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5-year pharmacy funding deal revealed with greater focus on services

PSNC CEO Simon Dukes: The government has committed to a protected £13bn for five years
PSNC CEO Simon Dukes: The government has committed to a protected £13bn for five years

The global sum will remain at £2.59 billion, with medicines use reviews (MURs) phased out in favour of new clinical services, in a five-year funding settlement for England.

The new settlement, unveiled today (July 22) by the Pharmaceutical Services Negotiating Committee (PSNC), NHS England and the Department of Health and Social Care (DH), shows:

  • The global sum will remain at its current level of £2.592bn a year
  • Establishment payments will cease in April 2020, while the MUR service will end in 2021
  • This funding will be replaced with payments for new services, some of which are yet to be decided
  • Overall funding for the new medicine service (NMS), the single activity fee, the Quality Payment Scheme (QPS), the Pharmacy Access Scheme (PhAS) and retained margin will remain the same
  • All pharmacies will be paid to handle referrals from NHS 111 from October
  •  £10m from the global sum has been set as a contingency for pharmacies to dispense medicines under a serious shortage protocol, for which they will be paid £5.35 each time.
  • Funding has been set aside for pharmacies to offer a hepatitis C screening service for this financial year and the next.

Funding will remain at its reduced level of £2.592bn per year for the next five years, said PSNC, which stressed that this is more than the government had originally planned. However, it falls short of the £2.8 billion for 2015-16 – the last year before the government implemented its cuts.

Establishment payments – which the government promised in 2016 to phase out over “a number of years” – will cease completely in April 2020.

Meanwhile, MURs will be phased out by April 2021, with pharmacies only able to receive payment for 250 reviews carried out in this financial year, and 100 for the next. The service will be replaced by “structured medication reviews” carried out by “clinical” pharmacists working in recently created primary care networks (PCNs).

New services in the pipeline

The pharmacy funding lost from these streams will be replaced by payments for new, national clinical services, all of which have yet to be decided.

PSNC said it is planning to: launch a pilot of pharmacies identifying undiagnosed cardiovascular disease; to review a pilot of smoking cessation referrals from primary care; pilot an expanded version of NMS to cover further conditions; pilot discharge medication reviews; and multiple pilots for point-of-care testing, to “support efforts to tackle antimicrobial resistance”.

The Pharmacy Integration Fund – set aside by the government in 2016 to be invested over five years to “transform how pharmacy will operate in the NHS” – will be used to fund these pilots, PSNC said.

Two million pounds has been set aside to pay pharmacists to deliver hepatitis C screening for both this financial year and the next. The service is “time limited”, and no money has been allocated beyond March 2022.

In the meantime, all pharmacies will be paid £14 to deal with each referral from NHS 111 – following pilots across the country – from October, with no cap on the maximum number of consultations they can claim payment for.

“Transitional” payments

There will be a “transitional” payment of £900 for pharmacies who sign up to deliver the Community Pharmacist Consultation Service (CPCS) – which will replace the Digital Minor Illness Referral Service (DMIRS) and NHS Urgent Medicine Supply Advanced Service (NUMSAS) – by December 1, and £600 for those who do so by January 15.

PSNC plans to expand this service over the course of the five years include referrals from GP practices, NHS 111 online, urgent treatment centres and possibly A&E.

There will also be payments to support pharmacies to implement the EU medicine scanning law the Falsified Medicines Directive, a payment of £5.35 for each prescription dispensed under a serious shortage protocol – should the government ever issue one – and to work with PCNs.

Payments for the single activity fee, the NMS and the PhAS will remain the same for the next five years. While overall funding for the QPS will remain the same, it will be renamed the Pharmacy Quality Scheme, with new gateway and quality criteria that pharmacies will have to meet.

Taking a long-term view, PSNC said “discussions will be held on new funding models”.

Savings in the cost of dispensing will “free up funding and resources for value-added service delivery”, the negotiator claimed.

PSNC: Protected funding

PSNC CEO Simon Dukes said: “The NHS fully expected a cut in community pharmacy funding to have been made in 2018-19 – with therefore a funding level in 2019-20 of lower than £2.592bn.

“While we have not succeeded in getting an increase in the overall sum, we have secured a commitment from the government to a protected £13bn over five years,” he added.

“The planned services will enable the sector to transform its offer and I hope community pharmacists will be pleased about the new roles they will be able to offer.”

