By Conor Price
I often hear it said that Community Pharmacy lacks leadership. I don’t buy it. In fact, I think it’s wrong. Where Community Pharmacy struggles isn’t leadership within the sector, but leadership across the system.
That distinction matters.
Leadership inside a pharmacy business is not optional. You don’t survive without it. Contractors and superintendent pharmacists juggle workforce shortages, rising demand, regulatory pressure, thin margins, and patient expectations that keep growing while resources don’t. They manage teams, estates, risk, clinical services, supply chain disruption, and quality - often simultaneously, often under intense pressure. Strip leadership out of that equation and most pharmacies would have folded years ago.
Community Pharmacy contractors are, by necessity, strong leaders. They are deeply embedded in their neighbourhoods, trusted by patients, and for some communities the only consistent point of contact with the NHS. They build long-standing relationships, understand local need, and deliver care at pace. Running a pharmacy well is not accidental; it requires resilience, decisiveness, and constant prioritisation. That is leadership, whether the system recognises it or not.
Where the criticism starts to have some weight is when we move beyond individual organisations and into system leadership.
System leadership is different. It’s about shaping services across organisations, influencing direction at place or neighbourhood level, and working with partners whose incentives don’t always align with yours. It requires time, headspace, infrastructure, and, crucially, permission from the system to lead.
This is where Community Pharmacy has been set up to struggle.
Compare pharmacy with general practice. Over the past decade, general practice has been systematically invested in as a system actor: Clinical Directors for Primary Care Networks, GP Federations, Primary Care Collaboratives, leadership development programmes, funded management capacity, and explicit roles within Integrated Care Systems. That investment hasn’t been perfect, but it has created space for system leadership to emerge.
Community Pharmacy hasn’t had the same treatment. There is no equivalent, funded “Chief of Place” for pharmacy. No consistent neighbourhood leadership role. No transformation directors, system development capacity, or protected time to build relationships and shape services. Training hubs, where they work well, are still overwhelmingly GP-centric. In some systems, pharmacy barely features in Primary Care discussions at all — despite being labelled as part of it.
You can’t expect system leadership to flourish where the system hasn’t built the conditions for it.
On top of this sits the brutal reality of financial survival. When margins are tight and contracts feel perpetually fragile, it is entirely rational to focus inward. Like general practice, Community Pharmacy is forced into competition for services, for workforce, for viability. Collaboration becomes harder when the system pits providers against one another just to stay afloat.
That doesn’t mean system leadership isn’t possible. It means it requires a different mindset, and often personal risk.
System leadership asks leaders to park organisational self-interest, at least some of the time, and work for outcomes that may not immediately benefit their own business. It means building relationships with perceived competitors, challenging outdated assumptions, and being willing to say uncomfortable things in rooms where pharmacy hasn’t always been invited or taken seriously.
That takes confidence. It takes credibility. And it takes leaders prepared to put their heads above the parapet.
Community Pharmacy absolutely has a role to play in neighbourhood design, improving access, prevention, medicines optimisation, and new models of care alongside general practice and wider primary care. But that role won’t be realised through goodwill alone. It needs structure.
So, what needs to change?
First, I think we need Community Pharmacy Networks that operate at neighbourhood level, providing a collective voice comparable to a PCN Clinical Director. Not another meeting, but real leadership capacity with clarity of purpose.
Second, Pharmacy Federations should be supported and scaled where they work, providing centralised back-office functions, development capability, and leadership at place. Examples already exist; the system should learn from them rather than reinventing the wheel.
Third, Integrated Care Systems need to stop treating Community Pharmacy as an optional extra. Pharmacy is not an “add-on” once the GP side is sorted. That mindset is outdated and counterproductive. If primary care is serious about access, prevention, and sustainability, pharmacy must be part of the solution from the start.
Finally, pharmacy itself does need to step up, not by apologising for perceived weaknesses, but by thinking beyond individual organisational boxes. System leadership doesn’t replace operational leadership; it sits alongside it. It’s a different skillset, focused on influence, relationships, and long-term change.
So no, Community Pharmacy does not lack leadership. What it lacks is a system that has truly invested in enabling it to lead beyond its own walls. If we want integrated neighbourhood care to work, that has to change, and it has to change now.
About the author
Conor Price is Chief Executive of Community Pharmacy London and Director of CoreHealth Partners, working nationally to bring General Practice, Community Pharmacy and wider Primary Care closer together. With a background spanning frontline delivery and system leadership, he focuses on relationships, data and digital innovation that enable collaboration and practical reform across the NHS.
