The NHS plan proposes a much wider role for community pharmacies - and this is long overdue, says Nick Bosanquet

Of mall the immediate access services in the NHS - accident and emergency, ambulances, GP services, NHS Direct, walk-in centres and NHS Online - community pharmacy is the least known and the most widely used.

And there are many possibilities for extending its role in conjunction with primary care groups, primary care trusts and local health groups.

Community pharmacists are paid on the basis of an NHS contract held by health authorities. Any extension and development of the contract needs to be aligned to the core priorities for the profession and build on its strength in closeness of relationship to patients, not least to elderly people.

The key priority is to allow pharmacists to redefine and widen their core business. When the contract was first set, their core business was dispensing, and the contract was set in relation to this.

Now the key issue is building dimensions to the contract which will allow pharmacists to maximise their contribution to health improvement. Management of repeat prescribing is another priority. Pharmacists can make a major contribution to quality - and not just to managing cost.

The NHS plan proposes that new contracts for pharmacy services will be piloted by personal medical services schemes. And NHS Direct will refer callers to pharmacies and be able to arrange delivery of prescriptions. It also envisages pharmacists taking on a new role as 'they shift away from being paid mainly for individual prescriptions'.

The profession should aim to change perceptions of community pharmacies within the next two years. They should be seen as making a distinctive and vital contribution to the wider NHS objectives set out in the health improvement programmes in bettering outcomes and health status, especially for the most deprived in the population.

They should also be seen as an important resource in advice-giving, able to reduce demand on the NHS for minor ailments.

Accessibility is a key advantage of community pharmacies. No appointments are necessary to see a pharmacist, and their premises are open far longer than surgery hours. Pharmacies are widely distributed geographically and there is a strong loyalty and continuity of contact.

Community pharmacists could be the main centre for smoking cessation programmes, giving advice and providing gum and the nicotine patches for which there is a strong evidence base. This could also be linked to programmes for monitoring heart disease.

The community pharmacy could develop and systematise its role in advice-giving for minor infections and dermatology, making a crucial contribution to managing demand within the local health economy.

All types and size of pharmacists could take part in these activities, which are particularly relevant in deprived areas and health action zones.

They would show that community pharmacists could make a key contribution to the core mission of the NHS.

Other programmes, such as those pioneered in Scotland for monitoring medication, could easily be added.

1But smoking cessation, weight reduction and advice for minor ailments are relevant nearly everywhere and could involve a substantial amount of work.They would provide for joint development PCGs/local health groups/PCTs in a way that more specialised programmes for small groups would not.

Community pharmacies already provide an example of successful private/public partnership and this could be extended.

There should be a development fund of the order of£50m a year or£500,000 per HA to develop the new services. In addition, community pharmacies should aim to raise some funding from the larger pharmacy companies, the pharmaceutical industry, information technology/Internet companies and other sources to increase their resources.

It would not be unreasonable to look for another£50m from these sources.A prospectus for potential funders of the new programmes should be drawn up, with evidence of how the new activities could provide value for money for the NHS.

Community pharmacies could also develop Internet communication with clients, refine advice-giving for over-the-counter medicines, and make a stronger national case for the reclassification of more medicines.

They could also provide some linkage between the NHS and the expanding area of complementary therapies.

Community pharmacy could position itself as a leading force in improving outcomes and access. Changes in the contract will follow from the changed role and activity.