Pharmacy Access Scheme (PhAS)
Pharmacy Access Scheme (PhAS)
On 20th October 2016, as part of the two-year final funding package imposed upon community pharmacies in England, the Department of Health (DH) confirmed the introduction of a Pharmacy Access Scheme (PhAS), with the stated aim of ensuring that a baseline level of patient access to NHS community pharmacy services is protected. DH states that the PhAS will protect access in areas where there are fewer pharmacies with higher health needs, so that no area need be left without access to NHS community pharmaceutical services.
Qualifying pharmacies will receive an additional payment, meaning those pharmacies will be protected from the full effect of the reduction in funding from December 2016.
The DH guidance on PhAS provides detailed information on the scheme.
Deadline for reviews has now passed
DH guidance on PhAS states that applications for review will need to be made within three months of the start of the scheme and reviews will be administered by NHS England. Therefore, the deadline was the end of February 2017, with one potential exception for some physical feature anomaly review applications.
The Drug Tariff provides that, ‘applications for review in cases relating to physical feature anomalies will be considered beyond this three month period, but only if the application relates to a change in circumstances which occurs after the end of the three month period. In such cases, the application for review must be brought within three months of the change in circumstances.’
PSNC issued a briefing with key points on PhAS works and the review process: PSNC Briefing 005/17: The Pharmacy Access Scheme – the review process closes at the end of February 2017.
Eligibility for the PhAS
Pharmacies do not need to apply to the scheme to be eligible; eligibility has been calculated nationally by DH, based on data relating to how many prescription items a pharmacy dispensed in 2015/16, to assess their size and data relating to the distances between pharmacies.
A pharmacy will be eligible for the PhAS if it meets all of the following three criteria:
- the pharmacy is more than a mile away from its nearest pharmacy (measured by road distance);
- the pharmacy is on the pharmaceutical list as at 1 September 2016; and
- the pharmacy is not in the top 25% largest pharmacies by dispensing volume.
The scheme will run from 1 December 2016 to 31 March 2018.
During this time, eligibility will be fixed to the pharmacies that are deemed eligible in the list published on 20 October 2016.
Distance-selling pharmacies (e.g. internet pharmacies) are not included in the scheme; this is because the scheme is intended to protect physical access to bricks and mortar pharmacies. Appliance contractors and dispensing doctors are also not included in the scheme.
Pharmacies that hold local pharmaceutical services (LPS) contracts with NHS England have not been included in the scheme, because their contracts are funded outside of the CPCF, although, it had been envisaged that LPS pharmacies may receive similar payments depending on the terms of their LPS contracts. See under “LPS Pharmacies” for current information.
Deemed Eligible List
Applying the PhAS criteria means that 1,356 pharmacies qualify for the PhAS and these are detailed in the list published on the 20 October 2016 by DH.
On 4 November 2016, the deemed eligible list was updated by the Department of Health to remove pharmacies that were included in error. The pharmacies removed were Distance-Selling Pharmacies, which aren’t eligible for the scheme, and Local Pharmaceutical Services pharmacies, which have separate contractual arrangements.
Update 26 July 2017
PSNC has been working with the Department of Health (DH) and NHS England to recognise the unique position of Local Pharmaceutical Services (LPS) which returned to the pharmaceutical list and were effectively excluded from the Pharmacy Access Scheme (PhAS).
LPS pharmacies that returned to the pharmaceutical list recently, or will return before 31 March 2018, are unable to meet the eligibility requirement for a pharmacy to have been on the pharmaceutical list on 1 September 2016; and, in most cases, apply for a review before the end of February 2017.
NHS England and DH have accepted that, in principle, all LPS pharmacies returning to the pharmaceutical list after 1 September 2016 should be:
- considered for PhAS eligibility; and,
- able to seek a review (for inaccuracy, physical feature anomaly or near miss), if not automatically eligible.
There will be appropriate changes to clarify this in the Drug Tariff. LPS pharmacies will still be required to meet the other criteria to be eligible for PhAS payments, i.e. to be more than a mile away from the nearest pharmacy and not be in the top 25% of pharmacies by dispensing volume.
NHS England has already considered any speculative review applications made by LPS contractors before their pharmacies returned to the pharmaceutical list and is expected to communicate with other LPS pharmacies (and former LPS pharmacies that returned to the pharmaceutical list after 1 September 2016), as appropriate, to explain the situation.
