18 minute read 17 Nov 2023

With the right steps, pharmacies can lead the way in patient care, taking pressure off GPs and hospitals.

Smiling man giving medicine to daughter on sofa

How pharmacy innovation could improve patient health care in England

Authors
Michael Thompson

EY EMEIA Strategy and Workforce Advisory Leader, People Advisory Services

Passionate about fostering a truly inclusive environment where people can realize their full potential. Experienced strategic leader. Husband.

Trevellyan Collier

Partner, Consulting, Ernst & Young LLP

A digital optimist transforming organisations for growth. Brings clients closer to their customers and patients. Cornish pig farmer. Husband and enthusiastic surfer.

18 minute read 17 Nov 2023
Related topics Health Consulting Consumer products and retail Innovation Life Sciences
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With the right steps, pharmacies can lead the way in patient care, taking pressure off GPs and hospitals.

In brief

  • In the future, pharmacies might not just be places to collect medicines: they could transform into community hubs providing health care services to patients.
  • Pharmacies could become the first port of call for support with long-term condition management and minor ailments.
  • Several operational, technological and regulatory changes will need to happen to improve patients’ experience, support the expansion of the pharmacy’s scope.

There are significant issues with the provision of health care in England. From long waiting lists to a shortage of doctors1 and nurses,2 many patients are unable to access the care they need when they need it. Community pharmacies are often an under-used resource in primary care; there are not always opportunities for highly trained pharmacists to care for patients in ways which live up to their qualifications and capabilities.3

NHS England has developed a delivery plan for recovering access to primary care, with £645mn investment over two years to increase the services offered in community pharmacies.4 This can help reduce the burden on GPs and increase patient access to primary care in the short term, but with long-term investment and planning there is a real opportunity to shift perceptions of primary care.

  • Methodology

    According to the General Pharmaceutical Council register of pharmacists, there are 52,805 pharmacists registered in England for 2023.5 Assuming 50% of those dedicate 20 hours per week (50% of working hours) to patient care and make four appointments per hour, EY Consulting projects 2.1mn primary care appointments could be carried by pharmacists every week.

The benefit of repositioning the role of the pharmacy

2.1mn

additional primary care appointments could be generated in England every week.

What could the future of pharmacies look like?

By the end of the decade, pharmacies might no longer be the dispensing destinations they are today. Instead, they could become hubs for patient service, unleashing the full potential of pharmacists in primary care.

Medication management could move online, with pharmacy apps reminding patients to take medicine and order repeat prescriptions. Automated dispensing hubs could make up prescriptions to be delivered directly to patients at home.

Pharmacies and pharmacists have the potential to become the first port of call for primary care, with patients visiting pharmacies for support with long-term conditions through medication management, testing and holistic preventative health care, or resolving minor ailments.

Explore five videos below depicting different scenarios and experiences in the pharmacies of the future 

By 2030, these experiences could become commonplace in leading pharmacies. To achieve this, they would need to have automated or outsourced dispensing, with patients managing their prescriptions online. This would free up pharmacist time to take on more primary care responsibilities, releasing pressure on general practitioners (GPs).

The day-to-day work of pharmacies could shift to patient-facing primary care by offering consultations for minor ailments, prescribing medicines and advising on holistic health and wellness. They might also partner with other organisations which specialise in certain treatments to bring the best and most up to date health offers to their patients.

The pharmacy workforce could diversify and adapt to fulfil its expanded role in primary care. Pharmacists might be able to specialise in long-term condition management and work across several locations to maximise their reach and impact with patients.

In addition to pharmacists, the workforce could include nurses, phlebotomists, scanning technicians, physiotherapists, mental health specialists and other highly trained and skilled team members to enhance the care available to patients in the community.

Finally, the pharmacy itself might look different. Without the need for a dispensary, more space could be dedicated to consultation and treatment rooms. They could feel more like the best GP surgeries of today, which combined with retail space in stores will shift the focus to holistic preventative wellness and cosmetic care.

This transformation in the role of the pharmacy has the potential to revolutionise patients’ experiences of health care in England. Increasing the pharmacy capacity for primary care services could also relieve the pressure on other parts of the health care system.

