Every year, as Chief Economist of the World Pharmacy Council (WPC), I have the privilege of compiling the organisation’s major annual update to members, the Sector Analysis Report. In 2025 this has clearly shown that two dominant and conflicting narratives are shaping community pharmacy worldwide: a rapid expansion of new services, and an urgent struggle for financial viability.
Across the 14 WPC member countries, governments have learnt lessons from the COVID-19 pandemic and are finally leveraging pharmacies’ unique position to alleviate pressure on primary and emergency care. It is clear this is what communities want to happen. In Canada, where authorised pharmacist scope of practice is already amongst the highest in the world, national polling in late 2025 showed the strength of public support for an expanded pharmacy role. 75 per cent of Canadians support expanding pharmacy services, and one in three actively chose pharmacy over another healthcare provider for broader healthcare needs beyond the core clinical dispensing role.
Significant recent provincial moves are responding to this public demand. For example, Ontario announced plans for pharmacists to prescribe for 14 new minor ailments (adding to the current list of 19), and to order specific laboratory tests and perform additional point-of-care tests, while Manitoba is set to authorise prescribing for birth control and HIV medications.
Nova Scotia — which now holds the status of the most advanced community pharmacy scope of practice authorisation in the world — continues to expand community pharmacy clinics that provide an extended suite of pharmacy primary care services at no charge to patients. And Alberta — a long-time global leader, having built a mature service model over 15 years — in 2023-24 saw its 1,700 pharmacies provide over 8 million non-dispensing clinical services, an average of about 5,000 per pharmacy. These included comprehensive care plans (36 per cent of the total), prescribing activities (31 per cent) and vaccinations (25 per cent).
The expansion in authorised and funded clinical services is a global phenomenon. In Ireland, a landmark 2025 Community Pharmacy Agreement — the first national agreement there since 1996 — introduced a Common Conditions Service for acute common conditions like shingles and impetigo, alongside expanded vaccination and contraception services. Similarly, New Zealand has empowered community pharmacists to initiate treatments for gout prophylaxis and supply HIV prevention medication (PrEP), embedding pharmacy firmly in public health prevention.
England’s highly anticipated Pharmacy First service, launched in 2024, has started to prove its worth. In the year to March 2025, over 2.4 million consultations for conditions like sore throat and UTIs were delivered, with recent research published by the UK’s Health Security Agency showing no increase in antibiotic resistance. Meanwhile, in Scotland, authorised community pharmacists have been able to independently prescribe NHS-funded medicines through the Pharmacy First Plus service since September 2020 — this service supports patients and their families with acute common conditions that go beyond the standard Pharmacy First Scotland Service. In the last three years the proportion of the Scottish pharmacist workforce with independent prescribing rights has increased from 23 per cent to 51 per cent.
The economic argument for expanding government-funded services is compelling. In 2025, researchers from York University modelled a potential £1.2 billion of savings and other benefits from expanding community pharmacies’ role in medicines optimisation — and a further £2.7 billion in health outcomes value (see Economic Analysis of Expanding the Role of Community Pharmacy Services in Medicines Optimisation, available via npa.co.uk). This adds to evidence from a large number of studies of community pharmacy’s current and potential economic and social value, many of which are highlighted in a feature section of the public version of the Sector Analysis report.
EU nations are also integrating pharmacies deeper into their healthcare systems. Portugal has fully implemented a system for community pharmacies to dispense hospital-prescribed medicines, benefiting 150,000 patients per year by saving them frequent hospital trips. Research in 2025 confirmed that involving pharmacies in SARS-CoV-2 testing in Portugal massively improved accessibility, halving the average distance to a test site — this mirrored similar research there for their seasonal influenza vaccination program.
Table 1: Scope of practice international comparison table
Despite these advancements, the economic model of community pharmacy is under severe threat in several large countries. The most visible symptom is a wave of pharmacy closures which have been shown through research to disproportionately affect the most vulnerable communities.
In England, the number of pharmacies has fallen for the seventh consecutive year, with 756 closures since 2021. Alarmingly, analysis by the UK’s National Pharmacy Association shows these closures are concentrated in the most deprived areas, worsening health inequalities. While a new 2025 funding framework offers a potential short-term lifeline with a significant baseline increase and debt relief, stakeholders warn it must be just the start of sustainable reinvestment.
