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NHS England to phase out small pharmacy funding

Contractors of essential small pharmacies say they are expected to become financially independent

Contractors say NHS England's area teams are unwilling to fund pharmacies with low prescription volumes indefinitely


Pharmacies with low prescription volumes could face closure due to the phasing out of their support funding, C+D has learned.

The commissioning body’s area teams can choose to extend a national top-up scheme – designed to support small businesses at least 1km from another pharmacy – that ends in March.

But contractors operating under the Essential Small Pharmacies Local Pharmaceutical Services (ESPLPS) scheme told C+D last week that area teams were not prepared to fund their pharmacies indefinitely – instead expecting the businesses to make themselves more profitable.

NHS England told C+D it could not comment on this “hearsay”. It only confirmed it lacked the legal power to continue the ESPLPS scheme nationally, and its area teams were considering where support would be needed.

In a letter seen by C+D, one NHS England area team told a contractor – who wished to remain anonymous – that local funding may not be ready in time for the national scheme’s end in March. If further funding was granted, there would come a point when payments would reduce every quarter and the business would eventually have to become financially independent, it said.

Another anonymous contractor told C+D that they had received a letter from their own NHS England area team stating that it did not want to continue to fund ESPLPS pharmacies indefinitely.

"Really poor" attitude

Raj Morjaria, owner of Millers Chemist in Cheddleton, Staffordshire, said he had expected his area team to “rubber stamp” his application for further funding, but its attitude had been “really poor”.

“They were saying, ‘you can be replaced by distance-selling pharmacies’. It was so disappointing, trying to convince them that pharmacy is far more than a collection and delivery service,” he told C+D.

NHS England medical director for the North Midlands Ken Deacon said the allegations did not represent the views of the Shropshire and Staffordshire area team and the commissioning body “strongly refuted” them.

PSNC told C+D it thought most ESPLPS pharmacies would “eventually” be able to become financially independent, and it hoped NHS England would ensure the businesses would be supported “for as long as is needed to enable them to continue providing essential services to local populations”.

“We would not regard short-term contracts that gradually reduce the income available to these pharmacies to less than is needed as a satisfactory outcome to these local negotiations,” said PSNC head of regulation Steve Lutener.

There were a maximum of 99 pharmacies in England operating under the scheme last August, added PSNC, which has issued guidance to help their applications for funding.


What do you think of NHS England's decision?

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NHS England delayed for months seeking legal advice and finally decided to dump all responsibility for LPS on the Area Teams, on the basis that because they were local contracts, their future should be addressed locally - even though most are funded historically as a matter of nationally-determined policy. LPS contractors were finally advised by their Area Teams that they could submit a proposal for a new LPS contract but it would be considered after due consultation on its own merits, without reference to the existing contract - or they could simply join the pharmaceutical list and sink or swim, like any other contractor. Most will have to do so anyway once LPS funding ends in March and until their proposal is approved and a new contract in place - which is unlikely to be before September. Discretionary development funding is available to LPS contractors in the interim but ATs seem mostly to be keeping very quiet about it. Since ESPLPS top up payments come from the pharmacy global sum, the funding can only be used for pharmaceutical services and so reducing spending on essential small pharmacies will merely redistribute fees and allowances costs in the direction of other pharmaceutical services providers, so if Area Teams think they will be making any savings in losing an LPS, they are sorely mistaken. In fact, more patients - those who used to use the LPS pharmacies for advice - will now either use their GP as a first point of call (unit cost £45 per consultation) or A&E (£114 per session), and in rural areas opportunistically-minded dispensing practices will move in to trouser an additional average £1.10p per prescription item dispensed, over the existing 90p per item paid to the pharmacy. And sudden gaps will appear in many of the nice new Pharmaceutical Needs Assessments currently under consultation, making an additional administrative burden on the Area Teams as new applications offering unforeseen benefits start to come in. I haven't even mentioned the political recoil and media fuss that will result as we head towards a General Election. So who benefits from LPS pharmacies being allowed to go under? Not the NHS. Not the patients. Not the independent contractors whose commitment and flexibility adds a value to the service the large multiples and medical practices can't match. I can hardly believe this is being allowed to happen.

