Pharmacy First service and other changes agreed as Recovery Plan negotiations conclude

Community Pharmacy England has reached agreement with Government and the NHS on the launch of a new national Pharmacy First service as well as other changes to pharmacy funding and services.

Our Committee unanimously agreed to accept the deal which sets out how the £645 million investment pledged within the Delivery plan for recovering access to primary care will be used to support community pharmacy services.

The agreement follows many months of complex negotiations between Community Pharmacy England, the Department of Health and Social Care (DHSC) and NHS England (NHSE), with progress slowed at points by the complex matrix of Government stakeholders with whom DHSC had to consult.

Under the agreement, a new Pharmacy First service which includes providing advice and NHS-funded treatment, where appropriate, for seven common conditions will be launched on 31st January 2024 (subject to the required IT systems being in place) as an Advanced Service.

Consultations can be provided to patients presenting to the pharmacy as well as those referred by NHS 111, GPs and others. The service will also incorporate the existing Community Pharmacist Consultation Service.

In the consultations with a pharmacist, people with symptoms suggestive of the seven conditions will be provided with advice and will be supplied, where clinically necessary, with a prescription-only treatment under a Patient Group Direction (PGD). In the future, we hope that independent prescribers will be able to use their skills to complete episodes of care within the service, without the need for a PGD.

An expanded Pharmacy Contraception Service will also launch from 1st December 2023, and the Hypertension Case-Finding Service will also relaunch on that date with additional funding available to support both of these services.

During the negotiations, our strategy was driven by some key principles including our aim to incentivise sign-up for the new services, generate capacity, reduce risk for pharmacy owners and establish conditions for business growth. Through the negotiations we have won significant improvements for community pharmacy on key areas such as:

• The writing-off of previous funding over-delivery: We have negotiated a write-off of funding over-delivery worth £112 million for CPCF Years 3, 4 and 5. If this money had been re-claimed from pharmacy owners over a year, it would have resulted in a reduction in the Single Activity Fee of around 10 pence per item.
• Protecting baseline CPCF funding: We said the new money must be accessible as soon as possible rather than risk further over-delivery against Year 5 CPCF funding – the writing off of some Year 5 projected over-delivery supports this.
• The inclusion of an upfront payment for Pharmacy First: We secured an upfront payment of £2,000 per pharmacy ahead of the Pharmacy First launch to support pharmacy owners to prepare and build capacity for the new service.
• Increasing service fees: We pushed for monthly payments to support ongoing capacity to deliver Pharmacy First, and for an uplift in fees across all services. We were successful in our argument for a higher fee for Pharmacy First consultations and secured a £1,000 monthly payment, but despite our detailed costing rationale for an increase in the Pharmacy Contraception Service fee, this part of our bid was rejected by DHSC and NHSE.
• Reducing activity thresholds at the start of the scheme: We pushed for more achievable activity thresholds to give pharmacy owners the best chance of securing the monthly fixed payments for Pharmacy First and successfully negotiated down both the initial activity thresholds and the rate at which they will increase over the course of 2024.
• Supporting implementation now and for the future: We were clear that IT systems must be in place ahead of service launches and also successfully argued for greater use of skill-mix in the Hypertension Case-Finding and Pharmacy Contraception Services. Pharmacy owners will have access to clinical services IT systems which will send data to the NHSBSA’s MYS portal and to GP records, and allow more parts of the GP record to be seen. This is a significant step forward that will support the future development of community pharmacy services.
• Revised deadline for bundling of services: We delayed a proposed deadline for linking eligibility for the £1,000 Pharmacy First monthly payment to the provision of the Hypertension Case-Finding and Pharmacy Contraception Services given the capacity issues in the sector.
• Service caps: We have agreed a different approach to the cost control mechanism for the Pharmacy First service so that successful community pharmacies could continue to grow their service offer without losing out on fees.

