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The Company Chemists’ Association has warned the Government that pharmacies in England could decide to stop rolling out Pharmacy First because of the pressure created by the contractual requirement that they provide a “bundle” of services to receive monthly payments.

Under what Community Pharmacy England (CPE) described as a “phased introduction of bundling requirements”, pharmacies needed to register to provide the hypertension case-finding and pharmacy contraception services by May 31 and deliver at least one ambulatory blood pressure (ABPM) monitoring provision a month from October this year.

Pharmacies must also complete “a specified number” of contraception consultations including for emergency contraception from March 2026 to get monthly Pharmacy First payments. CPE said it will agree that number with the Government and NHE England “in due course”.

The CCA warned the pressures on pharmacies generated by that “bundling” arrangement, although intended to “incentivise pharmacies to offer a broad range of services”, could lead to “unintended consequences”.

Challenge of providing regular ABPM checks could be insurmountable

The CCA said the “challenge of providing regular ABPM checks could prove insurmountable for many pharmacies, meaning lost threshold payments and a risk that pharmacies stop providing the Pharmacy First service altogether”.

An analysis carried out by the trade body found less than a third of pharmacies currently meet the new threshold requirements to access full funding.

The CCA urged the Government to allow home blood pressure monitoring in addition to ABPM “as an alternative to support patients who do not wish to have ABPM”.

“Providing at least one ABPM every month is expected to be challenging, with demand low and a high number of opportunistic blood pressure checks required to identify suitable patients,” the CCA said.

“There is a wide variance in current use of ABPM testing. One factor is that patients may not be willing to undertake an ABPM and return for a follow-up appointment at a pharmacy, especially when most patients are used to accessing a pharmacy as and when they require.”

CCA chief executive Malcolm Harrison said allowing pharmacies to provide home blood pressure monitoring as well as ABPM “will ensure more pharmacies deliver the service and receive threshold payments which are vital to ensuring that pharmacies are able to stay afloat”.

In a breakdown of the bundled services, the CCA found that as of January 2025, 90 per cent of pharmacies provided Pharmacy First, 77 per cent provided blood pressure checks and 52 per cent provided the contraception service.

“Pharmacy teams can continue to provide and be paid for delivering only one or two of the three services. However, this will mean they would be ineligible for threshold payments, previously only linked to Pharmacy First,” the CCA said.

“If threshold payments are consistently missed, pharmacies may reconsider the sustainability of offering Pharmacy First. This could lead to pharmacies stopping this important element of primary care.”

New National Pharmacy Association chief executive Henry Gregg said: "Providing a comprehensive and consistent package of NHS pharmacy services makes a lot of sense for patients, but we need to make sure this is rolled out in a way that pharmacies can manage.

"It’s important to maximise the services pharmacies can offer which means listening carefully to issues with implementation and ensuring that we don’t place barriers to pharmacies offering services that would limit the takeup of brilliant services that patients really value."