Consultation threshold for Pharmacy First payment reduced for August

Community pharmacies will only need to perform 15 Pharmacy First clinical pathway consultations in August to meet the minimum threshold, rather than the 20 originally set for the month.

This comes as recent data has revealed that one in five community pharmacies participating in Pharmacy First in England failed to meet the minimum threshold of five clinical pathway consultations required in April.

Pharmacies receive £15 per Pharmacy First consultation, plus a monthly fixed payment of £1,000 if they meet a minimum activity threshold of consultations that pass a gateway point under clinical pathways for seven common conditions.

The threshold is currently set at 10, and was due to increase to 20 in August.

But pharmacy leaders told Pulse’s sister title The Pharmacist that the increasing thresholds were a major concern.

In April, the minimum threshold was five, but analysis by The Pharmacist has revealed that around 19% of participating pharmacies delivered fewer than five clinical pathway consultations in that month.

It also found that, in April:

• Around 11% of participating pharmacies delivered no clinical pathway consultations at all.

• Three-quarters (76%) of participating pharmacies delivered fewer than 20 clinical pathway consultations – the minimum number that was originally supposed to be required from August.

• 65% delivered fewer than 15 consultations – the new August threshold.

• Nine in 10 (89%) of participating pharmacies delivered fewer than 30 clinical pathways – the minimum number that will be required from October.

Janet Morrison, chief executive of Community Pharmacy England (CPE), said that the negotiator had argued for the August threshold to remain at 10, at least while further discussions took place.

‘But that is not something ministers have decided to do,’ she said.

Instead, the August threshold has been changed to 15 – but this easement only applies to the month of August, Ms Morrison said.

‘We will continue to work with DHSC and NHS England to review ongoing service data and consider its implications for the planned ramp up in thresholds for September and October in the light of the impact of seasonality and the low levels of GP referrals,’ she said.

‘It is our strongly held view that community pharmacy has carried out its side of the bargain in launching the Pharmacy First service – preparing and training their teams and promoting the service to GPs, other health professionals and the public.  You could not have worked harder.

‘However, we believe that NHS England need to match that commitment through more effective advertising and ensuring that GPs refer as many patients as possible,’ she added.

And she welcomed the willingness of ministers to listen to the sector’s concerns and to act quickly ‘to make an adjustment so soon after coming into office’.

‘We remain determined to push for full commitment on all sides to the shared objective of making the service a success, mindful that it is critical to the government’s manifesto commitment to build on the service to create a wider Community Pharmacist Prescribing Service,’ Ms Morrison added.

Paul Rees, chief executive of the National Pharmacy Association (NPA), told The Pharmacist earlier this week that ‘the rigid monthly targets for consultations’ were ‘leading to many pharmacies missing out on funding even where they are making good progress on consultation numbers’.

‘We have already called on Kier Starmer to ensure the full £645m put aside to fund this scheme is invested in community pharmacy, with not a single penny clawed back to use for other purposes,’ he added.

And Malcolm Harrison, chief executive of the Company Chemists’ Association (CCA), said that while Pharmacy First ‘has been a hugely successful service to date’, there was ‘growing concern that activity thresholds will be raised too early for the bulk of contractors’.

‘With GP referrals and patient awareness still relatively low, a steep rise in activity thresholds could harm delivery of the service,’ he said.

‘These concerns and potential solutions have been raised with NHS England [NHSE]. As an immediate priority, NHSE must provide additional support to GPs to boost referrals and deploy high-quality and targeted public engagement campaigns to drive public awareness,’ he added.

Some 423,310 Pharmacy First consultations were delivered in the first three months of the service, official figures from the NHS Business Service Authority (NHSBSA) have revealed.

Dr Leyla Hannbeck, chief executive of the Independent Pharmacies Association (IPA), previously commented that ‘challenges’ stemmed from the fact that ‘GP referrals are low’.

And Brendon Jiang, vice-chair of the Royal Pharmaceutical Society (RPS) England Pharmacy Board, said that ‘a number of factors’ were needed to make ‘any new service a success’, including ‘IT infrastructure, local relationships, and streaming the referrals process’.

Pharmacists are dealing with patient need in ‘a safe and appropriate way’ under Pharmacy First, a leading GP has said.

Speaking about Pharmacy First at the NHS England (NHSE) board meeting last week, non-executive director Professor Dame Helen Stokes-Lampard said: ‘We have so much unmet need in general practice is that what’s happened is that you’ve taken a bit of unmet need and dealt with it in a safe and appropriate way.’

At the same meeting, Professor Stokes-Lampard – who is soon to become New Zealand’s CMO – noted that the NHS ‘is already starting to see tension’ as a result of GP practices ‘pulling back’ from doing discretionary work ahead of potential collective action.

A version of this article was first published by Pulse’s sister title The Pharmacist