The ongoing covid-19 crisis has taught Europe’s healthcare systems several important lessons. One of them is the need for effective organisation and deployment of primary healthcare to ensure the continuity of care within our communities.
In this ongoing covid-19 pandemic, the network of pharmacies near people’s homes is playing a vital role in supporting local communities. Community pharmacists are trained to provide high-quality reliable information to the public, and avoid unnecessary concerns, while relieving pressure on the rest of the healthcare system. They have been accessible 24/7, even during lockdowns, and have arranged home delivery services for the most vulnerable people to ensure continued access to treatments.
As recommended by the OECD, many European countries have introduced changes in legislation to expand the role of pharmacists and relieve pressure on the rest of the healthcare system. [1,2] Some countries have also secured additional funds to empower pharmacists in their vital work on the frontline against covid-19.
At the onset of the crisis, several countries implemented measures to guarantee the continuity of treatment for patients with chronic conditions and reduce the number of non-essential visits to primary care surgeries or hospitals. This was done by giving pharmacists the opportunity to renew repeat prescriptions for chronic medications and enabling the electronic transfer of prescriptions to pharmacies where this had not been implemented yet. In several countries, this also included the extension of the pharmacist’s scope to provide alternative solutions for occurring medicine shortages.
In countries such as France, Portugal, and Spain, community pharmacies have also been granted extended powers to dispense certain medicines which before were only accessible via hospitals. According to a Portuguese study commissioned to measure the value generated by this intervention, the survey respondents revealed an increased satisfaction level with the service provided by community pharmacies, compared to hospital pharmacies in every evaluated category: opening hours, waiting time, privacy, availability of the pharmacist and overall experience of the service. The study also shows that, in a post-pandemic scenario, 91% would choose to keep this service provided by the community pharmacy. 
Throughout the crisis, community pharmacists have been the first line of advice, treatment, and referral for many European citizens on common ailments, successfully preventing unnecessary visits to emergency rooms. In Scotland, pharmacists have been empowered in this role during the covid-19 pandemic through the extension of the Minor Ailment Service and increased access to Emergency Care Summary Data.  The NHS Pharmacy First Service allows community pharmacies to give people expert help for treating conditions such as sore throats, earache, and cold sores, along with common clinical conditions such as urinary tract infections. Pharmacy teams will offer advice, treatment, or referral to other healthcare teams if required. In order to help pharmacies cope with increased pressures from the coronavirus, community pharmacies were also provided with additional funding. 
Pharmacists know their patients and their families very well across generations and understand their social context and needs. They can combine technical knowledge with the “human touch”, to provide personalized healthcare. This makes their role in providing accessible patient-centred care within their communities more critical than ever, especially for the vulnerable groups in society. Examples from the covid-19 crisis include the extended delivery services of medicines from pharmacies to vulnerable patients’ homes and the support for victims of domestic violence observed during lockdowns. In countries such as Greece, the Netherlands, and Spain, community pharmacists have activated protocols to help those victims. It enables women who are in a situation of risk or danger to their physical, psychological and / or sexual integrity, to approach their trusted pharmacy and request a “Mask 19”. This code will then trigger the needed care protocol for these victims.
Another challenge healthcare systems have been faced with is the risk of a possible “twindemic” of both the seasonal flu and covid-19. In order to achieve a high uptake of the flu vaccination while ensuring that immunisation services can continue to be delivered safely and accessibly in the middle of a pandemic, healthcare systems have also granted expanded powers to community pharmacists in relation to dispensing and administering flu vaccinations. These include the supply of flu vaccines to at risk groups without the prior need for a prescription such as in Belgium and the launch of expanded pharmacist-delivered flu vaccination programmes and pilots in Germany, Greece, Ireland, Italy, and Portugal. Also for the roll-out of mass vaccination campaigns for covid-19, countries such as Ireland and the United Kingdom will make use of the accessible network of pharmacies to assist in the administration of vaccines in the community.
Amid these challenges it is vital to maximise the use of community pharmacy practice to meet patients’ needs and maintain continuity of services. Community pharmacy has demonstrated its value for patients and healthcare systems during this crisis and is ready to further expand this contribution as part of sustainable collaboration models with other healthcare professions in the community.
Alain Delgutte, PGEU President and member of the National Council of the French Chamber of Pharmacists (ONP)
Duarte Santos, PGEU Past President and member of the Board of the National Association of Pharmacies in Portugal (ANF)
Competing interests: none declared.