VINCENT HALL, Dispenser Manager/ Dispensing Assistant

Essential small pharmacies offer a valuable service to the population they serve where GP Practices operate a reduced hours service and where elderly and young families have to travel long distances to access services. In these instances the EPS pharmacy offer a very valuable first port of call for the locals who are often very concerned about their condition. Our pharmacy is in a locality where GP practice has over time reduced surgery hours in the satellite surgery near us and the customers find it extremely useful to be able to access services from the pharmacy where we also manage their repeats because they cannot get to the surgery.The GP practice would have had lot of issues if the pharmacy was not there to enable them to reduce their hours. Now with advent of electronic prescriptions such pharmacies will prove to be even more valuable for face to face access to healthcare and advice.The NHS should think again if they are proposing to close these pharmacies that are crucially important to the communities they serve. If funding is going to be reduced then this should be done for rural doctor practices where they are financially supported to continue to offer a service to the community they serve! Thre NHS is funding additional payments for doctors to locate in rural areas and perhaps they should do the same for essential pharmacies!

Janet Newport, Pharmaceutical Adviser

The Devon Cornwall & Isles of Scilly Area Team recently conducted a public engagement exercise to ensure they fully understood the needs of patients in an area where an ESP contractor operates. We were left with no doubt of how valued the pharmaceutical services being provided was needed and appreciated by the public. The service provided by the pharmacist and his team was exemplary, NHS England will certainly be continuing to support this contractor. Of course we will be encouraging the contractor to seek ways to become financially independent and the contract will be regularly reviewed. As commissioners we would be failing in our duty and heavily criticised if we didn't..................

SydBashford Sold&Retired&DeRegistered, Community pharmacist

Because these pharmacies are generally Rural, serving a population with a Dr and no immediate access to the next nearset pharmacy. Lower prescription volume than the minimum of 2450/ month required for practice payment or establishment payment, means there would be NO pharmacy if not subsidised..

Paul Thomas, Other GP

I suspect the patients of rural practices will welcome the closure of their heavily subsidised pharmacy and be only too delighted again to get their medicines at the same place they go to see their doctors, who coujd employ a clinical pharmacist (or even take one on as a partner), engage more doctors, nurses and improve their premises with the additional income. ( the reverse being the case when a pharmacy opens). In addition, unlike the corporate giants they pay UK taxes on any remaining profits. Odd world we live in which contrives to swell the coffers of Walgreens BA at the taxpayer's expense. Are pharmacies really an essential part of the NHS? I don't think so but you needn't hold your breath guys. The future for corporate pharmacy is far brighter than it is for general practice, which is being euthanised on the altar of greed.

dave k, Community pharmacist

i am failing to understand why some pharmacies should be subsidised..

John Randell, Non Pharmacist Branch Manager

NHS England told C+D it could not comment on this “hearsay”. It only confirmed it lacked the legal power to continue the ESPLPS scheme nationally, and its area teams were considering where support would be needed. its not hearsay if you have just if you follow it up with a statement that backs what is going to happen...they is a basis for the statrement

Philip Caton, Community pharmacist

By that logic all pharmacies could be replaced by distance selling pharmacy! Then it might dawn on the powers that be that the reason small pharmacies are necessary is because it's not just about prescriptions and not all prescriptions are repeats. And try this for size!! Some of our patients are being cold called by a distance selling pharmacy and told that by signing up to receive their prescriptions ( which are only delivered on a Thursday btw) they will be saving the NHS by not clogging up the surgeries! Is this the best we can expect from a registered pharmacy? Babies and bathwater spring to mind.

Mr CAUSTIC, Community pharmacist

what happens if they are out! do they have to wait another week. we had patients sent a leaflet to sign up to a distance pharmacy and they thought it was us offering a postal service. they rang us for repeat prescriptions which we ordered for them only for the script not to be received by us. when we rang the surgery they said sent by etp. already . it was only after calling them persistently that the surgery noticed the script had been sent elsewhere. i told the patients it was coming from the new pharmacy they had signed up with and would arrive by post. they were out when it arrived and that caused further delay. luckily i always tell my patient to order a week in advance.. needless to say they decided to cancel the postal service and come back to us. postal services are ok if you are in all the time and can get to the door in time ,before the driver goes away having left a card. so no calls of nature allowed, you might be in the toilet and miss your drug delivery!

Richard Hodgson, Community pharmacist

To add to your last sentence - what if the driver gets no reply and leaves the medication in the communal hallway of sheltered accommodation? Yes this did happen. Reported to me by a carer who just happened to call and recognised the type of bag.

Chris Cairns, Academic pharmacist

I am not sure how this sits with the Code of conduct, ethics and performance. Telling mis-truths about NHS services does not fit well with being 'Honest and Trustworthy' and trying to obtain patients by possible disreputable means does not say 'Show respect for others' to me. I know as an academic I am less affected by commercialism than others but I do feel that we should still apply both professional and business ethics in pharmacy. Are there grounds for a complaint to be made to the GPhC?

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