However, today’s pharmacies are not set up in the right way to put patient’s care first and are a long way from being able to realise these changes.

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Pharmacists doing stock take
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1

Chapter 1

Pharmacies in crisis

Whilst there can be a bright future for pharmacies, there is no doubt the sector is currently in crisis across England.

Perception of the role of pharmacists in primary health care

The relationship between pharmacy and patient is usually transactional; patients see pharmacies as a support to their health rather than as a health care destination.6 According to a recent Ipsos study, the public seems to have an incomplete understanding of even the current range of pharmacy services on offer. For instance, most patients are aware pharmacies can fill a prescription, whilst only 30% know they can get support with oral contraception or checking blood pressure.7 At the same time, GPs are sometimes doubtful of community pharmacies’ potential to expand health care services to patients.8 Local governments and the NHS could help to raise awareness about the role of pharmacists to strengthen their relationships with patients, GPs and hospitals.9

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The profitability challenge

Many pharmacies are struggling to remain profitable. The situation is particularly challenging in England where it is estimated just 7% of pharmacies are profitable.10

Pharmacies rely on the government to pay for medicines and services, but the freeze in funding over the lifecycle of the current five-year framework amounts to a 30% cut in real terms.11 On top of this, pharmacies have been hit with significant wage and energy inflation and medicine shortages.12 In addition to increasing concern about the viability of community pharmacies on the high street, this limits the ability of pharmacies to invest in new services.

Workforce crisis in pharmacy

The crisis extends to the workforce. Pharmacists are being tempted away from community pharmacies by roles at GPs or primary care networks that offer more diverse work or locum roles that bring greater flexibility. In 2022, it was found that 81% of community pharmacists are considering leaving their roles13 and pharmacist vacancy rates are 8% in England.14 Community pharmacies cannot do more for less money with a shrinking workforce. A system-wide approach including NHS England and community pharmacies will be needed to effectively train, attract, and retain pharmacists if pharmacies are to take on an expanding role in primary care.

The decline of the high street pharmacy?

These factors are already leading to a decline in the number of community pharmacies. In the future, more pharmacies are likely to close as dispensing becomes automated and drives experiences combining both physical and digital channels and online competitors pick up market share, meaning fewer patients will need to visit the traditional community pharmacy. As a parallel, since the shift to online banking, high street banks have closed at a rate of 4% per year over the last decade due to high costs and a lack of innovation in in-store service provision. 15 If pharmacies fail to transform their role in patient care, the closure rate may increase. However, with the right investment, this decline could be slowed.

  • Methodology

    This chart was modelled based on:

    • Data on historical and current number of community pharmacies in England available publicly from NHSE’s statistical collection of general pharmaceutical services in England 16
    • Data on the historical number of high street banks in England available publicly from the ONS 17

    The three scenarios model three different possible situations:

    1.  The closure of community pharmacies continues at the same rate as the last four years
    2.  The closure of community pharmacies accelerates to the decline of the high street banks over the last seven years

    The closure of community pharmacies continues at a rate halfway between the rates of the two above scenarios. 

Female customer picking and looking at the medicine box from the shelf. Senior woman buying medicine at drugstore.
(Chapter breaker)
2

Chapter 2

Patient care at the top of the agenda: the opportunities

Despite these challenges, with the right support and patient-centric approaches, community pharmacies can lead the way in primary care.

Today, the time a pharmacist could dedicate to give expert advice to patient is limited because of their focus on dispensing.18 Automation and digitisation, alongside the £645mn NHS investment planned for community services,19 could allow pharmacies to deliver a higher volume and range of services. Pharmacies could become the first choice for community care and support patients with minor ailments and long-term condition management. Such initiatives could also alleviate pressure on other parts of the NHS, as shown by studies carried out in Scotland, where similar plans for community pharmacies are in place.20

In addition, pharmacies might provide a greater range of discretionary private services, from flu jabs and travel vaccinations to health MOTs or consultations on nutrition, lifestyle and wellness, building new revenue streams by working closely with local businesses.

Services may be offered digitally where practical, providing greater convenience for patients and ensuring pharmacists are fully utilised. 

