CPCF settlement: 2019/20 to 2023/24

Funding will remain £2.592bn for each of 2022/23 and 2023/24. Community Pharmacy England submitted a significant amount of evidence on the financial and other pressures facing the sector, but our requests for a wider funding uplift were rejected. Community Pharmacy England is in ongoing dialogue with DHSC and NHS England about these pressures and will be working to seek monies from outside the CPCF to relieve the strains on contractors’ finances this winter.

Community Pharmacy England will publish indicative income tables when changes are made to help contractors to predict what their income is likely to be.

Payment deadline and timetable tracker
A tool to help keep track of how and when to claim for new services, including details of how these payments will appear on the Schedule of Payments.

Transitional payments

The arrangements for 2022/23 and 2023/24 include an extension of the Transitional Payment to recognise ongoing pressures. The Transitional Payment will continue to be paid in full to the sector with up to £70m allocated (to be paid in 2023/24 as a flat fee) and the remaining balance to be distributed with 75% related to services and 25% related to dispensing activity.

Drug Tariff changes

Crucially, £100m in over-earned margin will be written off for the sector over the two-year period of 2022/23 and 2023/24. This was a significant and hard-fought gain for the sector, and the £100m would have been lost to the sector had Community Pharmacy England not agreed to this deal. Rejecting this deal would have meant losing the £100m, which was not an option given the precarious financial position that so many contractors are now in.

This excess margin write-off means that Drug Tariff prices will be relatively higher in the New Year, allowing the sector to keep £100m that would otherwise have been paid back to Government.

Reimbursement reforms

Community Pharmacy England, DHSC and NHS England have agreed to the implementation of reimbursement reforms – splitting the Discount Deduction scale and Category A changes – to be completed by March 2023 (in line with previously published plans). DHSC has also committed to reviewing the implementation of the Price Concessions system.

Our Response to the DHSC consultation on community pharmacy reimbursement reforms

Economic review

Importantly, NHS England has committed to commissioning an independent economic analysis of NHS pharmaceutical services, to be carried out with Community Pharmacy England and contractors. This follows the significant concerns raised by Community Pharmacy England about the economic sustainability of the sector both through the CPCF Annual Review process and these negotiations, and it should help to inform future negotiations.

Earlier advance payments and PEPS

All community pharmacy contractors will have the chance to receive earlier advance payments from November 2021. This agreement came as part of discussions on the Pharmacy Earlier Payment Scheme (PEPS), which DHSC decided to end following the collapse of Greensill Capital. The option to receive earlier payments (for prescriptions dispensed from October 2021 onwards) should benefit all contractors, whether or not they had taken advantage of the PEPS.

PEPS pharmacy contractors should note that the final PEPS payments will be paid on 1st October 2021 and from 1st November, a 12-month transition arrangement has been agreed for existing PEPS pharmacy contractors to transfer over to the new earlier advance payment timetable available to ALL contractors from November 2021.

PEPS webpage

Early advance payments for all contractors following an end to PEPS

Pharmacy Access Scheme (PhAS)

An updated PhAS began in January 2022, to continue to support patient access to isolated, eligible pharmacies. Eligibility was reassessed based on the volume and distance criteria specified in the Drug Tariff. Payments changed to be set in bands based on a bell curve of dispensing volume, with a maximum payment set a £17,500 per year. The total budget allocation will not exceed £20 million per year.

PhAS webpage

The full list of pharmacies eligible for the 2022 PhAS can be found on the GOV.UK website.

Community Pharmacy England Briefing 033/21: Pharmacy Access Scheme starting from January 2022

DHSC guidance: 2022 Pharmacy Access Scheme

Pharmacy Quality Schemes (PQS) have also been agreed for the two years, giving contractors access to the full £75m funding in both years. The Year 4 PQS finally agreed has been reduced in scope significantly following representations made by Community Pharmacy England about the capacity of the sector and recognising the delayed start for the scheme, as a result of the Government’s slow progress on the approval of the overall Year 4 and 5 agreement. The Year 5 scheme is already agreed and once the fine detail has been finalised, the requirements will be published to provide contractors with advance notice ahead of the start of Year 5.

PQS webpage

Making a start on the new PQS 2022/23

Years 4 and 5 will see a phased rollout of service extensions and of the new Pharmacy Contraception Service (PCS) following representations from Community Pharmacy England that the sector is already overwhelmed and could not cope with multiple changes to services commencing at the same time. DHSC and NHS England have also agreed that no further new services will be introduced or expanded within the current CPCF funding envelope.

Key rollout and launch dates are planned as follows:

• January 2023: Launch of the initial tier of the new PCS – please note, the service will not start on 11th January 2023 as originally planned, but it is expected to commence in early 2023;
• March 2023: Expansion of the CPCS to include referrals from Urgent and Emergency Care settings;
• 4th October 2023: Launch of the second tier of the PCS; and
• From later in 2023 (date to be determined): Expansion of the NMS to include anti-depressants.

