Community pharmacy in England

Funding

The Community Pharmacy Contractual Framework (CPCF) is an agreement between the Department for Health and Social Care (DHSC), NHS England, and Community Pharmacy England (CPE).

Agreed in July 2019, it set out a five-year deal for community pharmacies, guaranteeing funding levels until 2023/24. It provides £2.59 billion of funding, annually, to fund NHS pharmacy services in England.

Details of arrangements for year 4 (2022/23) and year 5 (2023/24) of the CPCF were announced in September 2022. New services were introduced, and some existing services were to be expanded.

In addition to the £2.59 billion of annual funding, NHS England commits to providing a non-recurrent additional investment of £100 million across years 4 and 5 to support contractors, through an increase to the retained medicine margin. The retained margin is a profit pharmacies can earn on dispensing medicines through cost effective purchasing. The government can allow for a greater retained margin, by deliberately setting the reimbursement price of a medicine above its cost price.

The agreement also recognised that there would still be unallocated funding in years 4 and 5, for future clinical services. This would be delivered to contractors through the delivery of new and expanded clinical services and further payment mechanisms.

The deal set out that no further clinical services, beyond those set out in the deal, would be introduced under the current funding envelope.

Community Pharmacy England has called for an “urgent uplift” in CPCF funding to “help businesses to cope with soaring costs being driven by inflation and the workforce crisis”. It also criticised the DHSC and NHS England for refusing “to move away from the five-year CPCF deal, despite the overwhelming evidence of the current economic pressures”.

Stakeholders told an Expert Panel, commissioned by the Health and Social Care Committee to evaluate government commitments in pharmacy in England, of their concerns about the CPCF. They highlighted that it had been agreed pre-pandemic, prior to current inflationary pressures and increased dispensing workload. They also noted that the agreement was partly based on efficiencies being introduced, such as automated dispensing processes, that have not been delivered.

Service expansion

There has been a growing recognition of underused potential in the community pharmacy sector. Community pharmacy’s clinical service offer has expanded in recent years, through a mixed provision of Essential, Advanced, National Enhanced and Locally Commissioned Services.

The NHS Community Pharmacist Consultation Service (CPCS) launched on 29 October 2019 as an Advanced Service. It aims to relieve pressure on the wider NHS by enabling general practice to refer patients with a minor illness or need for an urgent supply of medicine, to a community pharmacy. Under the year 4 and year 5 CPCF agreement, more healthcare settings are now able to refer patients into the CPCS.

In May 2023, NHS England published its Delivery Plan for Recovering Access to Primary Care. The Plan set out a £645 million investment, over two years, to expand services offered by community pharmacy. It committed to introducing a “Pharmacy First” service for patients, by the end of 2023. It would allow pharmacists to supply prescription only medicines for seven common conditions; sinusitis, sore throat, earache, infected insect bite, impetigo, shingles and uncomplicated urinary tract infections in women.

The Delivery Plan also set out a commitment to expand the Blood Pressure Check Advanced Service, and to expand the Pharmacy Contraception Advanced Service.

Workload and staffing

CPE has expressed (PDF) concern about difficulties in staffing pharmacies, an associated increase in staffing costs:

Many pharmacies are operating in crisis mode and are being forced to reduce the services that they offer to patients and local communities.

This has been caused by a number of factors including systemic pharmacy funding cuts of at least 25% in real terms since 2015. Workforce issues have also led to locum pharmacist costs rising by 80% in the past year alone, and staffing costs overall have grown by close to 70% since 2015/16, with this expected to rise beyond 100% by 2024/25. Compounded by the rise in energy bills, inflationary pressures, rises in living wages and increasing instances of dispensing medicines at a loss due to market and pricing issues, the current financial situation is unsustainable.

Pharmacists in general practice

The Additional Roles Reimbursement Scheme (ARRS) was introduced in England in 2019, as part of the government’s manifesto commitment to improve access to general practice. Through the scheme, Primary Care Networks can claim reimbursement for the salaries of 17 roles (including pharmacists) that are set within the multidisciplinary team.

The scheme was initially intended to recruit up to an additional 20,000 FTE posts (across all the roles), over five years. This target has since increased to 26,000 FTE by March 2024. In May 2022, the government reported that it was “on track to deliver 26,000 more primary care staff” by March 2024.

In July 2023 there were 1,696 pharmacists working in GP practices in England (full-time equivalent). This has increased from 1,021 in June 2019. There were also 445 pharmacy technicians working in GP practices in July 2023.

The annual Community Pharmacy Workforce Survey provides information on workforce and vacancies. The 2022 survey showed that the number of full-time-equivalent (FTE) pharmacists was 17,843. There was a 6% reduction in the FTE workforce in 2022 compared with 2021.

Meanwhile, the vacancy rate rose in 2022. The vacancy rate is a measure of how many posts are not filled and is the best estimate of shortages. The vacancy rate for pharmacy technicians was 20%, while it was 16% for pharmacists and 9% for dispensing assistants. Overall, there were 3,381 FTE vacancies for pharmacists in 2022.

Some community pharmacists and pharmacy owners have reported sustained difficulty in securing locum pharmacists. Additionally, they say that a shortage has led to unsustainably high locum rates. They cited pharmacist recruitment into general practice as one of the reasons behind this, but also cited Covid-19 disruption, higher salaries resulting in people working fewer days, poor working conditions and lack of support with increasing workloads.

NHS England has said the ARRS will be reviewed in 2023/24 to “ensure that it remains fit for purpose and aligned to future ambitions for general practice”. In the NHS Delivery Plan for Recovering Access to Primary Care (May 2023, PDF), DHSC and NHS England said it would review and evaluate the ARRS, as part of its wider work on primary care, “to inform future options that could apply from 2024/25 onwards”.

Pharmacy closures

Data from the NHS Business Services Authority (NHSBSA) shows that there were 11,500 active community pharmacies in England in 2021/22, which was the lowest number since 2015/16. It said that in 2021/22, 308 new pharmacies opened and 418 closed.

More recent data was given in response to a Parliamentary Question in July 2023, where the government said that the number of pharmacies reduced by 222 between December 2022 and June 2023.

The reasons being cited for these closures include inadequate funding, rising operating costs and difficulty recruiting and retaining community pharmacists.

There has also been concern about the rate of temporary pharmacy closures where contractors have not secured a pharmacist to work part or all of the day, particularly among large pharmacy chains. A November 2022 article published by C+D magazine discussed possible reasons behind an increase in temporary closures. This includes a suggestions of a shortage of pharmacists, locum pay rates and working conditions.