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A local pharmaceutical committee has advised local contractors not to attend training for or sign up to supply smoking cessation drug varenicline, as part of a new stop smoking service level agreement (SLA), owing to “inadequate” funding.
In an update sent to contractors on 14 February 2025, Community Pharmacy South Yorkshire (CPSY) said it did not support the varenicline patient group direction (PGD) supply service under the existing fee structure.
CPSY “strongly advised” contractors to not attend training or sign up for this element of the service “until the matter of fees is resolved”.
In November 2024, varenicline was made available for NHS patients — three years after it was withdrawn owing to fears over a probable carcinogen. The oral pill, taken once a day, was previously available in the UK under the brand name Champix (manufactured by Pfizer) and is now available as a generic product.
Local service commissioners are seeking to reintroduce the nicotine receptor partial agonist, which reduces nicotine cravings, by using a PGD from community pharmacies under stop smoking SLAs.
Despite CPSY’s request to address inflationary pressures, rising national living wage costs and the cost of providing a pharmacist-led intervention, the organisation said the fee structure for supplying varenicline had not increased for several years.
The remuneration fee for the initial supply of varenicline is £15.00 in Doncaster, with a £3.00 fee for follow-up supplies, and £20.00 in Barnsley, South Yorkshire and Sheffield, with a £2.50 fee for follow-up supplies.
CPSY said it had requested the varenicline element be excluded from the SLA until an agreement on fees had been reached with South West Yorkshire Partnership NHS Foundation Trust (SWYT), which is the lead provider for Sheffield, Barnsley, South Yorkshire, Doncaster and Calderdale, West Yorkshire.
However, CPSY said the trust had “gone against this advice” and that SLAs had already been issued in Sheffield and Calderdale, West Yorkshire.
CPSY described the offer as “inadequate”, with the £2.50–£3.00 fee equating to no more than five minutes of pharmacist time, making it “highly likely” pharmacists would be providing the service at a loss.
“This undervaluation does not fairly compensate for the clinical expertise, time and responsibility involved in supplying varenicline under a PGD. It not only fails to support contractors but also risks undermining the long-term viability of the service and could result in patient safety risks by not remunerating sufficient time to undertake a consultation.
“If SWYT reconsiders its position and offers a more appropriate fee that better reflects the professional input required, CPSY will reconsider our support for the service,” it added.
Vicki Roberts, chief executive of CPSY, told The Pharmaceutical Journal: “£3 does not cover a pharmacist intervention, particularly when you look at what the other national PGD intervention services are paying. Pharmacy First is £15 for a consultation. Emergency hormonal contraception services locally are now all commanding between £15–£20 per consultation.”
She added that CPSY had provided SWYT with an SLA for Rochdale, Greater Manchester, which is “paying £15 per consultation plus the drug cost on top of that”.
“We felt that was far more appropriate for this type of service. If [SWYT] wanted to acknowledge that the first consultation with the patient is likely to take longer, then we were quite flexible and happy to look at a higher fee for the first consultation and a slightly lower fee for the follow-on consultation, but no lower than £12 per consultation.
“I do understand that they’ve got really tight budgets… but in my view, there’s no point in offering a service that no pharmacy is going to sign up to.
“There’s been quite a lot of negative press about pharmacists providing supplies of medication inappropriately recently… here we are, in a situation where a SLA is unfairly and unreasonably remunerating a service which, if taken up by contractors, could result in patient safety concerns and/or contractors dispensing at a loss,” she added.
Roberts said that she did not know if any contractors had yet signed up to the stop smoking service.
SWYT said: “We have met with representatives from CPSY and Community Pharmacy West Yorkshire and explained how each of our smoke-free services are commissioned separately by the local public health teams in each geographical area. This means that contracts and financial arrangements can differ between areas.
“All of the contracts are negotiated based on different timeframes, with defined budgets, and on the specific needs of the local community. This ensures we provide value for money within the financial boundaries which are set, while maintaining service levels that meet local need.”
