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Wales has begun the rolled-out of a community pharmacy prescribing service as part of reforms agreed by the Welsh health minister last December. Eluned Morgan approved wide-ranging changes following re-negotiation of the Community Pharmacy Contractual Framework with Community Pharmacy Wales, the representative body for community pharmacies in Wales. The roll out will allow appropriately trained community pharmacists to treat an extended range of conditions that currently require people to visit their GP. Initially pharmacist prescribers will be able to prescribe medicines, including antibiotics for acute illnesses like urinary tract and upper respiratory tract infections, and also prescribe routine contraception. The first of its kind in the UK, the service is being rolled out progressively across Wales, building on local schemes which are already in place.

In a compelling case for expanding the role of community pharmacies in the UK's vaccination efforts, a new report by a major think-tank has called on NHS England to designate all adult vaccinations as 'advanced services' under the next Community Pharmacy Contractual Framework (CPCF). Published in July this year, the report by Reform discusses the power of prevention and highlights the need to boost vaccine uptakes for better patient outcomes. Calling for the NHSE to allow the 'advanced services' to be routinely delivered by community pharmacies, the report highlights the proven capacity of community pharmacists to reach a wide demographic, particularly in underserved areas. It also emphasises on the strategic advantage of utilising community pharmacies which often have more flexible hours and remain open during the evenings and weekends, making them highly accessible to the public.

The Community Pharmacist Consultation Service (CPCS) will be expanded to enable urgent and emergency care settings to refer patients to a community pharmacist for a consultation for minor illness or urgent medicine supply from Monday (15 May), the DHSC and NHSE said. The service builds on the progress made in GP referrals via the CPCS and hospital referrals under the Discharge Medicine Service. It was originally planned to launch in March, and fee for this service will be the existing CPCS fee of £14, as per the agreement for both year 4 and year 5 of the Community Pharmacy Contractual Framework (CPCF) 2019 to 2024 5-year deal. In an update on the CPCF, published today (12 May), the Department of Health and Social Care (DHSC) and NHS England (NHSE) has also committed to the 4 October 2023 launch date for the Tier 2 of the Pharmacy Contraception Service, subject to a positive evaluation of the pilot. The Tier 1 of the service was launched on 24 April, delayed by over three months. This new service enables community pharmacists to provide ongoing management, via a patient group direction (PGD), of routine oral contraception that was initiated in general practice or by a sexual health clinic. The fees for this service are as follows: a fee for each consultation of £18; and a set-up fee of £900, paid in instalments. The Tier 2 will "enable community pharmacists to also initiate oral contraception, via a PGD, and provide ongoing clinical checks and annual reviews," Alette Addison, deputy director for pharmacy, dental and optical at the DHSC and Ali Sparke, director for dentistry, community pharmacy and optometry at the NHSE, said in a letter.

The Pharmaceutical Services Negotiating Committee (PSNC) has commissioned Nuffield Trust and The King's Fund to develop a new vision and strategic options for community pharmacy. The report is expected to be published in early summer next year, to underpin the future strategy for the sector. It will also support negotiations between PSNC and policymakers as the current five-year Community Pharmacy Contractual Framework (CPCF) comes to an end. Those negotiations will decide what happens after April 2024, and they will be critical to the future of the sector. The development of a compelling vision and an effective strategy for community pharmacy was a key recommendation from the Pharmacy Representation Review Steering Group (RSG). It forms one of the workstreams of the Transforming Pharmacy Representation Programme (TAPR) currently being undertaken by PSNC. But it is also a project that PSNC wants to undertake anyway to help lay the foundations for those crucial upcoming negotiations.

Pharmacy contractors, particularly those in England and Northern Ireland, faced an extremely challenging 2024. The general election delayed the new Community Pharmacy Contractual Framework (CPCF) negotiations leaving pharmacies in England having to endure further hardship, as a frankly unfit 2019 contract, was effectively extended. We have witnessed pharmacy closures on a weekly basis and it is clear that an increasing number of English contractors are struggling to pay their wholesaler bills on time. It is unacceptable that the Government have allowed this to happen. In Scotland and Wales settlements have factored in inflation, which is essential for the future. Whilst we should be cautiously optimistic about the NHS plan under the new Labour government, I'm acutely aware that the sector urgently needs an injection of cash to help offset the last five years of chronic underfunding. The next English CPCF must be inflation linked, the sector cannot absorb ever-increasing costs. Pharmacy teams already work incredibly hard to deliver care to their patients and communities.