Services pharmacies could provide to support with different types of conditions

  • 1. Minor ailments

    • In-person and video appointments
    • Independent prescribing
    • Referral to GP or hospital

  • 2. Long-term conditions

    • Specialist support for long-term conditions; for example:
      • Diabetes
      • Heart conditions
      • Dietary and bowel conditions
    • Medication review and management
    • Symptom review and management
    • Regular testing
    • Health and wellness support
    • Support network

  • 3. Diagnostic support

    • Blood tests
    • Diagnostic scanning
    • Quick health, fertility and infection testing to help GPs diagnose their patients
    • Home testing kits

  • 4. Holistic wellness

    • Access to specialist surgeries, e.g., physio and mental health
    • Promote preventative care and healthy lifestyles
    • Support communities

  • 5. Private services

    • Vaccinations and preventative health care
    • Health MOTs
    • Travel Jabs
    • Paid consultations with, e.g., physio or mental health nurse
    • Testing referrals from private health care insurers

Ultra-convenient interactions with pharmacies

An omnichannel experience combining physical and online touchpoints will be essential for patients to manage prescriptions and book services while feeling prioritised and cared for in stores.

Most of patients might order and manage their prescriptions online by 2030 and they may expect convenience, flexibility and speed. In this context, dispensing pharmacies that cannot provide instant updates on orders and offer flexible home delivery will lose customers. To make this experience a reality for patients, many pharmacies could work with outsourced dispensing and logistics organisations.

In addition, patients may be able to interact digitally with their pharmacist through pharmacy apps that could provide accessible information on conditions, medicines and other services. When patients need more advice, they could request video consultations or book in store appointments for a wide range of health and wellness related assistance.

Pharmacists could become the first person a patient sees about their ailments and could form lasting relationships with patients whilst helping them manage long-term conditions. There is also the potential for pharmacies to form trusted partnerships with GP surgeries and hospitals in end-to-end patient health care, working closely together throughout the patient lifecycle, supported by better integration of pharmacy and NHS systems to improve access to patient records. 

The time is right

The pharmacy sector is ready for disruption. Today, only one in 10 patients in England manage their repeat prescriptions digitally.22 However, since the pandemic, an increasing number of patients would consider digital solutions such as virtual consultations, especially for renewing their prescription or get support with a minor ailment.23

There are also increasing examples of innovation globally in the sector: 

  • Seventy percent of community pharmacies in Denmark now use dispensing robots.24
  • Pharmacies in Europe increasingly have access to patient medical records to help them advise patients better (e.g., Estonia and France).25
  • Online pharmacies in the UK and the US are already reimagining a faster and more seamless pharmacy experience.26

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A streetside digital thermometer with a heart shape at pharmacy sign
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3

Chapter 3

Enabling the expansion of primary care services in pharmacies

There are several fundamental changes and investments required for pharmacies to shift their operating model towards services.

Shifting the funding model ­­

Currently, the pharmacy funding model is tailored towards a dispensing based operating model, which does not incentivise transformative innovation: Only 11% of NHS England’s funds is dedicated to the provision of services.27 Although NHS England plans to invest £645mn over the next two years to increase the services offered in community pharmacies,28 it is not clear whether this will form part of a long-term solution or whether community pharmacies will be able to find the capacity to deliver these additional services. A more ambitious approach to pharmacy contracts that sustainably supports the delivery of these services will need to be developed.

Automating dispensing

As a result of increasing patient expectations and cost pressures, pharmacies may be driven to automate the dispensing of prescriptions. This would require investment in changes to their operating model or outsource dispensing to third parties. In time, most dispensing is likely to be carried out at regional centres.

Automation has also been proven to improve patient safety by removing human error from dispensing. Moving dispensing out of community pharmacies could also release space and pharmacist capacity for renewed focus on patient consultation and treatment. These changes should be embraced, as the pharmacy workforce is highly trained and can deliver better health outcomes in more patient facing roles.

Developing the right expertise and skills

Pharmacists are well-equipped in terms of knowledge to provide high-quality care to patients which complements the services already provided by GPs.

