The World Pharmacy Council (WPC) is the international representative body for community pharmacy in the developed world. In the majority of the countries we represent, community pharmacies are struggling under the weight of chronic underfunding and rising operational costs. This is a direct consequence of an unsustainable core funding model for dispensing.
For example, in three G7 countries – Germany, the United States, and the United Kingdom – the number of community pharmacies has been in decline for more than a decade. England alone has 800 fewer pharmacies than four years ago. Germany has lost more than 3,000 over the last 10 years, while since 2017 patients in the US now have 8,000 fewer pharmacies from which to choose.
With other parts of the health system also stretched to capacity, this is a public health crisis in the making, and risks dismantling one of the most accessible, trusted, and cost-effective pillars of our healthcare systems.
In September the WPC released its Position Statement on Dispensing & Core Funding, a call to policymakers and healthcare leaders around the world. The message is clear: dispensing is not a transactional task — it is a clinical service, and underfunding of this core role erodes patient safety, health equity, and the viability of community pharmacies.
Dispensing: the invisible safety net
All pharmacists know dispensing is not simply handing over a box of pills. It is highly regulated and evidence-driven, involving many steps including:
- A clinical review of every prescription for safety, efficacy, and suitability, catching errors that could lead to hospitalisations or worse.
- A thorough patient consultation to identify risks like adverse reactions, drug interactions, or adherence barriers — interventions that studies show prevent harm in one-third to onehalf of cases (PROMISe III Project, University of Tasmania, 2011).
- Extensive care coordination, particularly during high-risk transitions like hospital discharge, where pharmacists reconcile medications and prevent readmissions.
- Significant administrative and cost-containment tasks on behalf of patients and third-party payers, including through generic substitution and record-keeping.
- Ready and dependable availability of medications when patients need them.
Is this dose safe for a renal-impaired patient? Will this new antibiotic interact with the patient’s self-reported herbal supplement? Does this elderly patient’s confusion about their insulin pen require immediate intervention?
Every dispensed prescription involves clinical decisions which are often invisible, under-appreciated and therefore unvalued. Those clinical decisions often prevent early what otherwise can devolve into significant patient harm and costs to health systems.
Medications have never been a more important part of healthcare then they are today. Advances in science and technology allow patients to be treated with medications that not long ago would have required expensive and invasive hospitalisations.
Dispensing serves as the ultimate checkpoint before a medication reaches the patient. The interventions that occur during dispensing prevent hospitalisations, GP visits, or medication-related harm. Yet, despite this profound impact, payers and policy makers often view dispensing as a cost, not an investment in better care.
The domino effect of underfunding
When core funding for dispensing is inadequate, the consequences reverberate across the entire healthcare system:
Access and pharmacy ‘deserts’
In the UK, closures have been disproportionately high in rural and underserved areas – leaving communities without access to essential medicines and advice. This is also the case in my home country, the USA, where the term “pharmacy deserts” started to be used over ten years ago to describe areas where patients must travel unreasonable distances for care. Reduced viability does not always mean closure – similar effects can be felt through pharmacies being forced to cut hours, reduce staff, or remove services.
Shifted burden to GPs and hospitals
When pharmacies close or reduce services, patients turn to general practice and emergency departments for minor conditions and medication advice. This is inefficient, slow and very expensive. Underfunding dispensing is a bad investment. It doesn’t save money; it shifts more significant costs to more expensive parts of the system.
Worsening health inequities
Community pharmacies are uniquely positioned to combat the “Inverse Care Law”— the phenomenon where those who need healthcare the most receive it the least (Hart, 1971). A UK study — conducted before the most rapid decline in pharmacy numbers there — found while GP practices are less available in deprived areas, pharmacies are more prevalent (Todd et al., 2014). Closing pharmacies in these communities deepens health disparities, disproportionately affecting the elderly, rural populations, and low-income groups.
Erosion of public health capacity
The COVID-19 pandemic proved pharmacies are essential health infrastructure. From vaccinations to medicine supply chain resilience, pharmacies stepped up when other parts of the system were overwhelmed. Yet, without sustainable funding, their ability to respond to future crises — or even maintain current services — is at risk.
A funding model fit for the future
The WPC’s new position statement outlines five essential elements that must underpin core funding for dispensing to ensure viability, equity, and the productivity of health systems
Viability
Pharmacies cannot operate as charities. To be viable and continue to provide care for their communities they must also have core business fundamentals. Those include predictable revenue to invest in staff, technology, and expanded services. Dispensing is the core of community pharmacy, and funding for it must consider the business infrastructure cost and a sustainable return on investment
Responsiveness
Funding models must include automatic indexation for inflation and safeguards against erosion from drug pricing mechanisms. Without regular adjustments, pharmacy funding effectively goes backwards every year.
Equity
Funding must actively support pharmacies in rural, remote, and underserved communities to prevent access gaps.
Separation
Dispensing funding must be distinct from other services (such as vaccinations and medication reviews) to ensure investment in new services doesn’t come at the expense of core dispensing. Each additional service should be individually viable.
Efficiency
Administrative burdens — such as complex reimbursement processes — must be minimised to allow pharmacists to focus on patient care, not paperwork.
The WPC’s Position Statement is a roadmap for change. The starting point is for governments to formally recognise dispensing as a clinical service, not a logistical task. This means acknowledging the expertise, accountability, and patient safety outcomes that pharmacists deliver every day.
Flowing from this is the need for effective funding models that can then leverage community pharmacy as a strategic asset for the health system in each country. This is the key to unlocking pharmacy’s true potential to ease pressures on other parts of the system, reduce hospital admissions, lead public health and preventive initiatives, improve chronic disease outcomes, and optimise government’s stewardship of taxpayer dollars.
Investing in dispensing is investing in the health of our communities. The alternative — underfunding, closures, and a fractured healthcare safety net — is a risk we simply cannot afford to take.
The WPC’s full Position Statement on Dispensing & Core Funding is available at worldpharmacycouncil.org.
