The 2025 Sector Analysis Report has clearly shown two dominant, yet conflicting narratives are shaping community pharmacy worldwide: a rapid expansion of new services, and an urgent struggle for financial viability.
Across the 14 World Pharmacy Council member countries, governments and citizens have learnt lessons from the COVID-19 pandemic and are finally leveraging pharmacies’ unique position to alleviate pressure on primary and emergency care.
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. Seventy five percent of Canadians support expanding pharmacy services, and one in three actively chose pharmacy over another healthcare provider for broader healthcare needs beyond dispensing.
Public demand
Significant recent moves by Canadian provincial governments — the bodies responsible for healthcare regulation in each province — 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 — a central Canadian province — 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 which provide an extended suite of pharmacy primary care services at no charge to patients.
Alberta is a long-time global leader, having built a mature service model over 15 years. It recently saw its 1,700 pharmacies provide more than eight-million non-dispensing clinical services in 2023/24, an average of about 5,000 per pharmacy. These included comprehensive care plans (36 percent of the total), prescribing activities (31 percent) and vaccinations (25 percent). However, a step backward was seen in 2025 when Alberta discontinued public funding for most COVID-19 vaccinations in pharmacies, undermining a successful program which had administered more than 4.5 million doses.
Not only in Canada
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 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, 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, more than 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 — supporting patients and their families with acute common conditions which go beyond the standard Pharmacy First Scotland Service. In the last three years the proportion of the Scottish pharmacist workforce with independent prescribing rights increased from 23 percent to 51 percent.
The economic argument for expanding government-funded pharmacy services is compelling. In 2025, researchers from University of York modelled a potential GBP1.2 billion of savings and other benefits from expanding community pharmacy’s role in medicines optimisation — and a further GBP2.7 billion in health outcomes value.
This adds to growing 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 the public version of the Sector Analysis report.
European Union nations are also integrating pharmacies more deeply 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 when community pharmacies began providing SARS-CoV-2 (COVID-19) testing in Portugal — shifting it from hospitals and specialised centres into local pharmacies — access improved dramatically, with the average distance to a test site reduced by half. This echoed earlier Portuguese findings showing similar gains in accessibility when pharmacies delivered the seasonal influenza vaccination program.
Under severe threat
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 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 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, Latino, 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 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 of New Zealand secured a commitment to fully mitigate this loss. However, there remains a chronic underfunding issue where pharmacy funding has lagged almost 20 percent 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 difficult internal redistribution. Similarly, in Ireland, despite the new agreement there providing a welcome 10 percent average dispensing fee increase (the first in 17 years), further improvements are essential for long-term sustainability.
Global medicine crisis
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 which consumes vast amounts of staff time without compensation, and highlights inefficiencies due to pharmacist’s limited authorised scope of practice to substitute — even where continuity of care is critical.
A 2025 survey in England found 87 percent of pharmacies deal with supply issues daily, with 73 percent 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, the average time spent per pharmacy on shortages across
the EU has tripled in a decade, to a new high in 2024.
The future?
A wealth of research and success stories from across the WPC membership proves when properly integrated and funded, pharmacies deliver immense public value. Community pharmacies around the world are ready to do more; however, pharmacy’s own financial health must be secured.
To ensure sustainable and equitable patient access and efficient healthcare systems, the community pharmacy sector
must be recognised and supported as critical health and societal infrastructure, not merely as a cost centre.