However, the need to develop a wider variety of skills will only increase due to the prevalence of many complex long-term conditions and the development of innovative medications.29

Some pharmacists might focus on general skills in prescribing and running tests for patients with minor ailments, whilst others might specialise in specific conditions and work across several stores to reach as many patients as possible.

To maximise the support available to patients with long-term conditions, pharmacies could also become home to staff with wider skillsets, from nurses and phlebotomists to physios and mental health specialists.

Forming new health care partnerships

Greater and more consistent access to patients might enable pharmacists to work closely with partners in pharmaceutical companies, gathering data and referring patients for clinical trials. They could build stronger partnerships that enable more support for patients in managing and understanding the latest available treatments.

Health care and government organisations should consider the below questions as they prepare for and influence the direction of policy to enable these transformations. 

  • 1. How can pharmacies free up time for patient care?

    As a result of a trend towards digitisation and an instant, convenient, online customer experience, as well as existing inflationary pressures, pharmacies could be driven to automate the dispensing of prescriptions.

    This could either be through investing in changes to their operating model or outsourcing to third parties. In time, most dispensing is likely to be done in a small number of regional centres and provided as a service to pharmacies.

    This vision might only happen with major transformation projects to automate and digitise pharmacy operations and the patient experience.  

  • 2. How will pharmacists build the skills they need?

    Universities and training bodies will need to help the pharmacy workforce to adapt to deliver this vision, but these changes should create more diverse and fulfilling careers for all. Further areas of investigation for NHS England include defining the right health care roles in pharmacies to enhance patient care and preparing pharmacists to work more closely with patients when helping them to manage their conditions. 

  • 3. How can patient trust in new pharmacy services be increased?

    This expanded role of pharmacies in primary care would have an impact throughout the health care ecosystem. GPs and NHS 111 may need to be better at referring to pharmacies and patients will require clear messages on how pharmacies can help them and when they should self-refer.

    Pharmacists would also need access to patient records so that patients could trust they have up to date, consistent information about their medical and treatment histories.

  • 4. Do policies need to change to expand the role of pharmacies?

    Policy needs to set a clear direction for community pharmacy transformation and be supported by policy to give the sector the confidence to make the necessary investments. The £645mn investment in pharmacies from NHS England30 is hopefully a preview of this effort next five-year funding contract due in 2024. Future funding models will need to incentivise the pivot to services and support independent pharmacies to afford the investment required to reap the benefits of automation. 

  • 5. How might the role of GPs and hospitals support this change?

    For pharmacies to play a successful role in primary care, the roles of GPs and hospitals will also need to be adapted with a focus on supporting patients with the right care at the right time.

    There is a real opportunity to unleash the power of pharmacists in primary care to tackle capacity challenges in GPs and hospitals, but this might require several changes throughout the ecosystem and new challenges to tackle for health care actors.

Contributors: John Marsh (Partner, Workforce Advisory, Ernst & Young LLP), Jonty Naismith (Senior Manager, Transformation Delivery, Ernst & Young LLP), Fergus Finden-Browne (Senior Manager, Strategy & Transactions, Ernst & Young LLP), Nus Arshad (Senior Manager, Workforce Advisory, Ernst & Young LLP), Alex Britt (Senior Manager, Business Design, Ernst & Young LLP), Caroline Booth (Senior Manager, Innovation & Experience Design, EY-Seren Limited), Fatemeh Aminzare (Manager, Business Design, Ernst & Young LLP), Raphaelle de Beaumont (Senior Consultant, Innovation & Experience Design, EY-Seren Limited)

Summary

In the future, the role of the pharmacy is far more prominent and holistic than ever before. Although there is a long way to go, the untapped potential of pharmacies could transform primary care in England and help to achieve better patient outcomes.

About this article

Authors
Michael Thompson

EY EMEIA Strategy and Workforce Advisory Leader, People Advisory Services

Passionate about fostering a truly inclusive environment where people can realize their full potential. Experienced strategic leader. Husband.

Trevellyan Collier

Partner, Consulting, Ernst & Young LLP

A digital optimist transforming organisations for growth. Brings clients closer to their customers and patients. Cornish pig farmer. Husband and enthusiastic surfer.

Related topics Health Consulting Consumer products and retail Innovation Life Sciences
Upvote