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Community pharmacies have missed out on almost £10m in funding since the launch of Pharmacy First on 31 January 2024, analysis of NHS Business Services Authority (NHSBSA) data by The Pharmaceutical Journal has revealed.
Monthly data on the number of Pharmacy First clinical pathways consultations show that 9,600 pharmacies in England missed the consultation threshold to qualify for the monthly fixed payment of £1,000 between February 2024 and May 2024, totalling £9.6m in lost funding.
The monthly payment threshold for consultations has increased since the launch of the advanced service, which more than 90% of pharmacies in England, more than 10,500, have signed up to provide.
In February 2024 — the first month of the service — pharmacies had to provide one consultation to qualify for the fixed £1,000 payment. The NHSBSA data show that 1,553 pharmacies missed out on this, equating to more than £1.5m in funding.
In March and April 2024, the threshold increased to five consultations per month. In March, 2,347 pharmacies that had registered to provide the service missed the threshold, while in April, 2,271 pharmacies did not achieve the required numbers, equating to around £2.3m in funding per month.
Then, in May 2024, the monthly threshold increased to ten consultations. In that month, 3,429 pharmacies did not hit the numbers needed, equating to more than £3.4m in funding.
The threshold remained at 10 consultations per month for June and July 2024, and was set to increase to 20 consultations per month from August 2024.
However, Community Pharmacy England (CPE) warned in July 2024 that the thresholds had “been a topic of great concern for pharmacy owners and CPE” and announced that the Department of Health and Social Care (DHSC) had agreed that the threshold would be increased to 15 consultations in from 1 August 2024.
The threshold will increase to 20 consultations per month in September 2024, before rising to 30 consultations per month in October 2024.
Commenting on the lost funding, Ade Williams, director and superintendent pharmacist of MJ Williams Pharmacy Group and lead prescribing pharmacist at Bedminster Pharmacy in Bristol, said: “It is very disappointing that this has occurred, not least because, once again, community pharmacy has worked tirelessly to skill up, invested to create capacity to accommodate much-needed NHS care and find ourselves let down by the service specification and patient navigation design.
“Bearing in mind that the volume of patients presenting at community pharmacies across England continues to increase weekly, the question must now be asked: how were these thresholds set and on what evidence that they would be realistic and attainable?
“We must also reflect on why we seem to keep designing [services] badly; it continually undermines professional confidence and morale.”
Reena Barai, superintendent pharmacist at SG Barai Pharmacy in Sutton, Surrey, said the data needed addressing “urgently”.
“The channel shift of patients to community Pharmacy First will take a while. It is not appropriate to set threshold targets for activity on a service like this.”
Paul Rees, chief executive of the National Pharmacy Association, said: “We’ve been warning about issues with Pharmacy First thresholds for months now.
“Pharmacy First is a great idea, with potential to do so much more, but it was always going to take time to expand, particularly during the summer when people are away and sore throats are less of an issue.
“Ministers need to support the rollout of Pharmacy First and acknowledge the huge amount of work pharmacies do to ease pressure on the NHS by giving advice and support, mostly for free.
“We need to move to a system where pharmacies are properly paid for the vital support they give to their communities, not subject to the ebb and flow of demand with the seasons.”
Janet Morrison, chief executive of CPE, said: “The ability of pharmacy owners to meet the Pharmacy First monthly payment thresholds is a major ongoing concern, and the latest data highlights this burning issue.
“The change for August did help ease the situation for some, but we urgently need ministers to take further action to support pharmacies through the planned ramp up in thresholds for September and October. Amidst a funding crisis, community pharmacies cannot afford to lose out on this vital payment.
“It is our strongly held view that community pharmacy has carried out its side of the bargain in launching the Pharmacy First service, but NHS England need to match that commitment through more effective advertising and ensuring that GPs refer as many patients as possible.”
A survey by the Independent Pharmacies Association in March 2024 revealed that nearly two-thirds (60%) of pharmacists said they would struggle to achieve the minimum payment thresholds for Pharmacy First.
A spokesperson for the DHSC said that community pharmacy contractors have a three-month window within which they can claim payment for Pharmacy First consultations.
