Each community pharmacy in England earned on average just less than £5,000 from locally commissioned NHS services during the last full financial year, C+D's PCT Investigation 2011 suggests.

The average PCT spend on enhanced services of £4,977 per pharmacy during 2010-11 was a slight (less than 1 per cent) increase on the previous 12 months, when the average pharmacy's equivalent income was £4,929.

However, the total amount PCTs are paying for local pharmacy services has risen more significantly, by almost 8 per cent, with the average PCT having spent almost £400,000 last year compared to less than £370,000 in 2009-10.

The reason for this discrepancy was not immediately obvious from the data, obtained by C+D through freedom of information (FOI) requests to PCTs, though it may be due to an increase in the number of pharmacies across the country (see analysis).

The increase in PCT spending on enhanced services was cautiously praised by contractor representatives including Numark managing director John D'Arcy, AAH head of marketing services Ajit Malhi and Alphega Pharmacy UK general manager Sue Moore.

"We welcome the improvement in the commissioning of services by PCTs," said Ms Moore. "They should be encouraged to continue to commission further pharmacy services, which in the long run is more efficient use of money and better for patients."

Mr Malhi added: "The success to date is a credit to a profession that has been a lot more proactive in recent times, engaging with communities and commissioners."

However, the average pharmacy revenue of less than £5,000 for enhanced services was labelled "pathetic" by contractor Graham Phillips, owner of the Manor Pharmacy (Wheathampstead) Ltd chain. "Bearing in mind the average pharmacy turnover is around £1 million," he said, "it proves enhanced commissioning has utterly failed to work."

And, while welcoming the overall direction of travel, sector leaders sounded warnings about the geographical variation within it.

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PSNC head of NHS services Alastair Buxton said: "The apparent increase in service commissioning is a positive sign but, as the data only covers around two thirds of PCTs in England, there is always a risk that this experience is not uniform across the country."

The 109 PCT responses to C+D's FOI request for information about spending on locally commissioned enhanced community pharmacy services during 2010-11 did reveal significant differences between the trusts.

PCT spending varied almost 200-fold, with City and Hackney forking out £2,439,791.29 on enhanced services compared with South Gloucestershire, spending just £12,534.

This means the gap between the highest and lowest spending PCTs has widened by more than £700,000 in 12 months, C+D's figures show – in 2009-10, Tower Hamlets topped the spending table at £1,730,060, while North Lincolnshire brought up the rear with £6,000.

While taking into account the number of pharmacies each PCT covers does temper the geographical gulf somewhat, the enhanced service fortunes of an individual pharmacy still varied by a factor of almost 90, depending on its postcode, in 2010-11.

The average pharmacy in Hull earned over £20,000 from locally commissioned NHS schemes last year; its equivalent in South Gloucestershire less than £250.

However, this gap has almost halved since 2009-10, when the average pharmacy in Tower Hamlets could count on almost £40,000 of income from enhanced services, compared with that in Norfolk scraping together less than £150.

The continuing contrast between different PCTs' spending on enhanced services prompted pharmacy representatives to restate the case for measures to mitigate the postcode lottery, including national commissioning frameworks and nationally commissioned services.

"Although we recognise that PCTs need to spend variable amounts on services to tackle specific local health concerns, we would like to see national services commissioned for conditions that are key public health issues, such as smoking and obesity," said Co-operative Pharmacy head of business development Mandeep Mudhar.

"While local demographics come into play, PCTs must share best practice regarding commissioning, which in turn would help to improve health outcomes."

Mr D'Arcy added: "While pleased to see the increased uptake, we do believe the best way forward would be to have enhanced services delivered through a national framework."

The C+D PCT Investigation 2011 showed that PCTs spent on average £1.06 per head on pharmacy enhanced services.

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