CPCF settlement: 2019/20 to 2023/24
CPCF settlement: 2019/20 to 2023/24
In July 2019, PSNC, NHS England and NHS Improvement (NHSE&I) and the Department of Health and Social Care (DHSC) agreed a five-year deal for community pharmacies, guaranteeing funding levels until 2023/24. The deal secures pharmacy funding and sets out a clear vision for the expansion of clinical service delivery over the next five years, in line with the NHS Long Term Plan.
Overview for Year Three: 2021/22
Arrangements for the Community Pharmacy Contractual Framework (CPCF) in 2021/22 have been agreed between PSNC, NHS England and NHS Improvement (NHSE&I) and the Department of Health and Social Care (DHSC), in line with the five-year CPCF deal.
This follows an intensive period of negotiations, lasting around three months. During this time, PSNC’s Negotiating Team fought hard to gain concessions on a number of key issues, all with the backing of the full Committee who eventually voted to accept the deal by an overwhelming majority.
In each section below we have outlined that element of the five-year CPCF agreement in more detail. The sections have been updated to include arrangements for Year Three (2021/22).
This checklist contains important dates for the CPCF which relate to services, contractual health campaigns and other NHS requirements.
Funding and payments
The community pharmacy sector will receive £2.592bn per year from 2019/20 to 2023/24. The briefings below provide an overview of the distribution of funding.
PSNC will continue to publish indicative income tables when changes are made to help contractors to predict what their income is likely to be.
Payment deadline and timetable tracker
A tool to help keep track of how and when to claim for new services, including details of how these payments will appear on the Schedule of Payments.
In June 2021, PSNC accepted an offer from HM Government that allowed all community pharmacy contractors in England to claim for their COVID-related costs. The revised offer from HM Government was a significant improvement on their original proposal which was rejected by PSNC last summer. The claiming window ended at 23.59 on 15th August 2021. Subject to a verification of evidence process by the NHS Business Services Authority (NHSBSA), contractors will be paid for their COVID costs in their 1st October payment.
Drug Tariff changes
As part of negotiations for 2021/22, PSNC gained recognition of underspend in previous years, leading to a 2p per item increase to the Single Activity Fee (SAF) from August 2021 and a £12.5m addition to retained margin in the next quarter (October to December 2021).
These payments will continue in 2021/22, with an additional £10 million allocated to these payments. Originally Transitional Payments were planned to last for two years, ceasing at the end of 2020/21. However, as the ongoing COVID-19 pandemic has disrupted plans for service introduction and legislative changes that would support pharmacies to make further dispensing efficiencies, PSNC has negotiated an extension for a further year. The payments are being made to support engagement with Primary Care Networks (PCNs) and Integrated Care Systems (ICS), digital transformation and dispensing efficiencies.
From 1st October 2021, part of the payment will be based on dispensing volume (as it always has been) and the other part will be based on service delivery. To be eligible for the service delivery element, contractors must have claimed for the New Medicine Service (NMS) at least once and have been actively registered for the Community Pharmacist Consultation Service (CPCS) in the previous month. Further details will be published in due course and will appear in the Drug Tariff.
Earlier advance payments and PEPS
All community pharmacy contractors will have the chance to receive earlier advance payments from November 2021. This agreement came as part of discussions on the Pharmacy Earlier Payment Scheme (PEPS), which DHSC decided to end following the collapse of Greensill Capital. The option to receive earlier payments (for prescriptions dispensed from October 2021 onwards) should benefit all contractors, whether or not they had taken advantage of the PEPS.
PEPS pharmacy contractors should note that the final PEPS payments will be paid on 1st October 2021 and from 1st November, a 12-month transition arrangement has been agreed for existing PEPS pharmacy contractors to transfer over to the new earlier advance payment timetable available to ALL contractors from November 2021.
Pharmacy Access Scheme (PhAS)
An updated PhAS starts from January 2022, to continue to support patient access to isolated, eligible pharmacies. Eligibility will be reassessed based on the volume and distance criteria specified in the Drug Tariff. Payments will change to be set in bands based on a bell curve of dispensing volume, with a maximum payment set a £17,500 per year. The total budget allocation will not exceed £20 million per year.
This payment ended on 31st March 2021 as planned. The budget allocated for the Establishment Payment was returned to the contract sum and will now be distributed as part of payments for other elements of the CPCF.
Pharmacy Quality Scheme (PQS)
PQS replaced the Quality Payments Scheme. The gateway and quality criteria will change on an annual basis, with some becoming CPCF Terms of Service requirements during 2020/21.
For 2021/22 scheme, there will be a focus on priorities supporting recovery from COVID-19. The scheme will officially begin on 1st September 2021 with a declaration period in February 2022. As with previous schemes, it has £75m funding available and contractors will be able to claim an Aspiration payment if they wish to, later this year.
In our negotiations on the scheme, a key win for PSNC was reducing the scope of this year’s PQS so that the estimated contractor costs and time required to complete the criteria will be well below those associated with the original NHS proposal for the scheme. PSNC hopes that this, along with arguing for more realistic targets across the scheme, will help reduce the impact on contractor workload, at what continues to be a very busy period for the sector.
