Future of community pharmacies

Since April 2013 NHS England has held responsibility for commissioning NHS primary care services, including community pharmacy services. Clinical commissioning groups (CCGs) and local authorities are also free to commission further services from community pharmacies over and above those commissioned by NHS England.

Community pharmacies in England provide services under the NHS Community Pharmacy Contractual Framework (CPCF), and can include a range of services categorised as ‘Essential’, ‘Advanced’, ‘Enhanced’ and ‘Locally Commissioned’:

• Essential services include dispensing medicines and appliances, providing advice on self-care and promoting healthy lifestyles.
• Advanced services could include the provision of Medicine Use Reviews, or offering NHS flu vaccinations.
• Enhanced services could include services such as anticoagulation monitoring.
• Locally commissioned services might include public health services commissioned by local authorities, such as smoking cessation services.

While pharmacy contractors must provide Essential services, they can choose whether they wish to provide Advanced and Enhanced services.

The CPCF for 2019/20 to 2023/24 came into force from 1 October 2019. This commits £2.592 billion each year to community pharmacy. Additional funding has been available to community pharmacies for flu vaccination and the medicines delivery service, and during the pandemic for Covid-19 vaccination and test collection services.

The National Pharmacy Association report ‘Impacts of current funding, policy and economic environment on independent pharmacy in England’ published in September 2020 provides the following summary of funding arrangements:

• NHS England accounts for c. 87% of revenues received by pharmacy services in the UK, with other income coming from additional services commissioned by local authorities and OTC [over the counter] sales.

Developments since the NHS Long Term Plan

Paragraph 4.21 of the NHS Long Term Plan (January 2019) noted that pharmacists will have a key role in delivering the objectives of the NHS in England over the next 10 years, and provided the following on community pharmacy:

In community pharmacy, we will work with government to make greater use of community pharmacists’ skills and opportunities to engage patients, while also exploring further efficiencies through reform of reimbursement and wider supply arrangements.

The Government note that the CPCF set out the ambitions for community pharmacy to be further integrated in the NHS by providing more clinical services, treatment for minor illnesses and relieving pressure on other parts of the NHS, including primary care. A PQ response in April 2022 noted that new clinical services have been introduced, including the Community Pharmacist Consultation Service where staff in general practices and NHS 111 can refer patients to community pharmacies for advice and treatment of minor illnesses.

The Discharge Medicines Service became a new Essential service within the CPCF on 15 February 2021. From this date NHS Trusts have been able to refer patients who would benefit from extra guidance around new prescribed medicines to community pharmacies, with the aim of reducing avoidable harm from medicines and hospital readmissions.

In recent PQ responses the Government has said it is currently negotiating with the Pharmaceutical Services Negotiating Committee on the expanded and additional services to be introduced in the fourth year of the CPCF.  These responses note that NHS England is investing a further £15.9 million over the next four years to support the expansion of frontline pharmacy staff in primary and community care, to provide increased access to educational, prescribing and clinical training and development opportunities for post registration pharmacy professionals to meet the needs of patients and local communities.

On 15 June 2022 NHS chief executive Amanda Pritchard announced that community pharmacies will be funded to spot early signs of cancer. This pilot will enable pharmacy staff who spot signs of cancer to directly refer people for scans and checks without needing to see a GP.

Under the Health and Care Act 2022, which received Royal Assent on 28 April 2022, every part of England will be covered by a statutory Integrated Care Board (ICB) and Integrated Care Partnership (ICP), in each of the 42 existing Integrated Care Systems (ICS) in England, bringing together NHS, local government and wider system partners to organise health and care services. ICBs will take on responsibility for most NHS services from July 2022, with a greater focus on closer working between NHS bodies. ICPs aim to promote integration between the NHS, local government, and other providers by producing an integrated care strategy for their area.

In June 2021 NHS England and NHS Improvement published an ICS Design Framework. This noted that ICS NHS bodies might also take on community pharmacy services commissioning.

Information on the impact of Covid-19 on community pharmacies can be found in the House of Commons Library debate pack briefing, Pharmacy and the impact of Covid-19 (March 2021). This was prepared ahead of a Westminster Hall debate on 11 March 2021. The briefing provides information on financial support provided to pharmacies during the pandemic, and the role of pharmacy in the vaccine roll-out.

In January 2022, the Pharmaceutical Services Negotiating Committee (PSNC), which represents NHS pharmacy contractors, produced a briefing on community pharmacy funding and capacity (PDF). The briefing stated that PSNC is calling for an uplift in funding, with “urgent attention… needed to maintain the system in its current form.”