The announcement that England’s community pharmacies are to be paid £1,000 a month to provide the government’s Pharmacy First scheme from January 2024 was a shot of new income for the profession. Putting Pharmacy First for once feels like a welcome change of government policy.
Critically, more money has been made available to smooth this roll-out. This is welcome for a sector that has not seen significant national funding growth for some years now.
The government’s announcement on 16 November 2023 clarifies that “given the importance of establishing Pharmacy First on a sustainable footing, we have agreed that the historic over-delivery of fees in years three and four of the CPCF [community pharmacy contractual framework] of £76m will not be recovered in year five, as would otherwise have been the case”.
The announcement adds that there will be “no recovery of any over-delivery in year five CPCF fees of up to £36m”, which it says means that “large fee reductions to balance the five-year deal that would have impacted significantly on contractors’ income and cashflow are now avoided”.
Over-delivery on the final year of the extant contract will be keenly watched, clearly.
Now things get interesting.
Changes to the sector have continued unabated, with LloydsPharmacy’s sale of all of its community branches altering the shape of the provider landscape in community pharmacy. The company’s ironically-named owners, Hallo Healthcare, claim that 99% of premises will remain open: clearly, this is no guarantee of how long they will do so.
The Pharmaceutical Journal noted in October 2023 that LloydsPharmacy was operating almost 90% fewer pharmacies than it was in March 2022: there have already been significant disposals in the sector.
As I mentioned in October 2023, this change of landscape away from the dominance of the big chains has the potential for smaller independent chains or single pharmacies to innovate rapidly, and respond to new incentives or demands.
But the options for cost control in purchasing at scale available to big chains, including the essential utilities and rental, are not equally available to smaller groupings or single businesses.
There is also the question of whether the new owners’ business models will make the former LloydsPharmacy branches sustainable. Of potential note here is the rise of online pharmacies.
The sector faces multiple challenges. Mark Porter, a GP with a media career alongside his main job, used his latest Times column on 27 November 2023 to reflect on how general practice’s competition for trained pharmacists has contributed to current instability in the community pharmacy sector.
Equally, the potential administrative burden for the NHS from having more pharmacy businesses to manage, to say nothing of the increase in contract monitoring for over-performance and under-performance, will be interesting for a system in England that does not seem to have much spare management capacity.
The funding pot
This new income is coming from a capped pot. The financing offers a £15 item of service fee for each Pharmacy First consultation, in association with a monthly fixed payment of £1,000 from February 2024 for contractors who reach a minimum number of monthly clinical pathway consultations.
Evidently, the Department for Health and Social Care does not intend to pay for what is not delivered: this is good for taxpayers, patients and pharmacists. By 31 March 2025, contractors will also have to deliver the ‘Community pharmacy contraception service’ and ‘Community pharmacy blood pressure check service’ to qualify for the monthly payment.
The cap on the funding pot will have been at the insistence of HM Treasury. It remains to be seen whether the cap will be seen as a ‘target’, with community pharmacies competing to reach their ‘share’.
This may improve access to patients in the early months of the scheme: equally, there are risks of unintended consequences if the use is not ‘smoothed’ across the financial year.
The government announcement stated: “Pharmacy First can be delivered remotely where it is safe to do so, and with suitable safeguards to ensure face-to-face clinical assessment can be provided in person or by good-quality video consultation where needed.”
The scheme is launching in winter: always a time of maximum demand pressures for health services. One consequential issue — of which many will be more mindful of post-COVID — is that of infection control during the respiratory disease peak season. It would be an unwelcome and bitter irony if this welcome new initiative were to become an inadvertent vector of disease spreading.
Another limitation on many — and probably most — high street pharmacies is a common factor with primary care (and indeed dentistry): limited room for physical expansion to deliver more services.
All of these obvious issues should be fixable, with some planning and imagination. Increasing the provision of services in primary care without adding to GP workload is unambiguously welcome: so too is maximising the knowledge and skills of pharmacy professionals.
Now to make a success of it.
Andy Cowper is the editor of Health Policy Insight