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Lack of control: Another reason our NHS contract fails pharmacies

By NPA chair, Olivier Picard

The NPA has long argued for radical changes to the Community Pharmacy Contractual Framework (CPCF) – beyond holding the simple position that we need more money in the CPCF fixed envelope (although that is also key to a sustainable future).

Among the several aspects requiring reform is the fi nancial uncertainty caused by seemingly indiscriminate clawbacks. The balancing mechanism that the Department of Health and Social Security uses to try to make the system fair fails to correct the underpayments at individual pharmacy level and allows raids on pharmacy funding up to 18 months after an item was dispensed. This is frustrating and unfair in itself.

But it’s just one of the ways in which pharmacies lack control over their own a airs, under current NHS contract arrangements:

• The CPCF fixed sum is subject to retrospective adjustment, months later

• Post Payment Verification can be a lengthy process with money clawed back years after the event

• Medicines margin is not equally accessible to all pharmacies impacted by local prescribing and clawback of overdelivered margin bears no relation to margin earned at a contractor level. (It’s worth remembering that margin clawback hasn’t happened for a while but is still part of the contract).

• Some clinical services paid from the fixed sum are reliant on others for referral, for example the Discharge Medicines Service and Pharmacy First Minor Illness consultations

• Some advanced services outside of the CPCF are pitched against GPs and the pharmacy’s success often depends on the attitude of such powerful ‘competitors’.

Overall the system lacks transparency and leaves most of the financial jeopardy with the pharmacy. Retrospective adjustments as well as the financial uncertainty put an immense burden onto our members, me included! To mitigate these problems, many pharmacies, including my own group of four, have increasingly looked to private services as a way to stabilise income and ‘take back control’.

By growing my own revenue outside the NHS, I am leaving myself less vulnerable to actions and decisions made outside my business, by a monopsony paymaster. The NHS pharmacy funding paradox is that 90 per cent of the work brings little of the profi t. That’s why my own pharmacies now offer, privately, ear microsuction; travel clinics; private Covid vaccines; a weight loss clinic; chicken pox vaccinations; and other services are being considered.

If you are taking a similar path, do make use of the NPA’s support, including our trusted partners, as I myself have done. We’ll be with you every step of the way. Yet, while diversifi cation can help some pharmacies improve their financial resilience and reduce their reliance on NHS income, it is not a realistic solution for every pharmacy or every community.

The demographics of some communities, specifi cally poorer areas, mean that a strong base of fee-paying patients won’t necessarily sustain a wide portfolio of private services. I therefore anticipate that NHS services, with dispensing at the core, are going to remain at the heart of what most pharmacies across the country provide for their communities.

Pharmacist prescribing services – inside and outside the NHS – may well change the short- and long-term calculations for many about where to lay the emphasis between NHS and non-NHS care.

Your prescribing journey: We’re with you every step of the way!

The NPA has launched the UK’s most comprehensive prescribing support programme for community pharmacy. Whether you’re preparing to prescribe, launching your first prescribing service or expanding your clinical offering, we give you everything you need in one place!

Learn Enrol on our training programme which provides a structured pathway that will build your confidence and capability in prescribing. This unique programme equips pharmacist independent prescribers (PIPs), and those who oversee prescribing activity, with the knowledge, skills, and resources to deliver safe, high quality prescribing services.

The ‘Clinical Excellence in Prescribing Practice – The Fundamentals’ course covers prescribing competency; the consultation; prescribing governance; risk assessment; advertising and servicereview. Launch Our training programme provides resources and guidance to help you launch your prescribing service, including remote consultation considerations and key governance protocols.

This unique programme is also suitable for those that oversee prescribing activity such as superintendent pharmacists and pharmacy managers or owners to help ensure that appropriate governance is in place. Deliver Resources and guidance to help you deliver your prescribing services, includes a record-keeping template, consultation checklist and more. Key resources include:

• Prescribing Service Risk Assessment Templates

• Prescribing Service SOP Template

• Medical History Consultation Checklist

• Prescribing Audit Template

• Guidance articles covering best practice and current clinical topics

• Prescribing competency resources

• Business continuity template.

Grow

Our special training programme includes modules on advertising and service review. The service review module contains an audit template to help identify areas for improvement, as well as a key performance indicators template which can be used to track whether a prescribing service is achieving its objectives.

Number of FTE community pharmacists falls

The NPA is a member of the Community Pharmacy Workforce Development Group (CPWDG), whose latest report warns that headline growth in the community pharmacy workforce is failing to translate into greater capacity – which is now lower than it was four years ago.

The number of full time equivalent (FTE) community pharmacists has fallen by 14 per cent since 2021, and the number of FTEtechnicians has fallenby 11 per cent. The report urges policymakers to develop a long-term workforce strategy, which must not assume that more students will result in more registrants and an increase in capacity.

