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Only one-third of pharmacies will be able to meet new Pharmacy First ‘bundling’ threshold requirements that are coming into force this year, according to report by the Company Chemists’ Association (CCA).
In its report, published on 2 June 2025, the CCA said that “latest data from February 2025 suggest only 3,429 of pharmacies provide each of the three services bundled for payment”.
Under the two-year community pharmacy contract, announced in March 2025, pharmacies need to provide Pharmacy First, the pharmacy contraception service and the hypertension case-finding service from June 2025 to qualify for monthly Pharmacy First threshold payments.
Pharmacies must also provide at least one ambulatory blood pressure monitoring (ABPM) measurement per month from October 2025, which involves a patient wearing a measuring device for 24 hours to regularly measure their blood pressure.
While pharmacies can continue to be paid for each individual service, the requirement to provide all three for the threshold payments means “delivering Pharmacy First may become financially unviable”, the report said.
In the report, the CCA also noted that providing at least one ABPM check per month will be challenging owing to low patient acceptability.
“It is a much greater patient commitment to undertake ABPM, than to receive a single blood pressure check,” it said.
“Patients need to wear a measuring device overnight and return to the pharmacy for a follow-up appointment.
“This is challenging for many pharmacies due to the nature of how patients access their services,” the CCA said, adding that pharmacies reach people in an ‘ad-hoc’ manner, which is more suited to opportunistic checks.
As a result, the report said that an alternative could be to offer patients home blood pressure monitoring (HBPM).
“ABPM is the most reliable way to diagnose all cases of high blood pressure and should remain the preferred route. However, where patients are unable or unwilling to accept ABPM, in line with NICE [National Institute for Health and Care Excellence] guidance, the use of HBPM would allow these patients to benefit from a confirmation of diagnosis and any resultant treatment,” it said.
HBPM involves a patient taking several measurements; however, they do not need to wear the measuring device for 24 hours.
“Patients may prefer to purchase or borrow a simple home blood pressure monitor and would not need to return to the pharmacy,” the CCA said.
“To ensure the patient pathway is complete, the pharmacy could follow up with the patient directly, in the same way they do for the new medicines service. Results could be provided via a phone call, simplifying the patient experience,” it added.
In its report, the CCA also acknowledged that it is expected that the upcoming emergency contraception service, which is due to be introduced later in 2025, will be included in the bundling payments.
“Emergency contraception is one of the most frequently accessed locally commissioned pharmacy services. Adding this service to the national contract will dramatically increase patient access, whilst simplifying the patient journey. It is expected that there will be considerable patient-led demand for the expanded contraception service,” it said.
However, the CCA asked for details of the service to be shared “as soon as possible”, to allow pharmacies sufficient time to prepare.
Commenting on the report, Alastair Buxton, director of NHS services at Community Pharmacy England, said: “Data we have indicates that the majority of pharmacies are already signed up to provide all three of the services, but the Department of Health and Social Care (DHSC) has been insistent in negotiations that ‘service bundling’ is non-negotiable if pharmacies are also to continue to be able to access fixed monthly payments for Pharmacy First.
“When the hypertension case-finding service was first being negotiated, we proposed home BP monitoring as an alternative, where patients couldn’t tolerate ABPM. That was not something that NHS England would agree to at that time, but we pushed the issue again in the last round of negotiations, and as indicated in the joint letter to pharmacy owners, they have agreed to revisit their position on the potential to use home BP monitoring within the service.
“Updating the pharmacy contraception service documentation to include emergency contraception was the first priority following the agreement of the funding settlement, and we have been working with NHS England and [the] DHSC to get this done over the last few weeks. All parties want to get the updated documentation published as soon as possible, and we expect it will be finalised and published in the next week or so.”
A spokesperson for the DHSC said: “After years of neglect, we inherited a pharmacy sector on the brink of collapse — and delivered the first real funding increase since 2014, investing £617m over two years.
“Community pharmacies are now receiving an enhanced payment for ABPM, with fees increasing by 13% to £50.85, strengthening pharmacies’ role in early detection of cardiovascular disease.”
