Part 2: Neighbourhood health – barriers and enablers

In Opinion

Follow this topic

Bookmark

Record learning outcomes

Neighbourhood care is no longer a conceptual ambition within the NHS in England. It is a practical response to structural pressure: rising long-term conditions, constrained public finances and a system that cannot continue to rely on hospital-centric solutions. 

Community pharmacy should be integral to this shift. Instead, it often sits in a grey space between policy intent and operational reality.

Pharmacies are everywhere the NHS needs to be. They are embedded in communities, trusted by patients and increasingly clinically skilled. Yet their role in neighbourhood care remains uneven, shaped as much by historical assumptions as by current system design. 

Elevating community pharmacy requires more than endorsement. It demands a recalibration of how the NHS funds, plans and partners with one of its most accessible clinical assets.

Disconnect 

The NHS increasingly asks community pharmacy to function as a neighbourhood care provider but continues to support it through contractual mechanisms rooted in a supply-led past. Clinical services have expanded, but they remain layered onto a framework that was never designed for sustained prevention, continuity or proactive population health.

This disconnect limits progress. When income depends heavily on transactional activity, it becomes difficult for pharmacies to plan services around neighbourhood need or invest confidently in workforce and infrastructure. The issue is not whether pharmacy delivers value. It is whether the system is structurally set up to recognise and scale that value.

• Enabler: A contractual approach that treats clinical contribution as core business, not an optional extra. Longer-term, outcomes-oriented commissioning would allow pharmacies to align their offer with neighbourhood priorities rather than short-term incentives. 

Workforce realities

Community pharmacy professionals across the country are operating at the edge of their capacity. Pharmacists are managing increasingly complex consultations; pharmacy technicians are taking on advanced roles; teams are absorbing new services at pace. This evolution reflects ambition, but it also exposes fragility.

Neighbourhood care assumes time: time to consult, to follow up, to coordinate. Yet protected learning time, supervision capacity and funded backfill remain inconsistent. Without addressing this gap, the system risks building neighbourhood models that rely on professional goodwill rather than sustainable workforce design.

• Enabler: A workforce strategy that recognises community pharmacy as a permanent clinical setting, supported by structured development pathways, realistic workload modelling and protected time to embed new responsibilities safely.

Planning with blind spots

Integrated care boards are charged with reshaping care around neighbourhoods, but community pharmacy’s involvement in this process varies widely. In some systems, pharmacies are active contributors to prevention and long-term condition pathways. In others, they are engaged late or positioned primarily as delivery outlets.

This inconsistency matters. Pharmacies see people frequently, often before deterioration triggers formal care pathways. Excluding pharmacies from neighbourhood design creates blind spots in access, medicines optimisation and early intervention.

• Enabler: Making pharmacy participation a default expectation within neighbourhood planning, supported by shared objectives, defined roles and consistent engagement mechanisms rather than ad hoc relationships.

Redefining access as a measurable outcome

Access is one of community pharmacy’s greatest strengths, yet it is rarely treated as an outcome in its own right. Same-day advice, walk-in resolution and frequent contact all reduce pressure elsewhere in the system, but these contributions are often invisible in commissioning frameworks.

• Enabler: Reframing access as a measurable clinical outcome would allow the NHS to recognise and reward the role pharmacies play in preventing escalation. In high-demand neighbourhoods, sustaining access may be as valuable as delivering any single intervention.

The data gap: trust without visibility

Neighbourhood care depends on information moving seamlessly across settings. Community pharmacy remains disadvantaged by limited access to shared care records and variable digital integration. This constrains clinical confidence and reinforces outdated perceptions of pharmacy as peripheral rather than integral to care teams. Without timely visibility of relevant patient information, pharmacy’s contribution remains narrower than its capability.

• Enabler: System-wide inclusion of community pharmacy within digital strategies, with appropriate access to shared records and two-way communication that supports collaborative decision-making at neighbourhood level.

From advocacy to alignment

The challenge for community pharmacy in 2026 is not recognition but alignment. Alignment between what the NHS needs neighbourhood care to deliver and how pharmacy is enabled to operate; alignment between workforce ambition and realistic capacity; and alignment between national policy signals and local commissioning behaviour.

For the DHSC, this means moving from incremental adjustment to deliberate structural reform. For NHS England and ICBs, it means designing neighbourhood models that assume pharmacy’s involvement from the outset. For pharmacy leadership bodies, it requires a confident articulation of pharmacy as neighbourhood infrastructure, not supplementary capacity.

• Call-out: Neighbourhood care cannot succeed if one of the NHS’s most accessible clinical workforces remains only partially enabled.

Johnny Skillicorn-Aston is an external relations and communications consultant. James Roach is an NHS director for primary and local care. The final article in this series will look at partnerships between pharma and community pharmacy to enable neighbourhood healthcare.