Darzi Report Reflections

Community Pharmacy is the Lifeline the NHS Cannot Afford to Lose

The recently published Independent Investigation of the National Health Service in England, more commonly referred to as the Darzi Report, lays bare the challenges facing our health system, and it also highlights a crucial opportunity that has, so far, been vastly underutilised. As Lord Darzi rightly points out, one of the NHS's greatest strengths lies in the accessibility and visibility of community pharmacy, particularly in serving deprived communities. Yet, despite this, our pharmacies are at risk, with more than 1,200 having closed their doors since 2017. As Chairman of Numark, I find these closures deeply concerning, especially when the report makes it clear that community pharmacies are perfectly positioned to alleviate some of the NHS’s most pressing issues.

In my opinion, community pharmacy is the most accessible arm of the NHS. According to the report, ‘more than 93% of patients living in areas of highest deprivation are within one mile of a pharmacy, compared to 71 per cent in areas of the lowest deprivation. These figures speak volumes about the essential role pharmacy services can play in supporting populations. Yet, despite this, pharmacies are closing, and the contract that once ensured a highly efficient distribution of services has been allowed to deteriorate. The opportunity now and in the future, to improve health outcomes derived from the use of medicines is huge.

The closures of pharmacies should set alarm bells ringing. Our communities rely on local access to healthcare, and with primary care services already overwhelmed, it’s vital that community pharmacy is given the opportunity to fill the gap. If access to pharmacy continues to decline, we are at serious risk of replicating the current issues facing general practice – long waiting times, overstretched resources, and a growing number of patients with unmet healthcare needs.

The Role of Pharmacy First

I was pleased to read that this report does more than outline problems – it also highlights a path forward.

One key initiative that exemplifies the potential of community pharmacy is the Pharmacy First service, which Lord Darzi referenced in his report as a model of care that could be expanded across the country. Scotland has already made great strides in this area and for many the Scottish Pharmacy First service is seen as the “jewel in the crown” of its community pharmacy contract. I, for one, am a big fan.

The results are impressive, there has been a notable reduction in GP appointments and A&E attendances for minor conditions, precisely the type of impact that the NHS needs to manage increasing demand. However, to make Pharmacy First a truly national solution, we need more than just policy recognition; we need real and sustained investment.

There is enormous potential for community pharmacies to play a much greater clinical role within the NHS. As well as pointing to the successes of initiatives like Pharmacy First, Lord Darzi outlined that nearly 30% of pharmacists are now independent prescribers, a number set to rise with the introduction of enhanced education pathways for all new graduates by 2026. These are game-changing developments that should not be ignored, what they do need is managed.

We’ve already seen the impact pharmacies can have through expanded clinical services. Whether it’s blood pressure checks, contraception services, or the treatment of minor illnesses, pharmacists have proven they can offer more than just a place to collect dispensed medicines. By shifting more responsibility to community pharmacy, we can free up valuable time and resources in other parts of the NHS – particularly in general practice and A&E – and improve patient outcomes.

That said, the potential for expanded services is not enough if the foundation isn’t secure. The report notes, spending on the community pharmacy contract has fallen by 8% since 2015, a figure that many contractors and pharmacy bodies would dispute. My estimation is that when inflation is considered, that figure rises to a 30% cut. Couple that with increasing demand and expanded services, a perfect storm is brewing, if it hasn’t already hit. If we are to truly unlock the potential of community pharmacy, this trend must be reversed. Sustained and reliable investment is critical if we are to prevent further closures and maintain, and ultimately improve, access to pharmacy services for all communities, particularly those most in need.

The Independent Investigation makes it clear that pharmacies can be part of the solution, but only if we act decisively. The current trajectory where pharmacies are shutting down and resources are stretched so thin is unsustainable. The government and NHS decision-makers must recognise that investing in community pharmacy isn’t just about maintaining an important healthcare service; it’s about future-proofing the NHS as a whole.

With the right investment and support, community pharmacies can offer more clinical services, reduce the strain on primary care including general practice, and ensure that those living in deprived areas continue to have access to vital healthcare from trusted professionals. Community pharmacy must be viewed not just as a place for medicines, but as an integral part of primary care; one that is local, accessible, and capable of delivering real healthcare improvements.

Lord Darzi’s report provides a clear call to action. Community pharmacy already plays a vital role in ensuring accessible healthcare, but without the necessary support and funding, we risk losing a service that is indispensable to both patients and the wider NHS.

I urge the government to act on Lord Darzi’s recommendations and commit to unlocking the full potential of community pharmacy. The NHS cannot continue to operate under its current pressures without substantial reform. Community pharmacy, as recognised in the report, must be a central pillar in the future of healthcare delivery. I have described previously the community pharmacy network as the “keystone of the bridge” within the NHS i.e. remove the keystone and the whole bridge comes crumbling down and that is why our pharmacies must be sustainable and thrive. By expanding Pharmacy First, investing in pharmacy services, and reversing the detrimental funding cuts, we can create a more resilient healthcare system, one that is accessible, efficient, and capable of meeting the growing needs of the population.

The findings of the Independent Investigation provide the basis for the new Westminster government and policymakers to act.

At Numark, we have long advocated for a stronger, more integrated role for community pharmacy within the wider healthcare system. Our 12 Principles of Community Pharmacy Practice provide a roadmap for how pharmacies can continue to support both the NHS and the communities they serve. These principles focus on accessible, person-centred care, underpinned by sustainable funding and a commitment to expanding clinical services that align with the evolving needs of patients.

By aligning with the principles of accessible, proactive care, pharmacies can provide value-added services, reduce the burden on primary care, and improve health outcomes for the most vulnerable populations. To achieve this, we need decisive action, with investing in the future of community pharmacy being the priority. It is time now to move beyond discussions and act to ensure pharmacies are equipped to meet the growing demands of the NHS and continue being the “keystone” of healthcare delivery.