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.

Community Pharmacy England 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, the strategy was driven by some key principles including the 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, Community Pharmacy England have won significant improvements for community pharmacy on key areas such as:

  • The writing-off of previous funding over-delivery: Community Pharmacy England 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: Community Pharmacy England 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: Community Pharmacy England 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: Community Pharmacy England pushed for monthly payments to support ongoing capacity to deliver, and for an uplift in fees across all services. They were successful in their argument for a higher fee for Pharmacy First consultations and secured a £1,000 monthly payment, but despite their detailed costing rationale for an increase in the Pharmacy Contraception Service fee, this part of their bid was rejected by DHSC and NHSE.

  • Reducing activity thresholds at the start of the scheme: Community Pharmacy England 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: Community Pharmacy England 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: Community Pharmacy England 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: Community Pharmacy England 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, Community Pharmacy England 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 Pharmacy First will continue to work with NHSE, DHSC, LPCs and everyone in the sector to help make this possible.