The situation is even worse in Germany, where 2024 saw a record net loss of 530 pharmacies — a 16th straight year of decline. A draft reform bill in 2025 aimed at expanding services was met with fierce opposition from WPC’s German member association (ABDA) for failing to address the “stagnation of dispensing remuneration”, leaving no room for service expansion.
Extreme market pressures are also evident in the United States, where Pharmacy Benefit Managers (PBMs) dominate the market, influencing and controlling drug pricing, remuneration and market behaviours. Unsustainable payment models are driving closures, with national research from the University of Southern California showing the first neighbourhoods to lose their pharmacies are often predominantly Black, Latinx, and low-income, creating “pharmacy deserts”. A similar theme emerges from Israel, where each of four privately-run Health Maintenance Organisations (HMOs) prohibit pharmacies from serving patients who are not insured through their organisations, creating an inefficient system and inequitable system for patients and pharmacies.
New Zealand faced a potential self-inflicted wound when a government plan to extend prescriptions to 12 months threatened to cut pharmacy income by more than the baseline annual uplift in remuneration. While the change does not alter dispensing frequency, it results in an increase in the number of repeat dispensings, for which New Zealand pharmacies receive a lower fee. After intense advocacy, in November 2025 the Pharmacy Guild secured a commitment to fully mitigate this loss. However there remains a chronic underfunding issue where pharmacy funding has lagged almost 20 per cent behind inflation over the last 18 years.
In Denmark, a new economic reform has created internal inequities, disproportionately disadvantaging smaller pharmacies. The national association’s challenge is to secure more funding while managing a difficult internal redistribution.
Compounding pharmacy’s financial pressures — and diverting resources and attention away from standard care and new services — is the escalating global crisis of medicine shortages. This worldwide issue results in a daily struggle that consumes vast amounts of staff time without compensation, and highlights inefficiencies due to pharmacists’ limited authorised scope of practice to substitute, even where continuity of care is critical.
A 2025 survey in England found 87 per cent of pharmacies deal with supply issues daily, with 73 per cent reporting direct risks to patient health. The problem is even more acute in bureaucracy-heavy Germany, where pharmacy staff spend an average of nearly 24 hours per week managing shortages. According to the Pharmaceutical Group of the European Union (PGEU), the average time spent per pharmacy on shortages across the EU has tripled in a decade, to a new high in 2024.
A wealth of research and success stories from across the WPC membership prove that when properly integrated and funded, pharmacies deliver immense public value.
Community pharmacies around the world are ready to do more, but as the first point of contact for millions and in the midst of worsening medicine shortages, pharmacy’s own financial health must be secured first. The community pharmacy sector must be viewed not as a cost centre, but as critical healthcare infrastructure to secure and expand for the benefit of equitable patient access and efficient healthcare systems. Simply put. Spending on health should be seen as an investment, not just as a cost.
The World Pharmacy Council’s Sector Analysis Report 2025 is available to read in full at wpc.ie.
The 2025 edition of annual World Pharmacy Council’s Sector Analysis Report has recently been published and can be accessed at wpc.ie. It provides an overview of community pharmacy practice, regulation, trends, opportunities, research and statistics, focused primarily on the twelve WPC member countries as at September 2025 — Australia, Belgium, Canada, Denmark, Germany, Ireland, Israel, New Zealand, Portugal, Spain, United Kingdom and United States of America.
The feature section of this 2025 edition relates to the Economic and Social Value of Community Pharmacy. By quantifying the effect community pharmacies and community pharmacy services have on overall health system costs, health outcomes and economic productivity, the community pharmacy sector can ensure it is viewed not as a cost centre, but as critical healthcare infrastructure to secure and expand. The feature section highlights evidence generated through major studies in countries such as Portugal, Finland, and the United Kingdom — each demonstrating, the substantial positive effect that community pharmacies have (and can have), on health systems, national budgets and the economy.
I would encourage IPU members to read this report, which provides valuable insight into the expanding scope of practice for pharmacists worldwide.
Tom Murray, IPU President and WPC Treasurer
Recent WPC publications
Position Statement: Dispensing & Core Funding – available at worldpharmacycouncil.org/research
Position Statement: Medicine Shortages — available at worldpharmacycouncil.org/news, go to 29 January 2024
Stephen Armstrong
Chief Economist, World Pharmacy Council
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