In Views

Follow this topic

Bookmark

Record learning outcomes

The 2026-27 pharmacy contract didn't give us exactly what we want. But it could be the start of genuine contractual reform towards making us financially sustainable, says Nick Kaye…

The new contract for England is, maybe, not as much as we want. But it's also fair to say that over 10 per cent is better than most other parts of healthcare.

I know it only moves the dial on the gap in the independent economic review by one per cent and community pharmacy budget as a percentage of NHS spend is not moving fast enough back to the 2.5 per cent it was in 2015.

But I think we should all be looking at some of the other parts of the new contract which is going to ask big questions of us all and what we want community pharmacy to look like in England. We can see this in three main areas.

The first is the fact independent prescribing is in the national contract now. I can already hear the ‘yes!’. But it’s not enough money, I completely agree. Yet, now it’s in existence, it’s for the next iteration to be better.

Of course, I’m excited but I accept this is part of a journey and it’s for national and local leaders to listen to frontline teams to work out how best to make sure this service is a success and how local commissioning may be able to add value into the financial model.

This is the most important part of the message it should be sending to all of us. This is where the NHS wants us to move and with every pharmacy graduate now being an independent prescriber as they leave university, it’s important to ensure the NHS sees us as a place for clinical delivery.

The second point which is really important is the way in which the meningitis B catch-up vaccination was commissioned, through all of our great work in the sector.

The vaccine space shows community pharmacy is the first place where meningitis B catch-up is commissioned. It makes us think about what NHS wants from us, that we are seen as a clinical setting for the delivery of care more than a shop.

This is significant and what could come next in this space is potentially really exciting, I think.

However, the third, and I think most important, point is that the government has agreed in this contract to the start of contractual reform. This is critical. Look at the direction of travel. What could this mean for the way in which we are reimbursed for medicine supply?

Let me try and clear up medicine supply. I think it is and will always be a key function of community pharmacy but ask yourself, is the current contract working for you?

We talk about dispensing at a loss, which we know is true on certain lines, but the government will just say ‘we deliver your margin. In fact, we increased your margin in the last contract round, so you don’t dispense at a loss’.

Does that work for you? Does margin work for you? I think it works for the government to drive the price the NHS pays to one of the cheapest in Europe and the G20.

And it may have worked for us in the past when the cost of drugs was decreasing. But in a world of drug price rises and branded generics, I really don’t think margin should be at the level it is in our contract.

It leaves lots of what we could earn to chance, or the whims of medicines optimisation teams. Maybe an increased single activity fee is a good idea.

Maybe bring back the practice allowance. What about depravation weighting? How would you pay for services? I have argued in the past that there should be a national booking system for pharmacy services.

We get paid for the number of appointments we upload (you could cap that number) and this would drive NHS systems to direct people to those appointments because they pay for them.

Wouldn’t it be great to know we had the funding to employ extra team members rather than taking the gamble is any someone might come into the pharmacy today?

What about additional roles reimbursement scheme pharmacists or pharmacy technicians in community pharmacy? How would that transform your day? What about a technology grant to allow us to invest in onsite automation or clinical area refurbishments?

When we talk about contractual reform, it is going to be important to get your voice heard. There is no point sitting on the sidelines and complaining afterwards.

This could be the genuine start to reform of our contract, making us financially sustainable, more predictable and allowing us to plan for a long-term future for us and the communities we service.

I believe it could be sustainable if it is shaped in the right way. So please get involved. And let’s shape the art of the possible together.

Nick Kaye is a National Pharmacy Association board member and pharmacist based in Newquay. These are his personal views.