pharmacies were very important. A host of work going further back has looked at the value of community pharmacy too.

Trade-offs

However, as any economist worth their salt will point out, with limited resources comes the need to make choices. Community pharmacy is no different; there is an obvious trade-off between state funding and the size of the network, for example.

Trade-offs have not been part of the recent surveys of the general public, nor other eff orts to capture the value of the sector. The trouble is, it’s easy to say that everything is important and valuable if you don’t have to pay.

Economists have the tools to help go beyond ratings of importance into trade-offs. People can be asked to make hypothetical choices – often referred to as discrete choice experiments – and analysis of those choices can identify what is most important to them, and even their willingness to pay.

For example, researchers at the University of Aberdeen looked at people’s preferences for a community-based health check for cardiovascular disease in a paper published in 2022. They found that people preferred a service provided at the weekend, by appointment, delivered by a nurse, for 30 minutes with follow-up after three months. They would be willing to pay £50 for this health check. Getting insights like these aren’t just academic.

If you know what people want and it can be delivered in practice then it follows that people will be more likely to take up the offer. Pharmacy First is a case in point. Do people still prefer to go to their GP even if they can get their issue resolved by going to a community pharmacy?

Person-centred policy

It’s time for research like the University of Aberdeen study, and any other research that has been done, to be brought together to aid our understanding of what is most important to people in these tough times.

If there’s a research gap (which seems likely), new research could help identify what is most important in community pharmacy to people in the UK and what they might be willing to give up if having everything they wanted was unfeasible. Now that would be person-centred – and perhaps harder to dismiss by the new Government.