Opinion: Lack of IP ambition sours CPCF settlement

So we eventually have a community pharmacy funding agreement for this year. In fact, the ink on the deal is still wet as I write this, but I have had a chance to digest it and look closely for the good, the bad and the ugly in the detail.   

Having spoken to friends and colleagues, the overwhelming response seems to be that it is better than we had feared, but not quite as good as we had hoped. A quantum leap from £3bn to £6bn in core funding was never going to happen, regardless of the noises that some have been making. This was always going to be about incremental change – and so it proved.

The good 

Let’s start with the good. The funding increase of 10% was probably above most people’s expectations. From what I can see, it will virtually all go into supporting medicines supply, either through margin or the single activity fee. This is important, because it has been a real pressure point for contractors with prescription numbers going up (although not quite as fast as the price
of ramipril). This should certainly help.

The inclusion of independent prescribing is an important milestone in the development of the national contract, while the ability to close pharmacies for four hours a month to finally have some time to train staff members is also very welcome. Training new joiners in particular has been impossible for the last few years due to the workload strains of rising prescription numbers and increasing patient demands. Now we can finally give our teams some attention.

The bad

The continuation of the annual box-ticking exercise that is the PQS is unsurprising but it really doesn’t add any value. The only good thing you can say is that at least it has been considerably trimmed down and shouldn’t be too taxing for pharmacy teams to complete.

The other big question is medicines margin: £500m didn’t work, neither did £800m, nor £900m – and I doubt £1.1bn will either. How long are we going to continue to flog this dead horse?

Every time we are told that margin has been over-delivered I can feel the collective roll of thousands of eyes; nobody believes the outputs. Will the extra £200m find its way to contractors’ bank accounts? I’m not convinced.

The ugly

Returning to prescribing, I’m really pleased to see that there will be a national service, but the details are so sketchy that maybe for once we can get some collective unity on the issue.

Firstly, the ambition. Adding a prescribing element to Pharmacy First and the contraception service, while low risk, is also a frustratingly low reward option. Why will anyone get excited about writing a prescription when they could use a PGD and take on less clinical and professional risk? 

The new clinical conditions are at best niche, apart from respiratory tract infections, which has the potential to be both a major service addition but also a big risk. Also, we cannot have the same situation as we do with regular Pharmacy First consultations where some patients don’t meet the threshold. If you are conducting a prescribing consultation correctly, you should be making a full patient record each time, which means you should be paid for each consultation regardless of the outcome.

In fact, incentivising medicines prescribing is a bad precedent to set. Prescribers need to use their professional judgement to decide what is appropriate and what is not. Using the same sort of pathway/gateway approach as the rest of Pharmacy First will not wash.

Reform vital

Looking at the deal in the round, the most important thing for me is the promise of a reform programme, which will hopefully allow us to deal with some of the broken elements of this contract. 

The Government cannot expect unlimited dispensing for a fixed fee, it cannot continue to pile additional work on pharmacy without uplifting core funding, and it must make changes to the margin system as nobody has any confidence that it actually works. The new deal is a start – but there remains much work to do.

* Alexander Humphries is the pen name of a practising community pharmacist. The views in this article are not necessarily those of Pharmacy Magazine. What are your views on the contract settlement for 2026/27? pm@1530.com