There is a note of caution. While some LPS pharmacies may appear technically eligible for PhAS payments, they may not receive any additional funding. This is because PhAS payments do not replicate or replace any LPS payments that were additional to Drug Tariff or equivalent funding. Also, smaller volume pharmacies that did not receive, and therefore have not lost, the Establishment Payment may actually benefit from the new higher Single Activity Fee (as opposed to the previous lower dispensing fee), so there may be no gap to ‘top-up’.
DH state that on average, the payment received by each PhAS pharmacy will equate to roughly £11,600 in 2016/17 and £17,600 in 2017/18. This is roughly £2,900 per month in 2016/17 and £1,500 per month in 2017/18. (Note that the monthly payment is higher in 2016/17 because the annual payment is split into 4 months (payments for December 2016 – March 2017) whereas the 2017/18 payment is split into 12 months.)
The exact payment a PhAS pharmacy will receive will be based on the funding it received in 2015/16. In addition, it will incorporate an efficiency saving, of 1% in 2016/17 and 3% in 2017/18. Full details are set out in the DH guidance on PhAS.
The scheme will be paid for from the funding for the community pharmacy contractual framework (CPCF).
On 31 March 2017, PSNC informed community pharmacy contractors that it had identified issues with payments being made under the Pharmacy Access Scheme (PhAS) and was working with the Department of Health and NHS England to find solutions.
These issues included:
- Inaccuracies in the payment calculations made by the Department of Health; and
- Issues for LPS pharmacies which have or will return to the Pharmaceutical List after the end of the review period, which ended on 28 February 2017.
In May 2017, the Department of Health (DH) wrote to all pharmacies receiving PhAS payments with corrected payments due to them under the scheme.
Community pharmacy contractors were informed at the end of March 2017 that PSNC had identified issues with the PhAS payments.
The extent of the problems became clear. The problems arose because DH had not calculated PhAS payments in accordance with the Drug Tariff and this has led to inaccurate payments being made to contractors.
DH reviewed all PhAS payment calculations and indicated that it is corrected errors in its methodology to make its calculations consistent with Drug Tariff provisions.
The problems include the following:
- DH used an estimate of 2015/16 remuneration rather than the actual remuneration that was paid to each pharmacy.
- DH did not use the fee levels at April 2016 to calculate estimated remuneration between April – November 2016.
- In certain cases, DH double counted the Quality Payment.
DH identified that in the three months before March 2017 under-payments were made to some contractors and over-payments were made to others. DH has said it will calculate an adjustment payment for any contractor who has been underpaid in these months, to make up the shortfall; and it will not seek to recover any overpayments made in these months.
A review process has been included in the scheme to allow for consideration of extenuating circumstances which may mean that access is not being protected in the way intended by the scheme.
DH guidance on PhAS confirms that applications for review will need to be made within three months of the start of the scheme (1st December 2016) and reviews will be administered by NHS England. Applications for review will be accepted from 1st November 2016 and NHS England aim to complete a review within six weeks of receiving a request.
NHS England have now published further details about the application for review process.
Please see this flowchart for details of what that process will involve.
In June 2017, NHS England confirmed that it had responded to the majority of contractors who asked for their eligibility to receive payments under the Pharmacy Access Scheme (PhAS) to be reviewed.
NHS England said that 71 additional pharmacies would now receive payments under the scheme. The successful pharmacies will receive payments backdated to the start of the scheme on 1st December 2016, and they have been sent a letter by NHS England confirming their status.
Other pharmacies have received letters confirming that the reviews of their applications have been completed and they are still not eligible for PhAS payments. The Drug Tariff states that: “Reviews will be administered and completed by NHS England; including the assessment of and decisions taken on all applications for appeals.” Those wishing to appeal or dispute a review decision are therefore advised to take this up with NHS England.
However, NHS England said that 15 applicants have not yet received final confirmation of the outcome of their application and will be informed by the end of June at the latest.
NHS England stated that purdah (which prevents civil servants from making announcements relating to the previous government during an election period) had prevented it from finishing this work sooner.
Cases that qualify for a review
The deadline for applying for this type of review has now passed.
An application for review can be made on the ground of an inaccuracy (for example, if the pharmacy postcode is incorrect or the distance from the next pharmacy is calculated incorrectly).
There is no need to demonstrate that the pharmacy is critical for access.
Physical feature anomalies
An application for review can be made on the ground of physical feature anomalies (such as a semi-permanent roadblock meaning two pharmacies are then more than 1 mile from each other).
According to NHS England applications for review in cases relating to physical feature anomalies will be considered beyond the three month period, but only if the application relates to a change in circumstances which occurs after the end of the three month period. In such cases, the application for review must be brought within three months of the change in circumstances.