The Challenges There cannot be anyone working in or with community pharmacy that either feels or sees the pain that emanates from the current operating climate. Pharmacy closures; increased workload and operating costs; increased patient and commissioner expectations; and, more fundamentally, an inadequate, undervalued and poorly structured remuneration and reimbursement contractual framework. As important as they are, we will not focus on these points here as they are not in the control of pharmacy owners and managers. They are the responsibility of those organisations that represent them at a national and local level who must deliver a better outcome as difficult as that may be. However, there are matters which are in the control of pharmacy owners and managers. These include their premises, their team, their systems and processes, their relationships with other healthcare providers and the broader community, their NHS and private service offer, and how they promote and deliver them to give the best patient experience. In order to create the head space to develop and implement a business plan, pharmacy owners and managers must make time to work on their business as well as in it. Then it requires the capacity and capability within their team to deliver the services and that excellent patient experience.

The tripartite negotiations to set the arrangements for the Community Pharmacy Contractual Framework (CPCF) in 2022/23 - Year 4 of the five-year CPCF deal - have now begun, the Pharmaceutical Services Negotiating Committee (PSNC) said. The discussions, beginning ahead of the start of the financial year, are taking place between the PSNC and the Department of Health and Social Care (DHSC) and the NHS England and NHS Improvement (NHSE&I). It will cover issues related to service, funding and other arrangements for pharmacies in 2022/23, in line with the five-year CPCF deal. The three entities will also discuss the progress made to date, which has been partly impacted by the Covid-19 pandemic, and the recent joint Annual Review process, where PSNC raised serious concerns around the available capacity within community pharmacy.

A full CPE Committee Meeting was organised in London on April 17 and 18, 2024, to discuss crucial sectoral issues. Key topics discussed during the two-day meeting included intolerable pressures on pharmacy owners, the ongoing Community Pharmacy Contractual Framework (CPCF) negotiations, implementation of the Pharmacy First service, and governance changes. Committee Members reviewed the progress of CPCF negotiations with the Department of Health and Social Care (DHSC) and NHS England. These critical negotiations are being led by the Negotiating Team (NT), which includes independent pharmacy owners and representatives of CCA and non-CCA multiples. The CPE has been advocating for an uplift to the core global sum, margin write-offs, an agreed mechanism for regular funding increases linked to activity and inflation, annual uplifts to service fees, more fundamental reform of the margin delivery framework and an economic review of the medicines supply chain. The Committee also discussed the results of the 2024 Pharmacy Pressures Survey, which was conducted during March and April.

The 2025/26 pharmacy contract consultation will include a review of the medicine margin and reimbursement arrangements, health and care minister Stephen Kinnock has confirmed. Kinnock made this statement in response to a written question from Nick Timothy, Conservative MP for West Suffolk, who asked the secretary of state for health and social care, if he will review the reimbursement system for pharmacies and GP practices dispensing medicines. Kinnock stated that consultation with Community Pharmacy England (CPE) for the 2025/26 Community Pharmacy Contractual Framework (CPCF) has started and will include "reviewing the allowance for medicine margin as part of funding, and any further changes to the reimbursement arrangements." However, he clarified that there are currently no plans to review the reimbursement system for general practices (GPs) dispensing medicines. Kinnock said: "Dispensing practices receive a dispensing fee, approximately £2.00 to £2.30 per item, which is intended to cover dispensing costs. "This fee is calculated based on forecasted volumes of prescriptions to be dispensed and the size of the funding envelope, according to a methodology agreed by the Department, the General Practitioners Committee (GPC), NHS Employers, and the Welsh Government."

It's no secret that as pharmacists we are navigating a new and more demanding healthcare landscape. Our role has changed significantly since the start of the 21st century due to increased expectations from the public, advances in science and technology and changing workforce pressures. The Community Pharmacy Contractual Framework for England has placed a higher focus on clinical service. In addition, the Covid-19 pandemic resulted in significant acceleration in changing how we work day-to-day and the public perception of our role. Community pharmacy owners and staff have been under relentless pressure for the last two years. Dispensing volumes are continually increasing but dispensing revenues are being replaced by launching new services. We must find solutions to reduce the time it takes to dispense medication so we can focus on these new revenue generating services. To not just succeed, but to thrive, it is becoming increasingly important to understand and embrace the technology available.

