September 2019 blog: Changing Times

Change is afoot. The new Community Pharmacy Contractual Framework (CPCF) will begin on 1 October 2019 and will be the biggest shift in our ways of working since the current contract was introduced on 1 April 2005, 14 years ago.

The initial funding for the 2005 contract was £1.766bn, and you will be keen to discover what’s on offer this time. I can announce that we have a five-year settlement and the funding will be £2.592bn per year until the end of 2023/4.

Curiosity drew me to look up the inflation rate over the last 14 years. The Bank of England gives a figure of 47%, which means our then £1.766bn would be worth around £2.596bn in today’s money. You could argue that we haven’t made much progress. However, this would ignore a context of current financial pressures, ever increasing workloads and the fact that the Government was not so long ago looking to reduce the amount it spent on community pharmacy. Therefore, a five-year deal, even with static funding and a forecast inflation rate of 2% a year, should be viewed positively. It gives us stable and certain funding, in an environment of increasing economic and political uncertainty. In short, we have what’s been described as a ‘roadmap for delivery and change’. There will be closer integration with Primary Care Networks (PCNs) and contractors will have an increased role in protecting public health as well as having an expanded role in urgent care and medicines safety.

I have listed our new service delivery changes below.

NHS Community Pharmacist Consultation Service (CPCS) – this will be rolled out from October 2019, referrals will be made from NHS 111 and replaces the current NUMSAS and DMIRS pilots. Fortunately, in Derbyshire, we already have experience of the two pilots, so we are in a good place to transition to CPCS. The new service is supported by transitional payments and attracts a £14 fee per completed consultation. Follow-up calls to ‘no-show’ patients have been reduced to one and further developments will be piloted (e.g. referrals from GPs, NHS111 online, Urgent Treatment Centres and, possibly, A&E).

Clinical Services: Prevention – as part of delivering the essential services all pharmacies will need to have Level 1 Healthy Living Pharmacy (HLP) status by 1 April 2020. The vast majority of our pharmacies are already HLPs, so only a few will have to go through the accreditation process.

Additional Clinical Services will include:

  • Hepatitis C testing, as a 2-year time limited advanced service, which will be introduced in 2019/20 for people using Needle & Syringe programmes;
  • Data capture for national public health campaigns with exploration of the use of “digital marketing assets”;
  • Pharmacy Integration Fund (PhIF) and the PCN Testbed programme will test services such as identification of undiagnosed CVD, point of care testing to tackle antimicrobial resistance, stop smoking referrals from secondary care, vaccination and immunisation, support for PCN service specifications and routine monitoring of patients on repeat medication.

Clinical Services: Medicines Optimisation – the development of a medicines reconciliation service for hospital discharge patients will ensure medication changes are picked up when the patient returns home. In addition, there will be consideration given to expanding the current New Medicines Service (NMS) to include further conditions and a new service to improve access to palliative care medicines will be piloted.

Clinical Services: Medicines Use Reviews (MURs) – being phased out and will be replaced by Structured Medication Reviews carried out by clinical pharmacists working within PCNs. Contractors will be able to provide up to 250 MURs this year (max. 200 by September and a further 50 by March 2020) and 100 next year.

Pharmacy Quality Scheme (PQS) – replaces the Quality Payments Scheme (QPS). There will be a few changes made to existing requirements with some of the quality criteria grouped into bundles for payment, slightly modified gateway criteria and to ease cash flow for contractors there will be Aspiration Payments (70% of the average number of points claimed across the two declaration periods in the 2018/19 QPS).

The above represents a shift away from a primarily prescription driven income stream and the Government will be pursuing legislative changes to allow all pharmacies to benefit from hub and spoke dispensing. PSNC is working with the DoH to identify a suitable model that will benefit the whole sector fairly. Other plans to enable change include exploring greater use of original pack dispensing to support automation, proposing legislative changes to allow better use of skill mix and enable clinical integration of pharmacists, and exploring the changes to funding and fee structures.

There’s still a lot of the finer detail to be agreed and there will be annual reviews of costs, capacity and progress within the Contractual Framework, so things will evolve and progress over the next five years. We may not know where we will end up, but at least we know the direction we are going.

Unfortunately, it remains the case that the Department of Health (DoH) still believes that there are too many pharmacies, especially where there are ‘clusters’ together. Some contractors may consider it commercially beneficial to consolidate and it’s important that the protection for those wishing to consolidate is strengthened.

Contractor Events and Support – PSNC will be holding a series of Sunday roadshow events for contractors and community pharmacists across England that will help you to understand the changes and how they will impact on your business.

If you don’t want to travel so far then please come to Derbyshire LPC’s AGM on Tuesday 17 September at Morley Hayes Hotel. Garry Myers, PSNC Representative, will give an overview of the recently agreed 5-year CPCF. This will include information to support contractors to deliver the first parts of the framework such as the NHS Community Pharmacist Consultation Service and the Pharmacy Quality Scheme. To come along and join us: book here.

Also, please join our Health Champions closed Facebook page. We are looking for members so please take a look at the page here and send a request to the group.