Commenting on the new funding contract, health secretary Matt Hancock said: “Pharmacists are integral to community health and I want to move towards the French model, where they offer a wider range of services and play a stronger role in the community.

“Community pharmacies are a vital and trusted part of our NHS, and this five-year deal will ensure more people get support in the most appropriate setting, which in turn helps relieve pressure on the wider health service.”

106 Comments
Question: 
What do you make of the new contract changes?

Tunde Sokoya, Community pharmacist

 

Reality Check In the current climate I would say the PSNC has done the best they can. The direction of travel and the     needs of the NHS have been plain for all          to see over the last 10 years. It's time to really showcase what community  pharmacy can bring to primary care. In all  honesty were MURs good value for In reality we're the MURs good value for money?
Will the money not be better spent funding DMIRS - in my opinion the best way to reduce unnecessary A&E attendance - the main challenge that keeps the health minister awake at night. Real chance to build a good evidence base to really showcase what community pharmacy can do.
Why should anyone with a sore throat or chest infection go to the GP at all-   This should be managed in the pharmacy. We have highly skilled independent pharmacist prescribers in community able to adequately deal with infections and make a difference by promoting rational prescribing of antibiotics- I see this contract as a real opportunity to showcase the real difference we make on a daily basis- carpe dium

 

 

Edward H Rowan, Locum pharmacist

Brilliant idea!

Take a pay cut and do other people's work as well!

Clarke Kent, Community pharmacist

Thought i’d make the 100th comment on this article! Woohoo! Seems to be a very emotive topic. Some keyboard warriors out in force it seems, with no other agenda than to stir up lots of emotion with their lack of knowledge, and general ‘nothingness’ of nothingness. All the best guys, it’s dog eat dog out there, (or in my case a lion eating everything!)

John Willetts, Locum pharmacist

I wonder how many pharmacists have considered the professional implications of this deal? Nearly all the services we provide require a DoC from CPPE to provide them. These in turn usually require you to complete 3-4 courses of study to obtain the DoC. These have to be renewed every 2-3 years. So  you will be spending more and more time studying and renewing courses - just to keep you job! Possibly 5-10+ hours every month in due course. Now I always understood that extra training and skill added value to the person. This shd mean an increase in salary to reflect the greater value. Will we get one? Er, no. Instead a pay decrease as inflation erodes the value, over a 5yr period, of a O% GS change. The GS has,  in turn, has been reduced by 7% since 2016. So, all of you guys 'n gals  interested in joining the profession: "Get in line now.. Ooops! Mary. Where have they all gone?"

Susan Lee, Superintendent Pharmacist

Just ask an airline pilot what they have to do to keep flying!

v p, Community pharmacist

While the rest of the NHS get a 2% or above pay increase. our great team are happy with a 0% increase over 5 years.

 

Ranjeev Patel, Non Pharmacist Branch Manager

If inflation is above zero (as it is), then a 0% increase is actually a decrease. When you factor in that pharmacies are doing more and more work each year, it probably works out about a 5% decrease. The prices of everything you have to pay to run a pharmacy go up every year without fail, so a 0% increase is nothing but a massive kick in the teeth. I wonder if the staff at the PSNC would be happy with a 0% pay rise?

Greatly Pedantic Highly Clueless, Senior Management

Jeff Bezos has a business mantra of "your margin is my opportunity". I can safely say that community pharmacy won't have anything to fear from Amazon. The government's aim for hub and spoke dispensing will be dead in the water because no major internet player will be interested with these margins. 

At the end of the day pharmacy will wither on the vine unless we grasp the nettle of providing pharmaceutical care. The PDA (the only pharmacy organisation worth a flying) suggested using MUR money to provide teams of properly trained clinical pharmacists that could provide pharmaceutical care. But do we have the skilled pharmacists to do this? It needs more than a bit of online learning from the CPPE. 

Interleukin -2, Community pharmacist

Are you a pharmacist? Pls what requires a bit of online learning?

John Ellis, Community pharmacist

Clearly there are some positives here, the NHS should be actively funding contractors to prescribe in community as well as supply, and they should be integrating this into the new pharmacy contract.

But let's not kid ourselves, many pharmacies will simply not be viable under this model, rates/rental/staffing overheads will bankrupt most within a year.

Change career to bar tending - better for your wealth

Chris Locum, Locum pharmacist

...if not better for your well being and mental health

Stephen Kane, Community pharmacist

Will the PSNC have the confidence in the qualities of this deal to put it to a vote of contractors?

