Let’s be clear. The core funding for England’s community pharmacies announced in July for the next five years is unlikely to be enough to achieve the transformational improvements both the NHS and pharmacists would like to see. For some pharmacies, it won’t even be enough to keep the doors open, unless other substantial sources of income can be found. The £2.59bn core funding needs to be a floor not a ceiling.
The funding model will be reviewed regularly over the course of the next five years and the balance between NHS expenditure on dispensing and new services is likely to shift significantly towards the delivery of services. This is something the NPA strongly supports.
Fundamentally, the shift to services implied in the new contractual framework for pharmacies in England presents an opportunity for independent pharmacies, who can build on the strength of their relationships with patients and others to deliver high quality, compassionate care and reap the rewards, professionally and commercially.
In contrast, the current remuneration system disadvantages independent contractors because the margin element of funding is not distributed equitably across the sector. There is now a public commitment from PSNC, NHSE and DHSC to achieve “smoother cash flow and fairer distribution of margin”, which could prove to be highly significant in time.
The introduction of the Community Pharmacist Consultation Service (CPCS) aligns with the NPA’s repeated calls for pharmacies to be positioned as the ‘front door to health’. As well as urgent care, the new settlement points to several prevention-focused services that are planned or to be tested – such as detecting CVD. This is welcome.
Although many patients will be disappointed to see MURs phased out, the prospect of a medicines reconciliation service and an expanded NMS signifies that community pharmacy will still have a significant role in medicines optimisation and it won’t become the exclusive preserve of pharmacists based in GP surgeries, as some had feared.
Yet pharmacies are being asked, with static funding, to manage increased workload and absorb inflationary pressures such as increases in the national living wage and pension contributions. Lower volume pharmacies are going to be hard hit by the removal of the establishment fee. Just when the NHS says it wants to make greater use of community pharmacists’ skills, many of our members are not breaking even, let alone in a position to invest in staff and clinical services.
It is great that the NHS is seeing community pharmacy as the front door to health, but at this level of funding it is likely that some of those doors are going to shut – permanently. The Government should be prepared to direct more money into community pharmacy to avoid uncontrolled closures or if it becomes clear that funding is insufficient to maintain new services such as the CPCS.