The agreement, and in particular the introduction of the new Pharmacy First service, represents an important strategic step for community pharmacy. Successful roll-out will help to embed the sector as a vital part of primary care in the eyes of Government and the NHS, and it will once again prove that where they are prepared to properly pay for solutions, community pharmacy can offer them.

With more funding now available for these services, and given the political imperative to make them a success to help us all to build community pharmacy’s future together, we believe that community pharmacies should now support these services if they can and look to offer them at scale. This will be incredibly challenging in the current climate, and we will continue to work with NHSE, DHSC, LPCs and everyone in the sector to help make this possible.

Read the joint letter to community pharmacy owners from Community Pharmacy England, DHSC and NHSE

Statements from Community Pharmacy England

Janet Morrison, Chief Executive of Community Pharmacy England, said:

“For pharmacy owners who are struggling to keep their businesses above water, looking to the future is incredibly challenging.  But today’s announcement is a huge positive for the sector – it will allow new money to flow into pharmacies, building on the immense contribution they played during the pandemic offering accessible advice and support in every community. It creates the building blocks for a clinical future maximising the use of the skills and professional competence of pharmacists and their teams. Though it will not be an easy agreement to deliver on, it is the most significant investment into community pharmacy in many years and it was no surprise that the Community Pharmacy England Committee were united in their unanimous decision to accept the final deal.

“Our focus will now turn to getting the money flowing to pharmacies and to preparing our long-term strategy to improve the sector’s future. Pharmacy First will help with this strategy, laying the foundations for future clinical services and establishing the sector as an increasingly vital part of primary care, offering an open door for the public and patients, relieving pressure and releasing capacity in other frontline NHS services. This is the future that the sector told Nuffield Trust and The King’s Fund that it wanted, and this was backed by our own summer polling in which 86% of respondents said they were positive about delivering a Pharmacy First service.  We all now need to work together to make it a success, delivering real value to patients and the public using all our skills and capabilities.

“Alongside Pharmacy First, Government and the NHS have responded to our calls for additional funding for other services. While it is frustrating that the fees for the Blood Pressure Check Service and the new Pharmacy Contraception Service will not change, £75 million per year additional funding has been made available to support the expansion of these services. This means many more consultations are achievable without putting pressure on the core contractual sum, and we hope pharmacies will be able to offer even more valued support to patients. We will be working hard over the coming months with partners across the sector to promote these services and to make them as manageable as possible for pharmacy owners and their teams. And we will be carefully monitoring the uptake of services and funding delivery to protect pharmacy owners.

“This is a critical funding injection and welcome vote of confidence in our future from Government and the NHS.  It will not solve pharmacy’s funding crisis: we have been clear on that throughout this complex negotiation, and we continue to press for further investment through our influencing and advocacy work programme. Our Negotiating Team have been managing the very delicate balance between the need to get vital funds flowing into pharmacies as quickly as possible and the importance of getting funding on the right terms, setting down markers for what will be needed now and for the future. As a result of this hard work, the final deal has come a long way from what was originally put on the table, not least with the inclusion of upfront payments, bringing the new money into play faster without counting towards the ringfenced contractual framework, writing off fee over-delivery of over £100m, and making headway on IT integration, use of skill-mix and more.

“There is a lot of work going on to support the implementation of today’s agreement – the tripartite implementation group are working hard on the roll-out of the services, their technical infrastructure and funding as well as planning the national public communications campaigns for Pharmacy First. We are working hard to ensure that we can actively jointly manage the roll-out of the service to ensure it achieves its potential. Alongside this we hope to be back in the negotiating room soon to start discussing what the CPCF will look like from April 2024. We continue to call for an increase to core funding to safeguard the sector’s future health. The recent publication of the Vision for Community Pharmacy has helped to shape the investment case for the sector, with our Committee now drawing up a strategy to help build a sustainable pharmacy network that’s fit for the future.”

