An independent investigation into the NHS has praised the value of community pharmacies and preventative services, while highlighting that more investment is needed in primary care to improve the health and care of the nation as a whole.

The Darzi review was commissioned by the health and social care secretary Wes Streeting to deliver 'a raw and frank assessment of the state of the NHS'.

In submissions to the report, pharmacy bodies highlighted funding, workforce and medicine supply concerns.

And the final report, published this evening (11 September), highlighted the need to shift spending on health and social care 'left', away from secondary care and towards community and primary care and prevention.

Access to community pharmacy 'a great strength'

Lord Darzi highlighted the accessibility of community pharmacy as ‘one of the great strengths of the health service in England’.

He said that ‘historically, the contract promoted a highly efficient distribution of pharmacies’, noting that ‘in contrast to many aspects of care, deprived communities are better served’.

But the report also noted that ‘pharmacies are now closing in significant numbers’.

‘While pharmacies have expanded the range of clinical services that they provide – such as blood pressure checks, prescription contraception, and minor illnesses – the total level of spending on the community pharmacy contract has fallen by 8%,’ the report said.

Risk community pharmacy ‘will face similar access problems to GPs’

Lord Darzi said that community pharmacy had ‘huge potential’ to provide ‘even more value-added services for the NHS’, especially with the advent of pharmacist prescribing on a more widespread scale.

He noted that Pharmacy First had already been one of the sector’s ‘notable successes’, and suggested that expanded community pharmacy services would be ‘likely to include greater treatment of common conditions and supporting active management of hypertension’.

‘But there is a very real risk that on current trajectory, community pharmacy will face similar access problems to general practice, with too few resources in the places where it is needed most,’ Lord Darzi said.

‘Perverse’ to cut public health spending ‘so substantially’

The report noted the success of preventative health programmes, such as ‘the impressive achievements' of the Diabetes Prevention Programme, which it said reduces the risk of type 2 diabetes by nearly 40%.

‘It is apparent that where bold action has been taken, health has improved,’ Lord Darzi said.

In particular, he drew attention to smoking cessation interventions, which both lowered smoking rates and positively impacted incidence and survival rates cardiovascular disease and cancer.

However, he added: ‘Given the potential power of preventative interventions, it is perverse that the public health grant to local authorities has been cut so substantially.’

He highlighted analysis from the Health Foundation which shows the public health grant was cut by more than a quarter between 2015-16 and this year, while ‘cuts to public health allocations have tended to be greater in cash terms in more deprived areas’.

And while spending on NHS health checks has dropped by £15 million, participation rates have fallen by 20%, the report added.

Lord Darzi also noted a ‘surge in multiple long-term conditions’, as well as fewer children getting key immunisations and fewer adults participating in important screening programmes.

And he said the impact of the pandemic was ‘magnified because the NHS had been seriously weakened in the decade preceding its onset’, while population health had ‘deteriorated’.

‘Too many people end up in hospital, because too little is spent in the community’

Much of the report focuses on pressures on secondary care, which Lord Darzi highlighted as the result of underinvestment in the community.

‘Too many people end up in hospital, because too little is spent in the community,’ he said.

He noted a ‘significant rise in attendances at hospital emergency departments’, suggesting this could be down to struggles with accessing GP appointments.

And he highlighted a submission from charity Age UK that suggested: ‘On any given day, over 2,000 people aged over 65 are admitted to hospital in an emergency for a condition that could have been treated earlier in the community or prevented altogether (such as a fall).'

Lord Darzi's report said: ‘Yet the current distribution of resources is perpetually reinforced: performance standards are focused on hospitals, not on primary care, community services or mental health, as is measurement. Single-year budgets necessarily reinforce the status quo—and when things go wrong the knee-jerk response is to throw more money at hospitals where the pressure is most apparent.’

He noted that while ‘successive governments have promised to shift care away from hospitals and into the community’, ‘in practice, the reverse has happened’.

Between 2006 and 2022, the share of the NHS budget spent on hospitals increased from 47% to 58%, Lord Darzi said.

‘The only sustainable solution to congestion in acute hospitals, for example, is to build up the capacity, capability, infrastructure and technology base of care that is delivered in the community, including general practice, community services, and mental health services. By keeping people well for longer, they are less likely to need hospital treatment,’ the report added.

He also noted the impact of hospital delays on patients waiting for planned procedures, including ‘a worse prognosis, more complex interventions, more powerful medications, and longer recovery times’.

Need for IT systems that work across settings

A lack of capital in the NHS has meant ‘too little digital technology to support its workforce’, Lord Darzi suggested.

And where information technology is invested in, this ‘continues to focus on acute hospitals, rather than other providers’, Lord Darzi said.

‘There are many possible technologies that would support more efficient, higher quality, safer care in the community. But they are largely absent.

‘Given the shift in the disease burden towards long-term conditions, there is a greater need for information systems that work across different settings,’ he said.