The CPWDG says the plan must refl ect therealities of a changing community pharmacy landscape by:

• Matching workforce supply to projected demand for existing services, alongside the service expansion envisaged in the 10 Year Health Plan for England.

• Recognising changing working patterns and career pathways, and account for the subsequent impact on workforce capacity.

• Ensuring that workforce policies implemented in other parts of the NHS do not unintentionally destabilise other sectors • Supporting the retention, development andcareer progression of pharmacy team.

• Providing sustainable funding for both core and additional services, enabling employers to invest in the workforce capacity required to meet growingdemand.

Improvements to the NPA Membership Hub

The NPA has launched its improved Member Portal, marking an important step forward in making it easier for members to access and engage with NPA services, courses and events. The improvements focus on simplifying key journeys, refreshing the portal’s look and feel, and making content easier to navigate.

This work provides a stronger foundation for how we present and deliver our digital services to members. What’s changed? • Simpler registration and login: We’ve streamlined the registration and login journey, removing the requirement for members to enter their membership number

• Improved course enrolment: The course enrolment journey has been simplified, and members can now enrol on a course as a guest without needing to register for the portal first.

• Refreshed design: A more engaging, modern look andfeel.

• Improved content navigation: Content is organised into more refined categories, helping members fi nd the information and resources they need moreeasily. What happens next? Improving the member experience is an ongoing process. We’ll continue to develop the portal’s content and presentation, building on the refreshed design and looking for further opportunities to make our digital services more accessible and useful.

This work supports our wider commitment to putting members at the heart of what we do and making it as easy as possible for them to access the value of their NPA membership. Please explore the improved portal. If you experience any di culties, please share this feedback so we can work to improve your experience.

1-in-10 patients went without medicine last year due to prescription charge worries

Ten per cent of patients in England say they went without a medicine they needed in the last year due to concerns about cost, new polling commissioned by the National Pharmacy Association has found.

The same survey of adults across England, carried out by Savanta, showed 80 per cent of respondents thought it was unfair that patients in England were charged a prescription fee while the rest of the UK were exempt.

Olivier Picard, chair of the National Pharmacy Association said: “No patient should ever see cost as being a barrier to accessing the medicines they need but this polling shows an alarming number do. Pharmacists are health professionals, not tax collectors.”

A SELECTION OF NEW NPA PRACTICE AND REGULATORY RESOURCES

Available on the NPA Membership Hub

CQC registration of community pharmacies (England)

The NPA has published guidance to help community pharmacy owners understand when the services and activities they provide may require registration with the Care Quality Commission (CQC).

The guidance outlines key principles and defi nitions, includes decision-making flowcharts and explains how to seek further advice from the CQC registration team.

Parenteral administration of POMs in emergencies

The NPA has published new guidance outlining which parenteral prescription-only medicines (POMs) may be administered in an emergency to save a life.

The guidance also covers the key legal, practical and record-keeping considerations associated with emergency administration. Changes to NHS pharmacy regulations (England) As part of the Community Pharmacy Contractual Framework (CPCF) 2026/2027, changes to the NHS Terms of Service came into force on 1 October 2026, with Disclosure and Barring Service (DBS) requirements taking e ect from 1 January 2027.

The NPA has published an update to ensure your policies, procedures and working arrangements are ready.

Parliamentary group reports on medicines shortages

Commenting on a report by the All-Party Parliamentary Group (APPG) for Pharmacy into medicine shortages, Henry Gregg, chief executive of the NPA said: “The APPG is right to recognise the immense challenges medicine shortages continue to pose both patients and pharmacies.

“It should cause deep alarm that we have some of the longest running medicine shortages in history, with Creon and Estradot recently having their title extended as being Britain’s longest running medicine shortage on record. “The government’s response to their consultation on allowing pharmacists to make substitutions if a medicine is not in stock is long overdue and should be published urgently.”

Prime Minister visits NPAboard member

Prime Minister Andy Burnham visited NPA board member Sanjay Ganvir, superintendent pharmacist of Green Light Pharmacy, to highlight the expansion across England of the NHS Pharmacy First Service, this autumn.

It was an opportunity to talk directly with the Prime Minister about the huge potential of community pharmacy in primary care, urgent care and publichealth. Sanjay explained that, as medicines experts, pharmacies can help government and patients get the best value from medicines.

Pharmacies can do so much more to provide accessible health services to patients, without the need for them to visit their GP. It was good to see such enthusiasm from the Prime Minster for this shift. But much more investment is needed to turbo-charge the pharmacy network’s contribution to health in every neighbourhood.