Fin McCaul, an independent community pharmacy owner, Community Pharmacy England Regional Representative for the North West, Negotiating Team Member and Chair of our Service Development Subcommittee, said:

“For all of us as community pharmacy owners, the idea of launching new services is a daunting one: we’re all struggling to get through each day and to survive from week to week. The hard-won £2,000 upfront payment for Pharmacy First was a must, as was reducing the thresholds for the monthly fixed payments, and over the coming weeks Community Pharmacy England will be working with LPCs to provide all the further support and guidance that we can to help.

“This is a service that needs to work: it is in line with our long-held ambitions as a sector, but it’s also strategically critical at a time when Government desperately needs to find some solutions to the GP access crisis. Making that happen, alongside surviving this winter, will be one of the biggest challenges that many of our businesses have ever faced. The upfront payment was critical for the service to have any chance of success, as are the IT connections and the moves to allow us to hand over more of the job to our teams. We were also cautious about the plans to ‘bundle’ or link Pharmacy First fixed payments with the Blood Pressure and Contraception Services and successfully argued for the date for this to be pushed back to reduce hurdles for us all.

“If we can make it work, the money these three services will bring, while not enough to solve all our problems, will undoubtedly offer a lifeline for some businesses. But the bigger prizes lie ahead: Pharmacy First will help us to position ourselves as an ever-more critical part of primary care, showing that we are able to respond positively to Government’s ambitions where we have the investment to do so. We will need to build on this in the years and negotiations to come.”

Peter Cattee, CEO of Peak Pharmacy, Community Pharmacy England Negotiating Team Member and Chair of our Funding and Contract Subcommittee, said:

“Throughout these negotiations we have been arguing for a re-assessment of the costs of providing services and stressing the need for core pharmacy funding to cover the spiralling costs that are crippling so many pharmacy businesses. Reflecting on the near decade-long policy to reduce pharmacy funding, it is perhaps unsurprising that our calls to increase some existing service fees were rejected. The upcoming independent economic review, as well as the ongoing Health Select Committee Inquiry, will give further opportunities for us to make these arguments loudly and clearly.

“These will be the focuses of our ongoing work, as will carefully monitoring delivery and funding of services, and continuing discussions on how to manage activity volume caps for Pharmacy First and other clinical services. This will be particularly important given the introduction of fixed monthly payments that are dependent on reaching activity thresholds, where service uptake is reliant on NHS marketing campaigns, and when predictions on the scale of this uptake are very uncertain at this point.

“What has become ever-clearer, politically, throughout this negotiation is that this service must be a success. Government and the NHS have indicated through their actions over the last decade they are content to squeeze pharmacy funding – no matter what evidence we give them, nor what unfolding crisis we warn of. But primary care needs this service, and Government and the NHS are willing to pay for it. We must make the most of this chance to embed ourselves further into primary care and build on it, alongside continuing to make the case for further investment and our strategic planning for the future.”

Stephen Thomas, Superintendent Pharmacist at Rowlands Pharmacy and Community Pharmacy England Negotiating Team Member, said:

“We entered these negotiations with a clear negotiating strategy and an ambition to get the promised money flowing into pharmacy businesses as quickly as possible. The complex nature of some of the discussions and of the cross-Governmental sign-off meant this has taken longer than we would have liked, but we have made significant headway over the past six months and shaped these services into something that should work better for pharmacy.

“We argued that funding needed to be generous enough to support the service and we also argued for higher fees to support capacity, whilst minimising the downside risks of unrealistic targets or cost control caps for what is a new service.  We also achieved agreement for active co-management of the service with DHSC and NHSE to monitor progress and trouble-shoot any barriers to delivery.

“The focus now is on delivery, which will be a huge challenge for all businesses in the current climate. The opportunity to make better use of skill mix will be vital for the Hypertension Case-Finding Service, and with more funding now available for it and for the new Pharmacy Contraception Service we do now believe that pharmacies should go ahead with providing these services as soon as they can. If we can show our ability to meet the Government’s clinical service ambitions this will help us to make the much-needed case for a better future for community pharmacy.”