The new GP contract, published on February 6, builds upon the five-year GP contract announced in January 2019. NHS England said the latest agreement “updates and enhances” its predecessor through securing at least £1.5 bn for general practice, which the Department of Health and Social Care has pledged to spend on the sector over the next four years.
There is no direct funding for community pharmacy, however the new money will support primary care networks (PCNs) to hire an additional 6,000 healthcare professionals including “clinical” pharmacists and, for the first time since PCNs were launched last year, pharmacy technicians. The 6,000 roles are in addition to the 20,000 PCN staff the government pledged to make available under the additional roles reimbursement scheme (ARRS) last year.
The money will also go towards funding pharmacists who choose to take on GP surgery contracts in one-off £20,000 payments.
But how will these changes and the extra funding affect community pharmacy?
Click on the bullet points to jump to different parts of C+D’s guide to the GP funding contract:
- What do pharmacists receive for becoming GP partners?
- What did the contract say about community pharmacy?
- How much will PCNs be reimbursed for employing pharmacists and pharmacy technicians?
- What will pharmacy technicians do in a PCN?
- How did PSNC, AIMp, NPA and RPS respond to the contract?
To encourage more health professionals to become partners in GP practices, including pharmacists, NHS England will give a one-off payment of £20,000 to full-time partners working 37.5 hours a week. Their practice will receive a “business training allowance” of £3,000 for the new partner as well as £2,500 for other expenses.
The British Medical Association (BMA) – which helped develop the contract – told C+D that community pharmacists can decide to join the partnership on a part-time basis and so will not be required to leave their community roles “completely”, receiving the payment pro-rata.
The payment will initially be granted as a loan to the practice and, after “an expected minimum number of years as a partner, for example five”, it will convert into a permanent payment, NHS England says.
As partners, pharmacists would part-own the business. Being a partner means sharing the practice’s profits and losses, bearing responsibility for it fulfilling its contract, and influencing its direction, according to BMA guidance published in 2018.
The payment has been introduced primarily to attract “early-to-midcareer” GPs into partnerships, NHS England says. However, the scheme will be “open to other professional groups”, including pharmacists and nurses over its initial running period of two to three years.
Further guidance on the scheme will be published as it evolves.
The contract acknowledges the need for clinical commissioning groups to help PCNs “support rotational working across acute, community and (in time) mental health trusts, as well as community pharmacy”.
NHS England continues: “We are seeing increasing examples of rotational working across the country and we strongly endorse this approach. It can help build more rewarding careers, support collaboration and secure extra capacity more quickly.”
According to NHS Employers, rotational posts are a strategy to “recruit, develop and retain staff…by moving [them] between two or more posts over a fixed period of time”.
The GP contract also mentions how the Community Pharmacist Consultation Service (CPCS), “will be expanded” depending on the outcome of ongoing pilots. Community pharmacies dealt with more than 150,000 referrals via the service between October 2019 and February 2020, according to NHS England.
Future flu jab money?
Community pharmacies are expected to collaborate with GP practices as part of a PCN, NHS England says. The networks are “ideally placed to take the lead on improving flu vaccine coverage”.
There will be an £8m fund to boost GP practice flu vaccine coverage in the over-65s available from April 2020. NHS England expects there to be an “aligned incentive” for community pharmacy via the Pharmacy Quality Scheme. Pharmaceutical Services Negotiating Committee (PSNC) told C+D on February 11 it was unable to give more details on this incentive.
In addition, from April all PCNs will also be expected to work with community pharmacies “to connect patients appropriately to the new medicines service”, NHS England says.
PCNs will be reimbursed the full annual salaries for “clinical” pharmacists and pharmacy technicians under the ARRS, NHS England says.
The 2019 GP contract had committed to paying PCNs just 70% of the cost of “clinical” pharmacists’ salaries under the scheme at £37,810 for each one annually. The 2020 GP contract increases the reimbursement for each pharmacist to £55,670, including overhead expenses.
Each PCN will receive up to £35,389 for a pharmacy technician, including expenses, NHS England says.
PCN pharmacy technicians will “play an important role, complementing clinical pharmacists, community pharmacists and other members of the PCN multi-disciplinary team”, NHS England says.
Their key responsibilities within PCNs are:
- Ensuring effective medicine use through conversations with patients
- Supporting medication reviews and reconciliation for new care home patients
- Supporting medicines use when patients transfer between different care settings, referring to the community pharmacist
- Reducing inappropriate antibiotic prescribing
- Providing training on implementing the electronic prescribing service
- Helping integrate pharmacy team members across community pharmacy, secondary care and mental health services
- Working alongside GP practice receptionists to organise prescription requests.
NHS England says it expects pharmacy technicians to take a leading role in medicine management systems across PCNs.
The contract recognises “workforce supply constraints” with pharmacy technicians and therefore expects that for 2020-21 and 2021-22, each PCN will recruit a maximum of one pharmacy technician under the ARRS, or up to two if they have a population of over 100,000 patients, the commissioner says.
Commenting on NHS England’s decision to fund the salaries of PCN pharmacists and pharmacy technicians up to a certain amount, PSNC CEO Simon Dukes said the extra investment could put more “financial stress” on the pharmacy sector and lead to more pharmacy closures.
The demand for pharmacy staff will rise and with it the “cost of labour, a position which seems all the more untenable given the complete refusal of the government and NHS to recognise pharmacies’ costs in delivering their ambitions set out in the Community Pharmacy Contractual Framework”, Mr Dukes said.
The Association of Independent Multiple Pharmacies (AIMp) CEO, Leyla Hannbeck is worried about “the impact that the further workforce drain will have on community pharmacy”.
The Royal Pharmaceutical Society said it hopes the decision to reimburse pharmacists and pharmacy technicians “will encourage PCNs to recruit into these new roles”.
National Pharmacy Association said: “In light of this [£1.5bn] investment in general practice, we trust that funds can also be found for community pharmacy when pharmacy contract discussions resume.”