Pharmacies relying on a physical feature anomaly will have to provide evidence of that anomaly. That is, they will need to make an application and submit evidence. This evidence will need to demonstrate, on a balance of probabilities that the normal “1-mile rule” produces an unreasonable outcome in the particular circumstances of their case. If a semi-permanent road or bridge closure means that the nearest pharmacy is in fact more than a mile away, the first stage of the review will be passed successfully. If the problem is that the distance to the nearest pharmacy is in fact less than a mile but the journey is particularly difficult, NHS England will need evidence of the level of difficulty and the problems surmounting that difficulty.
If a pharmacy satisfies the first stage of the test in a “physical feature anomaly” case, to then qualify for the PhAS payment, the pharmacy would also have to demonstrate on a balance of probabilities that they were critical for access. The burden of proof on that point would fall to the pharmacy. The top 25% of pharmacies by prescription volume would still be excluded here, as for the scheme generally.
A pharmacy seeking to demonstrate that it is critical for access would need to do this having regard to the aims of the scheme set out in DH Guidance. In particular, it would need to demonstrate that a local population relies on that pharmacy and would be materially affected by its closing. The health needs of the population may be relevant to whether or not the local population is materially affected by the closure.
“Near miss” pharmacies in areas of high deprivation
The deadline for applying for this type of review has now passed.
An application for review can be made on the ground of “Near miss” pharmacies in areas of high deprivation. This will cover pharmacies that are located in the top 20% most deprived areas in England, and who are located between 0.8 and 1.0 mile from another pharmacy. For this purpose, NHS England will look at the top 20% of Lower Layer Super Output Areas (LSOAs), when ranked by the Index of Multiple Deprivation (IMD). LSOAs are a standardised unit of geography in the UK. An LSOA varies in geographical size according to population density, but has an average population of about 1,600 in 2011.
Pharmacy contractors can find out their ranking by IMD by inputting their postcode here:
This produces an excel spreadsheet, including the LSOA name and code for that postcode, the IMD Rank and the IMD decile. Deciles 1 and 2 relate to the top 10% and 20% most deprived LSOAs.
If a pharmacy satisfies the first stage of the test, in a “near miss in an area of deprivation” case, to then qualify for the PhAS payment, the pharmacy would also have to demonstrate on a balance of probabilities that they were critical for access. The burden of proof on that point would fall to the pharmacy. The top 25% of pharmacies by prescription volume would still be excluded here, as for the scheme generally.
A pharmacy seeking to demonstrate that it is critical for access would need to do this having regard to the aims of the scheme set out in DH Guidance. In particular, it would need to demonstrate that a local population relies on that pharmacy and would be materially affected by its closing.
The health needs of the population may however be relevant to whether or not the local population is materially affected by the closure. The particular nature of the deprivation in “near miss” cases may therefore be relevant. They may also be particularly affected if there are strong links between that pharmacy and the local community via geography. For example, it is the sole pharmacy on a particular housing estate, even if another pharmacy is 0.9 miles away on a High Street.
Q. Will the PhAS come from the total community pharmacy funding envelope?
Yes, any funding for the PhAS will come from the total community pharmacy funding envelope. DH estimates that payments will total £16m for 2016/17 and £24m for 2017/18.
Q. How do I apply for the PhAS?
Pharmacies do not need to apply to the scheme to be eligible; eligibility has been calculated nationally, based on data relating to how many prescription items a pharmacy dispensed in 2015/16, to assess their size (small, medium or large), and data relating to the distances between pharmacies.
Q. If my pharmacy is eligible for PhAS, when will I get my first payment?
The first PhAS payment will be included in the pharmacy’s reconciliation payment that relates to prescriptions dispensed in December 2016. These payments will continue monthly until the payment for March 2018.
Q. Is eligibility for PhAS linked to Quality Payments?
The scheme assumes that PhAS pharmacies meet all the Quality payment criteria. If not, then the Quality Payment is reduced – PhAS will not make up any shortfall.
Q. Are distance selling pharmacies, pharmacies that hold local pharmaceutical services (LPS) contracts with NHS England, appliance contractors or dispensing doctors included in the scheme?
No. The scheme protects physical access to bricks and mortar community pharmacies.
Q. How long will the PhAS run for?
The scheme will run from 1 December 2016 to 31 March 2018.
Q. What happens after the expiry of the PhAS?
No indications have been given by DH about plans for the PhAS beyond 31 March 2018.
Pharmacy Access Scheme webinar
PSNC held a webinar about the Pharmacy Access Scheme and amendments to Regulations being introduced as part of the 2016/17 and 2017/18 package on 16th November 2016; a recorded version of the webinar is now available to watch.