The Scottish government has introduced an “upper threshold” for activity claims made under the Pharmacy First Scotland service, it last week (October 31) announced.
In a letter to NHS health boards and community pharmacists, the government said that the threshold is being introduced “to ensure a more equitable distribution” of the existing remuneration pot for Pharmacy First activity.
“Where weighted activity exceeds 1,000 in a calendar month, each activity point beyond this threshold will reduce to 0.1,” it said.
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This will include “claims for advice, referral and treatment for both standard and patient group direction (PGD) consultations”, as well as advice and referral claims for the Pharmacy First Plus independent prescribing service, it added.
The government said that it will “monitor activity over the six months from implementation to gauge whether this action has had the desired effect”.
And it added that from November 1, PGD advice and referral activity under the standard Pharmacy First service will be weighted to 1, while the weighting for treatment will remain at 5.
Pharmacy First Plus
The letter also set out details of a new “activity-based remuneration pot” from this month for Pharmacy First Plus, which allows independent prescribers (IPs) in Scotland to assess and treat conditions beyond the scope of the standard Pharmacy First service.
Contractors who employ an IP but do “not expect to meet the minimum requirement of 25 hours per week of service availability for a minimum of 45 weeks per year” will not be eligible for the existing “monthly £3,000 base payment”, it said.
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But these contractors are now able to “offer the service in line with all other requirements of the service specification and be remunerated for claimed activity”, it added.
It said that the Scottish government and Community Pharmacy Scotland (CPS) will discuss and agree on “future arrangements with regards to remuneration for hours of operation” next year.
The government intends “to extend the service as the cohort of qualified IP pharmacists increases and experience is gained in its scope and delivery” and this will be done “in a step-wise manner” with a new service specification to be published in 2026, it added.
“Newly established pot”
The government also revealed that from November 1, contractors delivering the Pharmacy First Plus service will receive payment from “a newly established monthly pot for IP prescribing activity” that has been “initially agreed at £0.5m”.
There is “no minimum activity threshold” to access this new payment pot, it added - but an IP who decides that it is “absolutely necessary to treat a common clinical condition” must “submit an NHS Pharmacy First Plus ‘Supply’ claim” to receive payment from it.
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The activity fee will be between £30 and £40 per intervention, the letter said, but the rate and weightings will be reviewed “after six months and regularly thereafter”.
It added that the new activity model “will be implemented for the December 2025 dispensing month”, with contractors to receive payment in February “for activity carried out in December, as well as a retrospective payment for eligible activity from November”.
And it said that contractors will next month receive a “balancing payment…set against the monthly figure of £0.5m for the month of October 2025 only” to “ensure the full delivery of the activity pot value for the financial year”.
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It comes as GP leaders in England have called for Pharmacy First funding to be “reallocated to general practice” to ensure patients receive “continuity of care from their GP team”.
A motion put forward for debate at the British Medical Association’s (BMA) annual conference claimed that the Pharmacy First service has “shortcomings”, including “limitations in scope, variability in service quality and the risk of fragmenting patient care”.
It was proposed by Oxfordshire local medical committee (LMC) for discussion at the conference taking place this week, where motions voted in become official BMA policy.
