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There was hope the new pharmacy contract in England might ease the pressure on pharmacies but it has fallen short. They need a multi-year, sustainable funding settlement, says Harry McQuillan…

The findings of Community Pharmacy England’s pharmacy pressures survey are sobering, disappointing and sadly, not surprising to those who own our community pharmacy network.

What this report does is shine a light on the reality our profession is facing. Community pharmacy, which remains one of the most accessible parts of healthcare, remains under strain like never before.

When more than half of pharmacy owners are operating at a loss, and nearly half are relying on their own personal savings to keep doors open, there is only one conclusion we can draw – this situation is unsustainable. It is also unacceptable.

At Numark, we have set out our vision in The Future Model of Community Pharmacy Practice. It is ambitious, built on 12 clear principles, and is underpinned by one immovable foundation – community pharmacies must be fairly funded, financially viable and able to invest with confidence if they are to continue delivering safe, high-quality care.

Pharmacies today are frontline healthcare hubs. They provide medicines supply, deliver vaccinations, support those with long-term conditions and play an ever-growing role in preventative care. They are perfectly placed to deliver on the ambitions of the NHS 10-year plan.

That simply cannot be done against a backdrop of financial instability, rising operational costs and escalating workforce pressures.

The survey’s findings lay bare the personal cost. Sixty per cent of owners took no salary last year. Many are working 70-plus hours a week, mortgaging homes, cashing in pensions and sacrificing their own health just to sustain services.

That is not only unsustainable, it is unsafe, and beyond that, it is morally wrong to expect those who protect community health to do so at such personal risk.

The accusation that community pharmacy is a retail-only environment or owners are ‘glorified shopkeepers’ has been directed at them in the past. No pure retail environment would accept this financial pressure – it would merely close the doors.

Community pharmacy does not because it is a care setting. Owners and their teams put the care of their patients before themselves and the results of the CPE survey confirm this to me.

This crisis is not just financial, it is a human crisis. Almost half of pharmacy teams report patients being negatively affected, whether through reduced access to services like Pharmacy First, shorter opening hours or the withdrawal of essentials such as prescription deliveries.

These consequences fall hardest on the most vulnerable, the elderly, the chronically ill and those in our most deprived communities. There was hope the new pharmacy contract in England might ease some of this pressure. While welcome in principle, it appears to have fallen short in practice.

We cannot ignore what this means. A health system that relies on businesses remortgaging to fund NHS services is not one that can claim to be delivering universal access to care. If the founding principle of the NHS is still to mean something, then community pharmacy must be safeguarded as part of that social contract.

The solutions are clear. Pharmacies need a multi-year, sustainable funding settlement, one that reflects inflationary pressures, workforce costs and the real demand placed on services. Policymakers must also ensure that community pharmacy is fully integrated into the wider health system, not treated as an optional add-on.

When pharmacy is supported to deliver consistently, the benefits are profound. Hypertension checks prevent strokes and heart attacks. Smoking cessation and weight management reduce cancer and chronic disease. Vaccinations prevent illness and protect communities.

Even the simple, consistent presence of a pharmacy improves early diagnosis and outcomes. These are proven, cost-effective interventions. To restrict access because a business cannot afford to provide them creates a two-tier system that is unworthy of the NHS.

This report must serve as a wake-up call. That said, we should not be disheartened. This is a problem that can be fixed. The NHS 10-year plan sets the right direction and I would welcome action to empower pharmacy owners and their teams to deliver on it.

That requires recognition of their role as a core part of the NHS, backed by funding that reflects reality. We cannot risk losing the businesses, the trust they hold or the care they provide. Millions of people depend on community pharmacy.

It is time we made sure the system depends on them too and supports them properly to do what they do best – protecting and improving the health of the communities they serve.

Harry McQuillan is the chairman of Numark. He was chief executive of Community Pharmacy Scotland between 2006 and 2024.