As a community pharmacist delivering multiple commissioned NHS clinical services every day, I have become increasingly concerned about the direction of travel for community pharmacy. Whilst I fully support the expansion of pharmacists’ clinical roles and welcome opportunities to improve patient access to NHS care, I worry that the expectations being placed upon community pharmacy are growing at a pace that is neither sustainable nor safe.
Each day I manage NHS 111 Community Pharmacy Clinical Pathway referrals, Pharmacy First consultations, emergency medicine supplies, vaccination services, safeguarding concerns, clinical interventions, supervision of dispensing, and the many operational responsibilities required to run a busy pharmacy safely. Increasingly, however, I am seeing NHS referrals that fall outside the intended scope of commissioned pharmacy services, requiring lengthy assessments before patients inevitably need onward referral elsewhere within the NHS.
Whilst each inappropriate referral may seem insignificant in isolation, their cumulative impact is substantial. Time spent assessing patients whose conditions clearly require urgent medical review reduces my capacity to provide timely care to those whose conditions can genuinely be managed within the pharmacy setting. Rather than improving efficiency, these referrals often duplicate assessments, delay definitive treatment and create frustration for both patients and clinicians.
One recent case highlights these concerns, where a patient was referred by NHS 111 with a foot infection. During this consultation, the patient explained they had already completed several unsuccessful courses of antibiotics. This should immediately have suggested a presentation requiring escalation rather than management within community pharmacy. Despite this, the patient was directed to my pharmacy before ultimately attending an urgent care service, where they received the specialist assessment and treatment they required.
Unfortunately, cases such as this are becoming increasingly common. Patients understandably expect that an NHS referral means their problem can be fully managed in the pharmacy. Explaining otherwise often leads to disappointment and loss of confidence in the healthcare system, despite those limitations being beyond my control.
A major challenge is the growing mismatch between public expectations and the reality of what community pharmacy is commissioned and resourced to provide.
Increasingly, it feels as though community pharmacy has become the default destination whenever capacity elsewhere within the NHS is limited. Whilst pharmacists have embraced an expanded clinical role, there is an important distinction between extending professional practice and transferring increasingly complex clinical risk into settings that are not commissioned, equipped or resourced to manage it safely.
These challenges are amplified by the reality that many community pharmacies operate with a single pharmacist. As the sole pharmacist in the branch, I carry responsibility for every clinical decision, every prescription check, every urgent consultation, every referral and every aspect of clinical governance, often simultaneously. Balancing these competing demands requires constant prioritisation and creates an intensity of pressure that is difficult to appreciate unless experienced first-hand.
The cumulative effect on both patient safety and workforce wellbeing is becoming increasingly difficult to ignore.
This is not simply a workforce issue; it is fundamentally a patient safety issue. Fatigue, excessive workload and relentless cognitive demand are recognised contributors to clinical error across healthcare. Many pharmacists are already experiencing burnout, moral distress and declining job satisfaction. Personally, I increasingly question what the future of community pharmacy will look like if expectations continue to expand without corresponding increases in staffing, investment, infrastructure and support.
I remain passionate about the future of community pharmacy and firmly believe pharmacists have an increasingly important role within integrated primary care. However, if that future is to be sustainable, expansion of services must be matched by realistic expectations, appropriate commissioning, adequate workforce investment and recognition that community pharmacy cannot become the solution to every pressure experienced elsewhere within the NHS.
By Scott Thompson, community pharmacy locum pharmacist
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