I have spent a lot of time recently thinking about why community pharmacy develops so differently from one part of the country to another.
The same national contractual framework exists. Contractors face many of the same financial and operational pressures. The broad policy ambitions are familiar everywhere: improve access, move care closer to home, make better use of clinical skills and integrate community pharmacy more effectively into primary care.
Yet local outcomes can look remarkably different.
Some areas introduce new services, test innovative approaches, share data effectively and involve community pharmacy in pathway design. In others, progress is slower, engagement is more transactional and the sector remains on the edge of wider primary care planning.
It is tempting to explain these differences by looking only at contractors. Are pharmacies sufficiently engaged? Do they deliver consistently? Are they willing to adopt new services?
Those are fair questions, but they tell only part of the story.
The more systems I observe, the more convinced I become that two components have an enormous influence over what community pharmacy can achieve locally: the strength of the local pharmaceutical committee (LPC) and the strength of the integrated care board (ICB).
Either one can make a difference independently. When both are strong – and, crucially, work well together – the possibilities become much greater.
One strong component can take you only so far
There are systems where the ICB is supportive, productive and genuinely interested in community pharmacy. Its leaders understand the sector, include it within primary care conversations and want to commission services through it.
But the LPC may have an extremely small team and limited capacity.
This is not a criticism of the people involved. In fact, it is often remarkable how much a small number of people deliver. However capable or committed they are, there is a limit to how many relationships they can maintain, meetings they can attend, opportunities they can develop and contractors they can support.
In those circumstances, the ICB may create a favourable environment and the contractor base may deliver reasonably well. But opportunities can still be missed because the representative infrastructure does not have enough capacity to convert goodwill into sustained delivery.
The opposite situation also exists.
Some areas have a strong LPC with a capable team, good relationships, innovative thinking and a clear ambition for the sector. They communicate well with contractors, understand local pressures and continually look for new ways that community pharmacy can contribute.
However, the wider system may be less mature in its engagement with the sector.
Commissioning can be slow. Community pharmacy may be invited into conversations after the important decisions have already been made. Services can be designed around existing organisational boundaries rather than around the assets available within communities.
A strong LPC can still achieve a great deal in that environment. Its contractors may perform well in some services and less strongly in others, producing a perfectly respectable overall position.
But the ceiling is lower than it needs to be.
One strong component can compensate for weakness elsewhere. It can maintain momentum, protect relationships and produce reasonable outcomes. What it cannot consistently do is create the conditions for transformation on its own.
What happens when both sides are strong?
The most exciting examples are found in systems where a well-resourced, forward-thinking LPC works alongside an ICB containing people who genuinely understand and champion community pharmacy.
That is where we begin to see something different.
Conversations move beyond asking whether pharmacies can deliver another isolated service. Instead, community pharmacy becomes part of pathway design from the beginning.
New services are commissioned. Existing services evolve more quickly. Contracting becomes more imaginative. Data sharing improves. Pharmacy teams become involved in prevention, urgent care, long-term condition management and neighbourhood delivery.
Crucially, community pharmacy starts to be viewed as part of the local clinical infrastructure – not simply as a provider to be approached when another part of the system runs out of capacity.
That distinction matters.
If the sector is treated as an occasional supplier, the conversation usually begins with a specification, a price and a deadline.
If it is treated as a strategic partner, the conversation begins with a population need and a shared question: how can we solve this together?
A strong LPC brings contractor insight, local relationships, operational understanding and the ability to mobilise the network. A strong ICB brings commissioning expertise, system authority, clinical leadership, data and connections across primary, secondary and community care.
Neither possesses the whole answer. Together, they can create something much more valuable than either could produce independently.
Perhaps this is the closest we currently get to community pharmacy nirvana: not a perfect system, but one in which the two essential components are capable, aligned and mutually trusting.
Commissioner relationships deserve greater attention
Community pharmacy rightly invests significant time in stakeholder and provider relationships.
We work with general practice, hospitals, local authorities, voluntary organisations, professional bodies and many others. All of those relationships matter, especially as neighbourhood models develop.
But I increasingly wonder whether any relationship is more consequential than the one we have with commissioners.
Commissioners determine whether an idea becomes a funded service. They influence whether community pharmacy is included in a pathway or left outside it. They connect pharmacy with medicines optimisation, primary care, population health, urgent care and digital teams.
Yet LPCs and ICBs can approach the same conversation from very different starting points.
We use different language. We operate within different governance arrangements. We face different pressures and measure success in different ways.
An LPC may see an urgent opportunity that would benefit patients and contractors. An ICB may see governance requirements, procurement questions, clinical accountability, financial risk and competing system priorities.
Neither perspective is wrong. The difficulty is that each side may not fully understand the other.
Some of the most productive local relationships I have seen involve people within an LPC who have previously worked in commissioning – or who remain closely embedded in the wider system.
Their value is difficult to overstate.
They understand how decisions are actually made, not simply how an organisational chart suggests they are made. They know when to engage medicines optimisation, when a proposal needs primary care sponsorship and how to translate a pharmacy opportunity into the language of system priorities, outcomes and risk.
They can also explain ICB realities to contractors and LPC colleagues. They become translators between two worlds that need one another but do not always naturally communicate.
This changes the commissioning conversation. The LPC is no longer only asking the system to support community pharmacy. It can demonstrate how community pharmacy helps the system solve its own problems.
People matter – but people also move on
This brings me back to a theme I have written about before: ultimately, it is all about the people.
The strongest partnerships are often built by individuals who trust one another, understand both sides and are willing to work through organisational complexity to get something done.
That human element is powerful – but it also makes progress fragile.
A pharmacy champion changes role. An ICB restructures. An LPC loses a key team member. A medicines optimisation lead retires. A new primary care director arrives with different priorities.
A relationship that took years to establish can weaken remarkably quickly.
If community pharmacy’s place within a system depends on one supportive commissioner or one exceptionally connected LPC leader, we have not achieved integration. We have achieved a fortunate alignment of individuals.
We need to retain the power of personal relationships while making those relationships less vulnerable to personnel changes.
That means creating systemic bridges between community pharmacy, LPCs, medicines optimisation and primary care teams.
These could include dedicated liaison or integration roles, joint appointments, shared work programmes, formal representation in decision-making structures and regular strategic, not merely contractual conversations.
There is also a strong case for developing people who can operate across these boundaries. We need more leaders who understand both contractor reality and system commissioning; people who can speak both languages and retain credibility on both sides.
This should not be an occasional add-on to someone’s already full role. If we believe community pharmacy is central to neighbourhood health, prevention and care closer to home, then the infrastructure needed to connect it to the rest of the system must be treated as essential too.
Building something that survives individuals
The future of community pharmacy will not be secured by strong contractors alone. Nor will it be secured by a good LPC acting in isolation, or by an enthusiastic ICB without sufficient representative capacity on the other side.
It requires all of these components to work together.
A capable and engaged contractor base.
An LPC with sufficient people, skills and capacity to represent, support and mobilise it.
An ICB that sees community pharmacy as part of primary care and backs that belief through commissioning, inclusion and practical delivery.
Most importantly, it requires a mature relationship between the LPC and the ICB, one built on trust, shared language, mutual understanding and a common purpose.
Strong individuals will always matter. They create momentum, challenge established thinking and open doors that structures alone cannot.
But our ambition must be to turn those personal connections into durable system capability.
Because the difference between respectable performance and genuinely transformative community pharmacy may not be another national strategy.
It may be whether the two most important local components are strong and whether we have built a bridge between them that remains standing when the people inevitably change.
