Community Pharmacy England (CPE) has revealed further details of the “capping methodology” used to limit the number of Pharmacy First clinical pathway consultations that pharmacies are paid a fee for completing.
In a set of FAQs published earlier this month (May 13), it explained that the banded caps were “put in place during the second half of 2024/25”.
The bands split pharmacies into six categories based on their “actual delivery of Pharmacy First” and set each a maximum number of consultations for which they can claim a fee, it said.
Read more: Pharmacy First consultation payment caps rise up to 94%
But the caps took a nosedive in April following the sector’s new funding deal.
Where a “band six” pharmacy could have claimed a service fee for 786 Pharmacy First consultations in January, as of April they could only claim 135 – down to 131 from next month.
With service fees rising from £15 to £17 from April, this means a possible cut of £9,563 in monthly fees for the pharmacies offering the maximum number of consultations between January and June.
Explaining the drastic drop, CPE said that “more of the limited funding available could have been allocated to fund more clinical pathways consultations in 2025/26 but this would have been at the expense of other funding streams” like the single activity fee (SAF).
While in 2024/25 unspent Pharmacy First funding meant that the caps increased “more and more”, there was “effectively a reset of the system” in 2025/26 along with the new funding deal, it added.
Read more: New Pharmacy First cash, bands and thresholds agreed
“Ultimately, CPE and the government’s agreed allocation means that the overall total volume of Pharmacy First clinical pathways consultations in 2025/26 can still grow substantially,” it said.
“However, it is unlikely that the cap levels for the highest delivering pharmacies will reach the same heights that they did in 2024/25,” it added.
“As we progress through 2025/26, any under-delivered volume will again be rolled over and used to increase allocations later in the year…we may therefore again see the caps become higher later in the year,” it added.
But it admitted that there may be further “adjustment to caps for existing services or the implementation of new caps for services that are not currently capped” due to a contract agreement to “consider the potential for caps on other clinical services” to prevent “over-commissioning”.
How do I increase my cap?
While the consultation caps have reduced, the frequency with which caps are changed has increased.
“In 2025/26, the caps will be updated monthly…unlike 2024/25 where caps were updated quarterly,” CPE said.
Read more: Pharmacy First, contraception and BP ‘bundling’ delayed
The negotiator also stressed that “caps are currently only in place for the clinical pathways element of Pharmacy First – the cap does not apply to minor illness or urgent medicine supply”.
And it said that medicines supplied will still be reimbursed for consultations delivered over the cap.
Pharmacies can check which band they are in via the NHS Business Services Authority (NHS BSA) website, it said.
Read more: UPDATED: Pharmacy First thresholds slashed until March
It added that pharmacies looking to increase their band – and cap – can do so by delivering more consultations.
“A pharmacy’s placement within a band is based on their previous delivery of the service,” it explained.
“Band placements and cap levels will be updated monthly and published on the NHSBSA website,” it added.
June changes
It comes as other changes to the Pharmacy First service are set to come into force from Sunday.
From June, a new £500 payment will be available to contractors delivering between 20 and 29 clinical pathway consultations per month under the new “banded approach”.
Read more: Funding breakdown: Write-offs, service payments and activity fees
To receive this or the £1,000 monthly Pharmacy First payment for delivering more than 30 consultations, pharmacies must also be registered and able to deliver the hypertension case-finding service (HCFS) and the pharmacy contraception service (PCS) from June 1.
The change comes with new rules requiring the services to be “bundled”, which have already been delayed by two months.
Meanwhile, the claim window for Pharmacy First will also be reduced to one month from June.