Pharmacy Contraception Service

Following a pilot involving pharmacies offering repeat supplies of oral contraception to people who had previously had the product prescribed, a Pharmacy Contraception Service will launch as an Advanced service in early 2023.

Initially the service will involve community pharmacists providing ongoing management of routine oral contraception that was initiated in general practice or a sexual health clinic; this is the Tier 1 service. The supplies will be authorised via a Patient Group Direction (PGD), with appropriate checks, such as the measurement of the patient’s blood pressure and body mass index, being undertaken, where necessary.

Subject to a positive evaluation of the ongoing pilot, from 4th October 2023, Tier 2 of the service will be introduced, which will enable community pharmacists to also initiate oral contraception, via a Patient Group Direction, and provide ongoing clinical checks and annual reviews.

Pharmacy Contraception Service webpage

Community Pharmacist Consultation Service (CPCS)

From March 2023, the CPCS will expand to enable Urgent and Emergency Care settings (hospital Emergency Departments and Urgent Treatment Centres) to refer patients to the service for a consultation for minor illness or urgent medicine supply. More detail to follow shortly.

CPCS webpage

New Medicine Service (NMS) expansion

From 19th April 2023, subject to positive evaluation of an ongoing pilot, the NMS will expand to include antidepressants to enable patients who are newly prescribed an antidepressant to receive extra support from their community pharmacist. More detail to follow shortly.

NMS webpage

Hypertension Case-Finding service

Hypertension Case-Finding was added to the CPCF as an Advanced service in October 2021. In the Year 4 and 5 agreement, to recognise the valuable skill mix that exists in community pharmacy, the service specification will be amended to allow provision by pharmacy technicians, in addition to the existing requirement for provision by pharmacists. Once a date for this change to take effect is determined, this will be announced to contractors on the page below.

Contractors who sign up to provide this Advanced service will receive a set-up fee of £440, then £15 per clinic check and £45 per ABPM. Additionally, there will be incentive payments funded from outside the CPCF envelope, which will be triggered when certain activity thresholds are reached: £1,000 is triggered by delivering 5 ABPM interventions in 2021/22, then £400 for 15 inventions in 2022/23, and £400 for 20 in 2023/24.

Hypertension Case-Finding Advanced Service webpage

Smoking Cessation Service

A Smoking Cessation Service will be added to the CPCF as an Advanced service from January 2022. In the Year 4 and 5 agreement, to recognise the valuable skill mix that exists in community pharmacy, the service specification will be amended to allow provision by pharmacy technicians, in addition to the existing requirement for provision by pharmacists. Once a date for this change to take effect is determined, this will be announced to contractors on the page below.

Contractors who sign up to provide this Advanced service will receive a set-up fee of £1,000, then £30 for the first consultation and £40 for the last consultation, with interim consultations paid at £10. This Advanced service will be most relevant to contractors already providing a locally commissioned service.

Smoking Cessation Advanced Service webpage

Discharge Medicines Service (DMS)

The DMS became a new Essential service on 15th February 2021. The service enables NHS Trusts to refer patients who would benefit from extra guidance around new prescribed medicines to their community pharmacy.

DMS webpage

Hepatitis C testing service

Hepatitis C testing became a new Advanced service on 1st September 2020. The service is focused on provision of point of care testing (POCT) for Hepatitis C antibodies to individuals who inject illicit drugs, e.g. steroids or heroin, but who haven’t yet moved to the point of accepting treatment for their substance use.

This service was decommissioned from 1st April 2023.

Service pilots

A range of new services will be piloted and introduced over the course of the five years to support the delivery of the NHS Long Term Plan. Whilst the pilots will be funded by the Pharmacy Integration Fund (PhIF), the introduction of new nationally commissioned services will be allocated funding from the overall contract sum as they are launched.

CPCF service development grid – a matrix document setting out when each of the agreed CPCF service development pilots may be implemented during the five-year deal.

Terms of service changes

As previously announced (see link below), all parties also agreed that contractor completion of an annual Health Education England (HEE) workforce survey would become mandatory, supporting the collection of better data on the sector’s workforce, which will assist workforce planning. To balance contractors’ workload, alongside the introduction of the mandatory workforce survey, the requirement to undertake an annual patient satisfaction questionnaire has been removed, meaning contractors no longer need to undertake this every year, effective immediately.

Terms of service changes: patient satisfaction and workforce surveys

Regulatory changes

There will be changes in market entry guidance within the Pharmacy Manual.

DHSC has also indicated that there will be legislative changes following the public consultations on hub and spoke dispensing and original pack dispensing, and that it will launch a public consultation on skill mix in pharmacies in due course.

Community Pharmacy England Briefing 017/21: Hub and Spoke dispensing

Education and training

In 2021/22, Health Education England (HEE) will be commissioned to provide a three-year programme of education and training for community pharmacy professionals, including independent prescribing training for existing pharmacists.

Also, from 2022/23, HEE will support the management of the training places in community pharmacy and responsibility for administration of payments to community pharmacy contractors for trainee pharmacists.