Andrew Lane on the Contractual Framework
02 Aug 2019
Following the announcement of the new Contractual Framework in England, the NPA's Andrew Lane urges independents to embrace change; but warns that pharmacies won’t be fit to deliver new services if starved of resources
We independents must fully embrace the clinical service agenda, which is our best hope for a change in fortunes from our currently precarious situation and the right thing to do for our patients.
Yet many pharmacies, worn down by funding cuts and escalating costs, are not in a position to invest in new services that would greatly benefit patients and the NHS.
So let’s be clear that the core funding for England’s pharmacies announced in July for the next five years is very unlikely to be enough to achieve the transformational improvements 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.
To ensure the service levels required for patients, 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, which 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 locally, to deliver high quality, compassionate care and reap the rewards professionally and commercially.
In contrast, the current system disadvantages independents, 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 (view our webinar here), which will incorporate the existing NUMSAS service and national rollout of NHS111 and GP referral into pharmacy, aligns with the NPA’s repeated calls for pharmacies to be positioned as the ‘front door to health’. If properly implemented, this service means patients will increasingly see community pharmacy as the first place to go for health services and will build confidence within the NHS that we are a solution to many key challenges that the health system faces.
As well as urgent care, the new settlement points to several prevention-focused services that are planned or to be tested – from detecting cardiovascular disease to point of care testing around minor illnesses. NPA members in London, Essex and many other parts of the country have shown themselves more than capable of improving access to health checks of various kinds.
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 still has a significant role in medicines optimisation; it won’t become the exclusive preserve of pharmacists based in GP surgeries, as some may have feared.
Yet, pharmacies are being asked, with static funding, to manage increased workload and absorb inflationary pressures such as increases in the minimum wage, pension contributions and new regulations. Lower volume pharmacies are going to be especially 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.
So it’s great that the NHS is seeing community pharmacy as the front door to health, but at this level of funding it’s 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 CPCS and transfer of care.
At the same time, this is yet another reminder of the importance of engaging with the NHS locally, via Primary Care Networks (PCNs). Pharmacies are well placed to support delivery of a range of services for which billions of new funding has been made available to primary care contractors (primary medical and community care resources will increase by £4.5 billion by 2023-24, under the new GP contract). The NPA has invested in new capacity to support independents to cooperate with one another on service delivery and to engage with PCNs effectively, as we recognise the vital importance of this local strand to service development.
The NPA is now examining the finer detail of the settlement and will advise members accordingly, as well as urgently considering our detailed policy response. We’ll advocate for more progress on areas not dealt with during the current round of negotiations. This includes reform of the concessionary price system to ensure that pharmacies are not dispensing at a loss. We also want a guarantee of full, accurate and timely drug reimbursement and payment of fees.
The journey to a more clinically focused future in community pharmacy is one we independents must, and should wish to take. We have a better chance of getting there if we take the journey together, and the NPA will be with our members every step of the way.
Andrew Lane is vice chair of the National Pharmacy Association