Doubt it.

 

Yep. Bit of wysiati in booze, no such luck in pharmacy. Glad to be getting out soon. 

Can C+D change my role title on here to ‘general skiv who communicates badly’ please. 

IAN FRASER, Locum pharmacist

Stop praising yourselves no increase for more core task with the prospects of rises in minimum wage/living wages , rates , admin/regulatory costs etc is effectively a cut ;a damn firm slap in the face to struggling community pharmacies dispensing less than 5,000 item and another weak negotiation

 

Stephen McGonigle, Information Technology

Pharmacy sales are reflecting this reality 

Stephen McGonigle, Information Technology

How did a career Civil Servant ever get the top PSNC job? No skin in the game. Salary and pension guaranteed!

Mike Hewitson, Superintendent Pharmacist

Simon Dukes is a class act. He is part of the solution, not part of the problem. I recognise that most people here won't have met or talked to him, but he genuinely gets the situation the sector is in. We'd be infinitely poorer without him.

Watto 59, Community pharmacist

There is no excuse for blatant dissembling by the PSNC.  Not my idea of a class act. 
 

Ranjeev Patel, Non Pharmacist Branch Manager

0% increase at a time when costs are sky-rocketing. Really classy.

IAN FRASER, Locum pharmacist

I’ve got skin in the game but will be out before contract is up and guarantee I could and would willing produce a lot better for a lot less I have passion understanding and great negotiating skills PSNC are civil service job hoppers

 

 

Barry Pharmacist, Community pharmacist

So are you a contractor or locum?

R A, Community pharmacist

"in favour of new clinical services"

I wonder if that is a subtle or not so subtle euphemism for all the non-profit making duties currently GP/Nurses are responsible for being palmed off to the community pharmacy sector?

Naturally the area manager who once managed a Phones 4 U store or Woolworths perhaps is going to gleam with greed at the small remuneration which will help reach their bonus target! Forgetting that the government is taking the pharmacy sector for a joke!

Sometimes I wonder why did I choose to study pharmacy?

Andrew carr, Pharmacy technician

Get rid of the PSNC, GPhC & RPS
https://platform.organise.org.uk/campaigns/pharmacy-reform

Barry Pharmacist, Community pharmacist

Got 15 signatures so that petition isn't going anywhere.

Andrew you should be in favour of these changes. Techs will be in charge of dispensing very soon. You'll be well in demand.

Kevin Cheng, Community pharmacist

Is it 2021 or 2022? The article somehow has both years in their article when MURs end. 250 this financial year and 100 the next takes us to 2021

Grace Lewis, Editorial

Thanks for flagging Kevin.

MURs will be phased out by the end of 2020-21. This has been updated in the article.

Grace Lewis, Deputy Editor

Ronald Trump, Pharmaceutical Adviser

If you're an old school contractor who's been used to milking the NHS for dispensing fees for the last 20/30/40 years and your reluctant to change, upskill and evolve the profession, then do us all a favour and sell up to a new-generation clinically/ service driven pharmacist who's not going to moan and actually embrace the opportunity to own their own business.

 

 

 

 

Alexander The Great, Community pharmacist

But... who is going to actually dispense and check prescriptions if you are doing all the "clinical" stuff??? You need to pay for the bread and butter of pharmacy and then pay ON TOP if you want other services. Dont take from us and then pretend to give us money for services. We have NO staff to dispense. Who is paying their living wage, training, holiday??? Who is paying all the expensive toner fees for printing 1000s of EPS tokens. Who is paying for the time taken to submit scripts and checking exemptions everyday???? Who is paying for my time checking for stock and cheapest NSCO stock?? Theyve cut us far too much.

The number 1 thing a patient wants from a pharmacy is to get their medicine QUICKLY and ACCURATELY... with so much cuts, neither is achieveable.

Sue Per, Locum pharmacist

There is more than ample time for the services that we are contracted to do, but clearly there will be less time if we engage in non contracted work such as "MDS" collection deliveries, managing repeats etc. In the digital era, and with the sophisticated faster PMR systems, productivity has increased substantially, and the paymaster is entitled to recoup some of the benefit from such increases!!. You must also take note that not all of the purchase profit is recouped by the paymasters!!The contractors are allowed to retain some of it.!! And there is also profit accrued from counter sales, private scripts, enhanced and other comissioned services

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