The Pharmaceutical Services Negotiating Committee (PSNC)'s members are seeking immediate rescue packages for the sector to help with energy bills and to ease capacity constraints. In a meeting held on 14th and 15th September, the committee members expressed their anger and frustration on the reluctance of NHS England and government to fund pharmacy sustainably. The meeting was held to consider practical steps to ease the pressures on the community pharmacy sector, and to oversee the progress of negotiations on the Community Pharmacy Contractual Framework (CPCF) and other work. Committee members, as pharmacy contractors, shared their experiences of the current pressures on all contractors, including the inability to deliver some services and to maintain core service levels; the capacity and workforce crises facing the sector; the critical need for funding support this winter; and the urgent need for Government to adapt the Price Concessions system to meet the needs of contractors. "The Price Concessions system is no longer working for contractors in the current volatile medicine supply environment and PSNC is clear this is not acceptable," said the committee.

The Pharmaceutical Services Negotiating Committee (PSNC) has expressed disappointment as the government continued to refuse to "a much-needed broader funding uplift" for the community pharmacies in England. This follows conclusion of the first Annual Review of the progress of the five-year Community Pharmacy Contractual Framework (CPCF) deal by PSNC, the Department of Health and Social Care (DHSC) and NHS England & NHS Improvement (NHSE&I). "We remain deeply frustrated by government's refusal to agree a much-needed broader funding uplift for the sector, but we are determined to continue to look for better ways forward for the sector throughout 2022 and beyond," said Bharat Patel, PSNC vice-chair, negotiating team member and an independent contractor. Patel noted that despite some important wins such as recognition of key challenges faced by pharmacies, the commitment to consider these as part of our Year 4 negotiations, and agreement to take forward work on service fee and other regulatory changes, the PSNC is disappointed that the review did not lead to "immediate and tangible outcomes and improvements for contractors." The negotiator had put forward data and analysis showing the capacity and cost constraints faced by pharmacies.

The Pharmacists' Defence Association (PDA) has written to the National Pharmacy Association (NPA) to highlight several important points regarding their proposed "day of action" on 20 June 2024. The NPA describes this initiative as a response to the "emergency across the community pharmacy sector." In a letter addressed to NPA Chair Nick Kaye and Chief Executive Paul Rees, the PDA's director of pharmacy, Jay Badenhorst stressed the need for NPA members to consider their obligations to staff and patients before participating in the planned actions. He stated, "We are supportive of a new contractual framework for the community pharmacy sector." "However, any actions taken must ensure the safety of patients and the operational integrity of pharmacies." The PDA's letter also expressed concerns over the safety and operational impact of the proposed symbolic gestures, including turning off lights and blacking out windows.

In its response to NHS England's consultation on 'the future of vaccination services', the Pharmaceutical Services Negotiating Committee (PSNC) has suggested that a wider range of NHS vaccinations being available from community pharmacies could support the achievement of increased vaccination levels. PSNC said: "Any additional services that contractors could provide can only be considered with additional remuneration above the current global sum in the community pharmacy contractual framework to ensure that the services are adequately resourced." Alastair Buxton, director of NHS Services at PSNC, said: "We've always known, and the evidence supports this, that community pharmacies are one of the most popular and accessible places for people to receive a range of vaccinations. "The NHS was slow to take advantage of this at the start of the Covid-19 pandemic, so we welcome this consultation from them to bring together a wide range of views on the topic. "In the longer-term, if the right funding and support is in place, many pharmacies could help deliver a much wider range of NHS vaccination programmes - giving the public the convenience and service that they want, and taking pressure off our general practice colleagues. It makes perfect sense, and we look forward to the NHS response to this consultation."

Pharmaceutical Services Negotiating Committee expects the next round of negotiations to set the arrangements for the Community Pharmacy Contractual Framework (CPCF) in 2022/23 - Year 4 of the five-year CPCF deal, to begin soon. The negotiator held a meeting on November 24 and 25 to discuss the burning issues affecting the sector and to plan for upcoming negotiations with the Department of Health and Social Care (DHSC) and NHS England and NHS Improvement (NHSE&I). It aims to complete these negotiations by April, allowing ample time for contractors to make arrangement prior to the beginning of the financial year. PSNC vice-chair, and independent contractor, Bharat Patel said the entire sector is worried about the "outlook for pharmacies as we head into a difficult winter," and is working to find solutions. He noted that PSNC "will be bringing proposals for additional funding and support, particularly around the treatment of 'walk-in' patients, to the table, along with a heavy dose of realism for government and the NHS about the current challenges in the sector." While expecting a difficult round of discussion with the government, Patel remained optimistic about a favourable outcome for pharmacies.

