Community pharmacy and general practice: The differences and Why Good Relationship Need Aligned Contracts

At THC, we create resources for General practice and community pharmacy, which are part of the same primary care family, but anyone who has worked across both worlds knows it does not always feel that way. The two often sit alongside each other rather than together, sharing patients and misconceptions about how and why each party operates as it does.

The inaugural community pharmacy conference and general practices conference held on 21st and 22nd June set out to close that gap and showcase what good working relationships actually look like.

In this blog, you will find a clear side-by-side of the two contracts. How each one is agreed. How each is funded. How the money is actually paid. What sits on top of the core funding. And how each is regulated.

You will also find an honest reflection on what it takes for the two to work well together.

Let's jump in!

What Works Well in Community Pharmacy

Pharmacy First, hypertension clinics, weight-loss clinics, vaccinations, medicine optimisation, digital transformation in how medicines are dispensed, joint training, and multidisciplinary team working were just a few of the ways pharmacy and general practice are already working productively together.

What good communication should look like

So much of the worry about pharmacy and general practice working more closely comes from an assumption that closer working means more work landing on the practice. More to chase, more to action, more pushed back across the boundary.

However, a pharmacist shared;

There is a difference between behaving like a clinician and informing a colleague.

She was not asking general practice to take on more.

We share the same patient. I am keeping you informed. I am not handing you another task.

Behaving like a clinician means owning the decision in front of you. Informing like a colleague means keeping the wider team in the loop so the patient is kept safe, without the practice becoming the bottleneck at every step.

I think this sentiment should extend beyond clinical roles. Whether you are a practice manager or a PCN manager, the same thing applies. We are on the same team, informing each other of what is happening and why.

Building trust starts with seeing everyone you work with as a colleague on your side, not against you.

We are all colleagues, and we are all learning together.

The new Community Pharmacy Contractual Framework

The new Community Pharmacy Contractual Framework for 2026/27 was published on 29 May 2026. It is the national contract that sets the funding and the rules for community pharmacy in England, agreed between the Department of Health and Social Care, NHS England and Community Pharmacy England. At £3.636 billion it is worth £340 million more than last year, a 10.3% uplift, and once again one of the largest budget rises anywhere in the NHS.

From this autumn, the framework will introduce a national NHS independent prescribing offer, an extension of Pharmacy First and the pharmacy contraception service, with up to five new prescribing pathways to follow once they are clinically signed off.

This is backed by a one-off £500 set-up fee, a £525 monthly payment and £17 for each consultation, the same fee paid for a Pharmacy First consultation.

The starting point is the seven conditions community pharmacy already manages under Pharmacy First: sinusitis, sore throat, earache, infected insect bites, impetigo, shingles and uncomplicated urinary tract infections, alongside the contraception service.

Independent prescribing allows pharmacists to treat these completely, and up to five further pathways will be added once a clinical reference group has signed them off; the exact conditions are not all confirmed yet.

Why trusted communication needs aligned contracts and incentives

If there was an overriding theme to the day, it was trusted communication.

Relationships first. Getting to know one another, because that is what creates trust.

I believe that. But we also have to be honest about the limits of relationships on their own.

We cannot escape the fact that general practice and community pharmacy are contracted in completely different ways, with different incomes and pressures, and, at times, genuinely competing interests.

Goodwill does not last if the contracts pull people in opposite directions.

It is worth being concrete about how different they are, because it is easy to underestimate.

Community pharmacy is not the NHS in the way general practice is. It is a network of private businesses delivering NHS services under contract. Community pharmacy staff are not eligible for the NHS Pension Scheme through their pharmacy employment.

They are not paid on Agenda for Change terms. And community pharmacies are regulated by the General Pharmaceutical Council, not the Care Quality Commission, which inspects general practice.

On top of that, the money flows differently.

Pharmacy income runs through dispensing fees and medicine margin, the single activity fee rising to £1.52 an item and retained margin set at £1.1 billion for the year, rather than the registered list and global sum that underpin general practice.

I have put together the infographic below to show just how different those contracting and reimbursement models are as a starter for ten.

The complexity does not stop at the money. Community pharmacy is not represented by a single voice.

Regulation, contract negotiation, professional leadership, and trade representation are split across separate organisations, from the General Pharmaceutical Council, which regulates, to Community Pharmacy England, which negotiates the national contract to a handful of trade bodies that speak for the owners.

I have mapped that landscape below ⬇️.

So alongside the relationships, we need aligned contracts and aligned incentives.

Not instead of trust, but to protect it.

Final Thoughts

For general practice and community pharmacy to work well together, we first have to appreciate that we are running different businesses, under different contractual models, with different constraints.

What it takes from there is good relationships. And good relationships start with seeing each other as equal colleagues, with different perspectives and expertise, and then working together to determine what shared care could actually look like and how we can improve it.

We work in a really complex environment, and that cannot be underestimated.

Aligning the contracts themselves is beyond most of us, but there is an opportunity to think through what shared care could look like with aligned local incentives, which is both good for the patient and good for both businesses.

About us

THC Primary Care is an award-winning healthcare consultancy specialising in Primary Care Network management and the creator of The Business of Healthcare. With over 20 years in the industry, we have supported more than 300 PCNs through interim management, training and consultancy.

Our expertise spans project management and business development across both primary and public sectors. Our work has been published in the London Journal of Primary Care, and we have authored over 250 blog posts sharing insights on primary care networks.

Keep in Touch