Evolution of community pharmacy services in the European Union and beyond: a cross-country survey of 33 national pharmacy organisations

INTRODUCTION: Community pharmacy practice in Europe has evolved, expanding beyond dispensing roles to include preventive, counselling, and clinical services. However, evidence on the implementation, reimbursement, and regulation of these services across the European Union (EU) remains limited, especially after the COVID-19 pandemic. Understanding these developments is crucial to inform workforce planning, funding frameworks, and the integration of pharmacists into primary care. With limited healthcare resources, investing in pharmacy-based public health interventions leverages pharmacies' accessibility, geographic distribution, trusted patient relationships, and skilled workforce. AIM: This study aimed to update the mapping of community pharmacy services (CPS) across Europe, comparing 2025 data with pre-pandemic (2020) findings, and to examine trends in service provision, reimbursement, and regulatory barriers from a health policy perspective. METHOD: A cross-sectional survey was conducted among national pharmacy associations in all 27 EU Member States and six neighbouring countries (n = 33), to contextualise EU findings within the wider European pharmacy practice landscape. A previously validated instrument was used to collect data on 47 CPS, including implementation level and reimbursement status. Responses were validated through national review, and data were analysed descriptively and compared with 2020 results. RESULTS: Across the 33 countries, a median of 26 services per country was reported (range: 9-43). Using a consistent data collection instrument and methodology, 77% (n = 36) of mapped CPS were available in a greater number of countries in 2025 than in 2020. Notable growth was observed in vaccination (10-19 countries), medication reconciliation (7-15), and first-time dispensing interventions (11-16). Public reimbursement increased for 49% (n = 23) of services between 2020 and 2025, with the largest increases in vaccination (+ 5 countries), screening (+ 4 countries), and dose administration aids (+ 3 countries). Despite this progress, variation between countries persists, alongside regulatory and operational barriers (remuneration, workforce capacity and interprofessional integration). CONCLUSION: Since 2020, CPS have expanded across Europe, with wider availability and, in some cases, progression from pilots or individual provision to national implementation. Wider and more sustainable implementation appears to depend on supportive regulatory frameworks and public remuneration.