Pharmacy sales specialist, Hutchings Consultants has revealed its market predictions for the next 12 months in a new report. The broker is anticipating that both independent group operators and corporate owners will continue to reassess their existing portfolios in 2024, making strategic disposals of varying sizes. "This is likely to result in transaction volumes remaining high for the foreseeable future," stated the report authored by Paul Steet, Associate Director, Hutchings Consultants. Community Pharmacy Contractual Framework negotiations will be the most notable opportunity for the sector to capitalise upon this year, the broker said, adding that it's "a belated opportunity for the sector to secure a vital uplift to the contract's fixed global sum."

Pharmacy bodies are "bitterly disappointed" that the latest deal on the national contract makes no commitment to "fresh funding", with one organisation calling it "the biggest dis-service ever done" to community pharmacy. The only commitment made in monetary terms was one in which NHS England agreed to write off a sum of £100m in excess margin earned by contractors in previous years. This allowance, which can't be seen as new cash injection, was said to have been made in recognition of the pressures facing the sector. The figure - reached after what the the Pharmaceutical Services Negotiating Committee called "a tense period of negotiations" with the Department of Health and Social Care and NHS England - will cover the final two years of the current five-year Community Pharmacy Contractual Framework. The deal was announced by PSNC chief executive Janet Morrison at an annual LPC Conference in Manchester on Thursday (22 September). Welcoming the attendees, she assured everyone that the committee was well aware of the pressures the sector was facing. "I heard how contractors are feeling and their frustrations over growing pressure and lack of financial support from the government. They confirmed that many now are unable to deliver the full range of services, and others are struggling to maintain core levels of services. And the ongoing impact of capacity and workforce crisis is critical, leading to temporary closures.

Community Pharmacy England (CPE) CEO, Janet Morrison said that the negotiations for the £645 million investment pledged to community pharmacies in 2023-25 have concluded. The government's primary care recovery plan is to be announced in a "few weeks" and negotiations for the Community Pharmacy Contractual Framework (CPCF) from April 2024 will begin. She said: "We have finished the substantive discussions on the recovery plan but detailed discussions about implementation are ongoing and we are awaiting final clearance from the Government and the NHS. "We hope that we will be in a position to make an announcement in the next few weeks and that negotiations on the CPCF from April 2024 will commence soon after that." Morrison reminded attendees that the Primary Care Recovery Plan is "to improve access to primary care by investing £645 million over the remainder of the year".

The Company Chemists Association (CCA)'s workforce finding showed that by 2024 eight years' worth of growth of the pharmacist workforce will have been funnelled away from community pharmacies. "In 2019, when NHS leaders realised they were unable to find enough GPs to meet the public's needs, they hastily decided to recruit pharmacists and other healthcare professionals to fill the gaps. This was implemented without any corresponding efforts to increase the supply of pharmacists, creating huge shortages," said CCA. "The bulk of the NHS's recruitment drive was paid for using additional money ringfenced by the NHS - the £2.4bn Additional Roles Reimbursement Scheme (ARRS). We estimate over the life course of ARRS funding (2019-2024), the equivalent of eight years of growth in the number of pharmacists in England will have been funnelled directly into primary care at the expense of other sectors. At the current rate, CCA estimate that community pharmacy will have experienced the equivalent of three fallow years by 2024. To ensure the pharmacy network is protected and able to take pressure off other parts of the NHS, there are several urgent measures which must be implemented. Countering the impact of primary care recruitment: Community pharmacists should be commissioned to provide 'packages of care' on behalf of GPs, rather than taking pharmacists away from accessible high street settings.

The Department of Health and Social Care (DHSC) has notified Community Pharmacy England (CPE) that they will no longer be able to implement the new hub and spoke models from 1 January 2025 as initially planned. The delay comes after the General Election, which put the progress of these amendments on hold. The DHSC is currently briefing new ministers across all policy areas, including hub and spoke dispensing between different pharmacy owners. As this process will take time, the implementation will not proceed as originally scheduled. CPE has stated that it does not yet have a clear timeline and will provide an update to the sector once more information becomes available. Malcolm Harrison, CEO of the Company Chemists' Association (CCA), expressed disappointment over the continued delays in fulfilling commitments made in the 2019 contractual framework agreement to support pharmacies.