The government’s desire to ‘maximise’ pharmacy-first approaches sounds like something we should welcome – but the elective care reform plan underplays the potential of community pharmacy, says Jasmine Shah, head of advice and support services at the National Pharmacy Association (NPA).

Sir Keir Starmer this week unveiled plans to tackle the NHS backlog of elective care (6 January 2025).

Elective care covers a broad range of planned, non-emergency services – from tests and scans to outpatient appointments, surgery and cancer treatment.

The waiting list currently stands at 7.5 million and the 18 week target is frequently missed. (Performance is measured by the constitutional standard: 92% of patients should wait no longer than 18 weeks from referral to treatment.)

Among the commitments in the new plan – Reforming Elective Care for Patients – is to expand non-surgical community-based ENT services and 'maximise pharmacy first approaches'. This sounds like something we should welcome, although at this point the plan is rather vague about what this might mean in practice.

Looking at the elective care plan overall, it actually underplays the potential of community pharmacy to help bring down waiting times by building up community-based support for prevention and hospital discharge.

Community pharmacy can play its part in elective care through appropriately funded pharmacy services being commissioned such as ear wax removal, otoscopy, managing common gastric ailments, commissioned smoking cessation services, weight management for people waiting for hip and knee surgery/replacements, community diagnostic services and managing pain until surgery.

Here are a few other ways that – properly supported and financed to do so – pharmacies could play their part:

  • Helping people settle back into the community after a stay in hospital – therefore allowing people to return home instead of taking up hospital beds. Fuller deployment of Discharge Medication Reviews could significantly reduce hospital readmission and lengths of stay.
  • Preventing medicines-related falls and therefore demand for hip replacements and other bone-related surgery – by widespread medication reviews in community pharmacy.
  • Highlighting and supporting reduction in anticholinergic burden in the elderly.
  • Early detection and management of heart disease – widespread application of the NHS Blood Pressure Service.
  • Overall strengthening of the capacity and effectiveness of primary care, fully deploying Pharmacy First. By giving people more support to live independently and longer in the community we would reduce the number of elective care interventions downstream.

Taken together, all of this would take pressure away from our overstretched hospitals and help deliver first class care on people's doorsteps. However, this cannot happen when pharmacies are closing at record rates and continue to face huge uncertainty about their future funding.