When a lady I had known for more than 25 years was growing fragile and rapidly losing weight, I knew that she needed medical attention quickly. She dismissed the seriousness of her symptoms and didn’t want to bother her busy GP. Despite her reluctance, I encouraged her daughter to take her to the doctor. She was diagnosed with colonic cancer and promptly started treatment.
Another patient came into my pharmacy concerned about a rash on her breast, which she presumed was heat rash. After a private examination, I sent her immediately to A&E. She was later diagnosed with breast cancer and started chemotherapy. She told me that, had she not come in, she would have assumed it was nothing until it could have been too late.
In both cases, diagnosis was possible because the patients had a good relationship with their community pharmacist. I was able to spot the signs thanks to the consistency of care that community pharmacy offers. People can come in regularly, no appointments needed. But these crucial interventions will never be recorded or recognised in their medical notes.
Community pharmacies are one of the four key pillars of the primary care system in England, alongside general practice (GP), dentistry and eyecare services. They’re found on high streets, in supermarkets, in GP practices or other community spaces, and are normally within 20 minutes’ walk for the local populations that use them. We’re known for selling and dispensing medicines, but in reality, our role is so much more than this.
We’re the people who notice when your grandma is getting more forgetful and might need a memory test; the people you’ll ask for advice when you weren’t given the time in your GP appointment; the people who can help find someone a safe space after they’ve suffered domestic abuse, when they’ve come in asking for ANI (action needed immediately). According to the Home Office, community pharmacy has reported 186 cases to domestic abuse services since the “Ask for ANI” scheme began in 2021.
But pharmacists are not recognised for all of this work. We represent the third-largest profession in the NHS and our capacity to care for our communities is huge. We often develop relationships with multiple generations of families, as we often stay in the same places and may even inspire our children to follow in our footsteps.
Unfortunately, I didn’t inspire my own children to do so. I often ask myself why. Is it because they watched their parents come home late every night after a 60-plus-hour working week? Or because they heard them worrying about their patients not being able to afford prescription charges? Or maybe because they watched them study until the early morning after a long working day, just to keep their qualifications up to date?
The trouble is that society has tended to see pharmacies as chemist shops, rather than a vital part of primary care. The care we provide is vast. This includes dosing out medication into containers, so people take the right pills at the right time; explaining blood test results to confused patients; checking medication safety and urging doctors to review prescriptions; organising repeat deliveries to patients’ homes; and spending hours trying to source medicines from wholesalers. During the pandemic, my partner and I (both pharmacists) barely saw our children in the lockdowns, sometimes returning home from work at 2am. Our children even helped with deliveries, walking 16km a day to deliver medication to shielding patients.
Thankfully, as the pressure on the NHS persists, the value of pharmacies is becoming more and more apparent. But just like GP practices, community pharmacies are set up as independent practices. We must procure our own stocks of medicines, buy or lease our pharmacies, pay our own staff, and take financial risks. We don’t receive paid leave, funded continuing professional development (CPD) leave, or an NHS pension.
And NHS funding for pharmacy isn’t sufficient. It often doesn’t even cover medications, let alone staff costs or the extensive care we provide. As a result, the National Pharmacy Association estimates that three-quarters of pharmacies could be at risk of closure due to financial pressures.
Pharmacists are bound by an ethical code to ensure patients receive their medication with “reasonable promptness”. But due to medicine shortages, we often end up searching for supplies. We witness first hand our patients’ pain and anger when they can’t receive their ADHD, epilepsy, anxiety or rheumatoid arthritis medication. Constantly managing their expectations while trying to meet our ethical obligations leaves us stressed, demoralised and emotionally exhausted.
The mental toll is tremendous. Ultimately, many pharmacists have left community practice over the past few years to work in less stressful and demanding environments, such as GP practices and hospitals. Others have reduced opening hours due to financial pressures or have chosen to retire. There are now 1,000 fewer pharmacies in England compared to 2015. Pharmacists across the country are living with post-traumatic stress disorder (PTSD) after the pandemic, when we were responsible for ensuring people had access to their medication and vital advice. If no one had been able to get their medicine during lockdowns, the impact on the nation’s public health would have been huge. We’re still suffering this collective trauma, and it has not been recognised.
NHS England is rolling out a new service called Pharmacy First, which will give pharmacists more prescribing power, allowing them to prescribe treatments for seven common conditions, such as earache, a sore throat and urinary tract infections (UTIs). This programme has been successful in Scotland and Wales for some time and will be the biggest expansion of pharmacy services in a decade. It’s a huge step forward in making better use of pharmacists’ expertise.
But we need more support and recognition for the extensive work we already do – we are the front door to the NHS, and ease pressure on our colleagues, especially GPs.
Of course, every part of our health and care system needs better funding, fairer pay and more attention. But community pharmacy is too often forgotten. Pharmacies aren’t just chemist shops – they are essential to national and community well-being, and it’s time they were recognised as such.
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