Deborah Evans FFRPS FRPharmS FRSPH, Managing Director of Pharmacy Complete, investigates what the new community pharmacy contractual framework (CPCF) means for pharmacy.
The CPCF was announced in July with a five-year funding deal. This funding is welcomed and provides some stability for contractors by knowing the global sum (£2.592bn per year) available. However, with no planned increase to allow for growth in demand or inflation, and 20% lower than 2015/16, the new deal will not alleviate the cashflow and profitability issues faced by many contractors, making future investment challenging. Further still, the establishment allowance will be phased out, meaning pharmacies will no longer receive money for simply being open.
Alignment of the CPCF with the GP contract is pleasing, with community pharmacy’s contribution recognised within the NHS Long Term Plan and an indication of potential commissioning for clinical services as a full partner in local Primary Care Networks (PCNs). This gives the opportunity for additional revenue and for pharmacy to be formally recognised working alongside GPs and others. Indeed, the GP Contract Network Directed Enhanced Service will require GP practices to engage and include community pharmacy from April 2020.
“Aside from integration into the PCNs, in many respects this is a contract in evolution”
Aside from integration into the PCNs, in many respects this is a contract in evolution. The basic structure remains, but most new services will take up to five years to be implemented.
One of the first changes will be a new Community Pharmacist Consultation Service replacing NHS Urgent Medicine Supply Advanced Service with referrals from NHS 111 for minor illness and urgent medicine supply. This is intended to relieve urgent care pressures. In the future, this service is expected to take referrals from GPs, NHS 111 online, Urgent Treatment Centres and A&E. Pharmacy will definitely be the front door of the NHS for many patients.
From April 2020, all pharmacies will be required to be a Level 1 Healthy Living Pharmacy recog-nising the importance the sector plays in prevention, providing wellbeing and self-care advice and signposting people to relevant services. This is where we are likely to see most development with a PCN Testbed Programme in detecting undiagnosed cardiovascular disease and referral to treatment, smoking cessation support following initiation in secondary care, a role in further immunisation and vaccination beyond flu, routine monitoring of patients on repeat medication, reducing antimi-crobial resistance and early cancer diagnosis. These services will take time to test, evaluate, com-mission and deliver.
Finally, pharmacy continues to play an important role in medicines optimisation with continuation of the New Medicine Service, potentially extending to new therapy areas. Pharmacy will maintain a critical role in patient safety with audits and training in a new Pharmacy Quality Scheme reflecting priorities within the GP contract. The Medicines Use Review Service is being phased out to reflect the Structured Medication Reviews that will be undertaken by clinical pharmacists working within the PCN. I am personally disappointed knowing the value these interventions make to patients, but it makes the connection between clinical and community pharmacists even more important.
Underpinning this contract is a belief from Government that there are still more pharmacies in some places than necessary, and that technology will drive efficiencies in dispensing. Pharmacies are cur-rently struggling with knowing how to move their business model from predominantly supply to clinical, many having cut workforce numbers as funding was cut. Over time we will see the money assigned to dispensing reduce, although £800m of the contract sum remains in retained profit margin. How this is managed is currently out for consultation, however pharmacy will con-tinue to work hard to procure medicines at as high a margin as they can.
Time for change
The sector must change. Time has to be freed up for pharmacists to undertake more direct patient-facing activity, meaning that the skill mix and development of the team becomes crucial, with dele-gation essential. Developing relationships within the PCN with GPs, clinical pharmacists, other pharmacies and providers will be critical. Shifting the business model to one that is less reliant on dispensing and the NHS will be vital for survival.
I predict fewer pharmacies, more dispensing hubs, increased online provision of prescriptions and pharmacies developing their business to include more private services, expanding their healthcare product provision and working together, much like GP Federations. Pharmacies developing their clinical provision, engaging with others and responding to the needs of their local populations will survive.
The pharmaceutical industry can play an important role in facilitating the change, responding to what pharmacy needs now and recognising the importance we play in transformation of the NHS.
Matt Hancock, Secretary of State for Health and Social Care said of the CPCF: “I am now delight-ed to set out this landmark 5-year settlement for the community pharmacy contractual framework which, from October 2019, will expand and transform the role of community pharmacies and em-bed them as the first port of call for minor illness and health advice in England.”
Go to www.pharmacycomplete.org