Community Pharmacy and Neighbourhood Working: Pharmacy First, Funding and Prevention

Insights by Shilpa Shah -  Chief Executive of Community Pharmacy North East London

Community pharmacy is primary care, and it has always worked at neighbourhood level. Shilpa Shah, Chief Executive of Community Pharmacy North East London, returned to The Business of Healthcare for a third time to explain what neighbourhood working, Pharmacy First and prevention now mean for the sector. She represents 370 pharmacies across seven London boroughs, and she is direct about what is working, what is not, and what the money is doing.

Following recent conversations with Michael Lennox, Integration Lead at the National Pharmacy Association, and time at the inaugural Community Pharmacy and General Practice Conference in June, I have been working to understand community pharmacy and the role of the pharmacist on a deeper level. Primary care does not function well when its parts do not understand one another, and pharmacy is too often the part left out of the conversation.

What is the business of pharmacy?

Is the business of pharmacy simply to sell medicine? No. A community pharmacy is a premises on the high street where anyone can walk in for health and wellbeing advice. Some of that becomes over-the-counter purchases, some pharmacy-only medicines you cannot buy in a supermarket, and increasingly NHS and private services.

Traditionally around 90 per cent of the business has been dispensing, and that is where most of the funding has come from. As that income depletes, pharmacies now have to look at everyone coming in for a prescription and think about the wider services they could offer.

Pharmacy First and the move to independent prescribing

Shilpa described Pharmacy First, with its seven clinical conditions, as a game changer. It has released capacity from general practice and started showing patients what a pharmacy can do beyond dispensing. Automation helps. Robots take on much of the dispensing, and modern medication record systems cut the routine checks, freeing up time for clinical services.

Her caveat is that many pharmacies are not yet at capacity. There is more they could do, and they need general practice colleagues to send more people in.

The 2026/2027 community pharmacy contract, announced at the end of May 2026, brought independent prescribing into the Pharmacy First service, and from 2026 all newly qualified pharmacists register as independent prescribers. Shilpa welcomes this, with two reservations. The funding attached feels insufficient to deliver it properly, and there is a bottleneck around the designated prescribing practitioners, usually GPs, who sign prescribing pharmacists off as competent.

The funding gap and the 2026/2027 contract

Every uplift is a step in the right direction, but the gap is enormous. The 2026/2027 contract delivered a 10.3 per cent increase, taking funding from around 3.3 billion pounds to around 3.6 billion pounds, roughly 340 million pounds more, and the second year running that pharmacy has been treated preferentially. Community Pharmacy England has also secured a government commitment, with the pharmacy minister Stephen Kinnock, to reform how pharmacy is paid.

This is familiar from general practice. When funding is released, it rarely feels like enough, because it is often money that should have arrived a decade ago, and Shilpa agreed it may never feel satisfactory.

Pharmacy is also contracted and paid in a completely different way from general practice, through dispensing fees and medicine margin rather than a registered patient list and a global sum. I have set out a fuller side-by-side of the two contracts in this blog.

Why medicines keep going out of stock, and who pays

The bigger day-to-day problem is stock. Pharmacies often buy medicines for more than they are reimbursed, and some pharmacists are dipping into savings and even pensions to keep dispensing. Shilpa traces it partly to how medicines are bought in England, and partly to a global market where suppliers would rather sell elsewhere.

North East London is pushing 28-day prescribing and electronic repeat dispensing, which smooths the supply chain and cuts workload for practices, and Shilpa says the area has one of the highest rates in the country. She also tells patients not to stockpile, because that makes shortages worse.

What neighbourhood working really means for community pharmacy

Neighbourhood working comes with a question. Who pays for community pharmacy to be in the room?

Community pharmacy has always worked in the neighbourhood, Shilpa says. It is a new name for something the sector already does, now with more structure, and that structure comes at a cost. North East London has had to employ someone three days a week purely to attend neighbourhood meetings, and has moved former PCN lead funding into neighbourhood leads. On some Thursdays there are four different meetings across the seven boroughs at once.

That is a lot of time in meetings, and so far very little funded work has come out of it. What has come out is recognition of what community pharmacy can do. Voluntary sector colleagues repeatedly tell her they had no idea pharmacies could do blood pressure checks, which shows how much public education is still needed.

In those meetings, she does not turn up to say pharmacy needs more money. She turns up with data from sources like Fingertips, names the local problem, and offers a solution. Years ago in Newham, one of the most polluted areas in London, she raised childhood asthma and offered ideas. There was no funding at the time.

Two years later, a lead GP came back with DEFRA funding, and they delivered it. As Shilpa put it, we have got solutions to everything. What they need is someone to say yes, and the funding to do it.

Prevention, CVD and the funding problem

In a deprived neighbourhood with a lot of undetected cardiovascular disease, community pharmacy should be paid to do cholesterol checks and HbA1c testing, to work alongside GPs, and to bring in dentistry and optometry too. The assumption that pharmacy will do this for free, on top of everything else, is unsustainable.

The problem is timing. Prevention pays off in four or five years, not next week, while secondary care holds both today's patients and the funding. So Shilpa is pragmatic. She chases grants from bodies like the British Heart Foundation, partners with GP federations who can hold the money because pharmacy committees cannot commission services themselves, and works to stop the NHS becoming a charity sector partner that does everything for free.

Reaching the patients who do not answer the text

How do you reach the patients who never respond to a text message? Go to where they already are. It is a live question in my own CVD work.

That means places of faith, local fairs, and football clubs, including the outreach that clubs like West Ham and Arsenal do with people who would never book a health check. It means walking groups. And it means posters where people already look. A UTI poster in a nail salon. Impetigo and ear infection information in barbers and schools. A free blood pressure check advertised in a cafe.

If texting reaches 70 per cent of people, that is not the group to worry about. It is the other 30 per cent, and reaching them takes a different kind of effort.

Key takeaways

●      Community pharmacy is primary care, and it has always worked at neighbourhood level.

●      Pharmacy First plus independent prescribing is expanding the clinical role of pharmacy, but the funding and the designated prescriber bottleneck are real constraints.

●      The 2026/2027 contract brought a further uplift, yet the underlying funding gap and the medicines supply problem remain the sharper issues.

●      Prevention needs funding that follows the patient, and grants plus federation partnerships are how community pharmacy is making it happen now.

●      To reach the patients who never answer the text, go to where they already are.

Listen to the full episode

This is Shilpa's third appearance on The Business of Healthcare, and one of the most practical yet. You can listen to the full conversation wherever you get your podcasts.

Listen to this episode here

If you want to go deeper into how community pharmacy and general practice fit together, three related pieces from THC:

●       Community pharmacy and general practice: the differences and why good relationships need aligned contracts

●       Episode 374: Community Pharmacy and General Practice Integration with Michael Lennox

●       How Do You Support Your PCN Pharmacist's Progression When You Have Devolved That Role Down to Practice?

Much of community pharmacy runs on goodwill. The unrecorded consultations, the hours in meetings that carry no funding, the medicines bought at a loss. None of that shows up in a contract line. Neighbourhood working could be what finally pays for that work, or it could become one more table where pharmacy is expected to work for free. Which way it goes is not yet clear. What Shilpa does is worth copying either way. Turn up with data, bring a solution, and keep showing people what community pharmacy can do.

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.

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