Martin Vlachynský // 31 March 2026

The EU healthcare challenge

Healthcare systems across Europe face a structural crisis. Ageing populations, staff shortages, and rigid competency boundaries are intensifying pressure on services across all member states. In Slovakia, there are around 20 people over the age of 70 for every nurse – a ratio expected to rise to 30 by 2030. Similar trends are seen throughout the EU.

No regulation alone will solve this crisis. Healthcare needs a scale-up – a consumer revolution like those in telecommunications, retail, or finance.

One of the most promising and underutilised levers in this transformation is the pharmacy network.

Pharmacies: an underused asset

Pharmacists are among Europe's most accessible health professionals, but most member states restrict their roles. Countries that have expanded pharmacy duties offer compelling evidence.

In the United Kingdom, a three-tier Pharmacy First model allows pharmacists to prescribe selected medicines, measure blood pressure, and take blood samples. A 2024 survey across five European countries found that 49% of consumers had visited a pharmacist instead of a doctor for health advice in the past year. Similar expanded competencies exist in Poland, Germany, and Switzerland, and pharmacy vaccination – from flu to hepatitis and HPV – has become standard practice from Denmark to Portugal.

Meanwhile, the Czech Republic has successfully liberalised the sale of over-the-counter (OTC) medicines in retail settings – a model that is well-tested, refined, and readily transferable.

Slovakia has one of the densest pharmacy networks in Europe, with 60% of people living within 5 minutes of a pharmacy. Slovakia has not expanded pharmacy roles as much, but new data show both a clear need and strong public demand for change.

What the Slovak survey found

INESS conducted a nationally representative survey of 1,086 respondents in September 2025. Four findings stand out.

Access to doctors is a widespread problem. Three-quarters of respondents needed a doctor’s appointment in the past year. Of those, more than one in ten failed to secure one at all, and another 43% only managed to do so with difficulty. This is not a problem concentrated in any single group – it cuts across income levels, regions, and age groups, though middle-aged adults and those with higher education report the greatest difficulties.

Pharmacies, by contrast, are highly accessible. Only 4% of respondents reported difficulty with the geographic accessibility of pharmacies – a remarkably low figure. Around one in four experienced problems with pharmacy opening hours, pointing to a gap that could be addressed by extending hours or introducing alternative access channels.

Supplementary pharmacy services are gaining traction. Around 14% of respondents have used supplementary services – such as blood sugar, blood pressure, or C-reactive protein (CRP) testing – at a pharmacy. Usage is notably higher (17–18%) among those who struggled to access a doctor, suggesting these services are already functioning as a partial substitute for primary care. Significant regional variation exists, with usage highest in western Slovakia and lowest in the east – a reminder that national averages can mask important disparities.

Public support for OTC liberalisation is broad and politically neutral. Two-thirds of respondents would welcome the ability to buy selected OTC medicines at supermarkets or petrol stations. Support is strikingly consistent across the political spectrum – 64–70% in favour regardless of political affiliation – signalling this is not a contentious reform.

Lessons and best practices for EU policymakers

There is no need to reinvent the wheel. Member states already differ widely in how they integrate pharmacists into their healthcare systems – and those differences are a ready source of tested, transferable solutions. The Slovak data, read alongside the wider European evidence, points to several actionable lessons.

Pharmacy accessibility is an asset, but it requires strategic activation. While dense pharmacy networks already exist across much of the EU, their full potential remains untapped. In areas where patients face limited access to doctors, pharmacies are increasingly serving as alternative points of care. Policymakers should ensure that regulatory and reimbursement frameworks evolve to reflect this practical reality.

Expanding pharmacy competencies requires formal frameworks, not just commercial initiative. Without formal qualification standards, defined service protocols, and structured communication channels between pharmacists and physicians, the quality and scale of these services will remain limited. The UK’s tiered model offers a replicable blueprint.

OTC liberalisation is low-hanging fruit. The Czech experience demonstrates that liberalising OTC medicine sales in retail settings is workable, popular, and safe. Slovak survey data confirms that public support is broad and politically neutral – and the template is ready to use.

Regional disparities matter. Even in a small country like Slovakia, significant regional variation in pharmacy service use exists. National policies should avoid one-size-fits-all solutions and target support to underserved areas.

Mind the access gaps. Young adults, low-income households, and people outside the formal labour market face the greatest barriers. Reform should be designed with these groups in mind, not just as a convenience for urban consumers.

Recommendations

Based on the Slovak survey and wider international evidence, INESS recommends:

• Expand pharmacy competencies through formal qualification standards and reimbursement frameworks, drawing on established models in the UK, Germany, and Poland.
• Create structured communication channels between pharmacists and outpatient physicians to support integrated, coordinated care.
• Liberalise OTC medicine sales in retail settings, using the Czech model as a tested and transferable template.
• Address regional disparities in pharmacy service access, particularly in rural and lower-income areas.

Europe’s local pharmacies are its most accessible health resource. Let’s put them to work.

This blog post is based on the INESS publication ‘Pharmacy Around the Corner? Survey of the Availability of Pharmacy Services in Slovakia (January 2026). Full methodology and detailed findings are available at www.iness.sk. INESS is the Slovak member of EPICENTER.