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Let’s not sugar-coat it, community pharmacy and general practice are still working in parallel, not partnership, says Trevor Gore…

We talk about ‘integration,’ but most days, it still feels like two busy professions running separate marathons on the same track.

As an associate director at the Institute for Collaborative Working (ICW), I can tell you this. Collaboration doesn’t happen by wishing for it but happens by designing for it. And the problem isn’t strategy or structure, it’s behaviour.

People don’t always act rationally, and that includes GPs, pharmacists, and even those of us who think we’re being logical. That’s where behavioural economics comes in (the science of why people do, or don’t do the things they know they should).

Pharmacy First, contraception services, hypertension checks all rely on one thing, predictable referral flows. But in too many areas, referrals happen only when someone remembers, or when the GP ‘feels like it.’

Rather than being collaboration, that’s chance. Behavioural economics gives us a fix in the default effect. If it’s harder to refer to pharmacy than to keep the patient, most GPs will just keep the patient.

People tend to do the thing that’s easiest, so, let’s flip the default. Make referrals digitally embedded with one click, one pathway. Get PCNs to formalise pharmacy referral routes, and don’t rely on ‘gentlemen’s agreements.’

Use social proof by sharing local data showing that other practices are referring successfully. Nobody wants to be the odd one out. Let’s stop asking for referrals and start engineering them, because if you want a behaviour to happen, make it easy, and if you want it to happen often, make it automatic.

Collaboration happens over cases, not coffee

Forget another ‘relationship-building meeting’ because if you want trust, build it around patients, not PowerPoints. Joint case reviews are where real collaboration lives.

A 10-minute meeting discussing Mrs Patel’s blood pressure readings does more for professional respect than ten networking events ever will. The behavioural driver here is reciprocity, when people experience your value firsthand, they naturally want to reciprocate.

A GP who sees a pharmacist solve a problem doesn’t forget it.  Pick one clinical area, hypertension, contraception, asthma, and start there, but keep meetings short and purposeful. Always feedback outcomes, so your contribution stays visible. Trust is built in moments of shared success.

Turn up because presence equals power

If you’re not at the ICS or PCN table, decisions will be made about you instead of with you. Behaviourally, this is all about availability bias where decision-makers give more weight to the people they see, hear, and remember.

So, if pharmacy isn’t visible in those strategic forums, we’re effectively invisible to the system. Make sure your name and your data are in the room.

Speak in solutions, not silos and bring stories that make pharmacy human. “Here’s what happened when we managed Mr Jones in community pharmacy instead of the GP”. Integration is a participation sport and you can’t influence the game from the sidelines.

When the GP’s not playing ball, try behavioural judo

Not every GP is going to welcome pharmacy involvement with open arms. Some are sceptical, others protective, and a few just plain busy.

Here’s where a little behavioural judo helps by redirecting their resistance rather than push against it. Social proof, ’Other practices have seen a 15% drop in common illness demand by referring.’

Loss aversion: ‘Without Pharmacy First, you’ll keep seeing these same low-acuity patients and it’s costing you time.” Reframe the win: ‘This isn’t about shifting workload; it’s about sharing it’. Start small and win one service, then build from there. If all else fails, escalate through the PCN diplomatically.

Collaboration sometimes needs assertiveness, but it never needs aggression. The hardest part of collaboration isn’t getting people to agree; it’s getting them to act.

Collaboration Is a skill, not a slogan

As an ICW associate director, I’ve seen the same pattern across every sector, from aerospace to healthcare: collaboration fails when it’s treated as a slogan, not a skill.

It’s not about everyone being nice, it’s about building structures, trust, and incentives that align human behaviour with shared outcomes. Community pharmacy has never been more central to primary care, but if we stay on the periphery of decision-making, we’ll stay on the periphery of opportunity too.

If we want joined-up care to stick, we need to design systems that make collaboration automatic. So, try all or some of the following, after all if your potential partners aren’t playing ball at the moment what have you got to lose?

Good collaboration isn’t just about good will. It’s about good design. The NHS doesn’t need another policy on collaboration. It needs people who practice it, and if you want to change the system, start by changing the default.

Trevor Gore is the founder of Maestro Consulting, a Self-Care Forum trustee and associate director at the Institute for Collaborative Working.