New Medicine Service (NMS) expansion
One of the agreed outcomes for 2021/22 was an expansion of NMS into more therapeutic areas. including epilepsy, Parkinson’s disease, gout, hypercholesterolaemia, glaucoma and urinary incontinence. The monthly NMS cap will rise from 0.5% to 1% of dispensed items; the maximum payment per NMS will remain the same.
A temporary introduction of catch-up NMS will also allow contractors to offer patients who were prescribed a new, eligible medicine (including from the expanded conditions) during the COVID-19 pandemic, but who did not receive the NMS at that time, additional support. The catch-up service may be offered to eligible patients between 1st September 2021 and 31st March 2022.
Additionally, the service will be amended to allow the opportunity for NMS to be offered to support carers of patients and the parents or guardians of children newly prescribed medication who could benefit from the service but where the patient is not able to provide informed consent themselves.
Hypertension Case-Finding service
Hypertension Case-Finding will be added to the CPCF as an Advanced service in October 2021. The service will identify those with undiagnosed hypertension, by offering to measure their blood pressure (clinic check) and then, where clinically indicated, offering ambulatory blood pressure monitoring (ABPM). Initially, provision must be by pharmacists.
Whilst the service specification has not yet been finalised, the fees have been agreed. Contractors who sign up to provide this Advanced service will receive a set-up fee of £440, then £15 per clinic check and £45 per ABPM. Additionally, there will be incentive payments funded from outside the CPCF envelope, which will be triggered when certain activity thresholds are reached: £1,000 is triggered by delivering 5 ABPM interventions in 2021/22, then £400 for 15 inventions in 2022/23, and £400 for 20 in 2023/24.
Smoking Cessation service
A Smoking Cessation service will be added to the CPCF as an Advanced service from January 2022. The service will enable NHS Trusts to refer discharged patients to a pharmacy to continue their smoking cessation care pathway after they leave hospital. Initially, provision must be by pharmacists.
Whilst the service specification has not yet been finalised, the fees have been agreed. Contractors who sign up to provide this Advanced service will receive a set-up fee of £1,000, then £30 for the first consultation and £40 for the last consultation, with interim consultations paid at £10. This Advanced service will be most relevant to contractors already providing a locally commissioned service.
NHS Community Pharmacist Consultation Service (CPCS)
This new Advanced service where patients are referred into community pharmacy by other NHS providers was launched in October 2020 with NHS 111 referrals. CPCS was soon extended to include referrals from NHS 111 Online to aid the COVID-19 response and, from 1st November 2020, referrals from GP practices were introduced. Contractors registered to provide the CPCS could claim a £300 engagement and setup payment if they undertook a range of actions to get ready for rolling out the GP referral pathway in their area by 30th June 2021.
During 2021/22, further work will be undertaken to develop the CPCS referral routes from Emergency Departments and Urgent Treatment Centres and work with systems to further embed these services in year 3 as part of integrated care pathways across Primary Care Networks (PCNs).
Discharge Medicines Service (DMS)
The DMS became a new Essential service on 15th February 2021. The service enables NHS Trusts to refer patients who would benefit from extra guidance around new prescribed medicines to their community pharmacy. The service has been identified by NHSE&I’s Medicines Safety Improvement Programme to be a significant contributor to the safety of patients at transitions of care, by reducing readmissions to hospital.
During 2021/22, work is ongoing to support the continued implementation.
Hepatitis C testing service
Hepatitis C testing became a new Advanced service on 1st September 2020. The service is focused on provision of point of care testing (POCT) for Hepatitis C antibodies to individuals who inject illicit drugs, e.g. steroids or heroin, but who haven’t yet moved to the point of accepting treatment for their substance use.
Medicines Use Reviews (MURs)
To free up capacity and funding for the CPCS, and also in recognition that NHSE&I does not consider them to offer good value for money, MURs were phased out over the first two years of the five-year deal. The service was decommissioned on 31st March 2021. The budget allocated for MURs was returned to the contract sum and will now be distributed as fees for other services.
A range of new services will be piloted and introduced over the course of the five years to support the delivery of the NHS Long Term Plan. Whilst the pilots will be funded by the Pharmacy Integration Funding (PhIF), the introduction of new nationally commissioned services will be allocated funding from the overall contract sum as they are launched.
CPCF service development grid – a matrix document setting out when each of the agreed CPCF service development pilots may be implemented during the five-year deal.
Changes to assist contractor efficiency
During 2021/22, changes to medicines legislation will be sought to enable original pack dispensing and the wider use of hub and spoke dispensing to improve efficiencies and better use of the skill mix in pharmacy teams so that the clinical skills of pharmacists can be directed to helping patients. This will be followed by appropriate changes to the CPCF.
In 2021/22, the following changes will be made to the NHS Regulations:
- a pandemic provision; and
- amendments to the market entry provisions so that NHSE&I may refuse any application that results in an oversupply of Essential services, including those seeking only a minor increase in opening hours.
Further details will be published on these in due course.
Terms of Service changes
The regulations required to enact several changes to the Terms of Service due to commence in July 2020 – including the requirement for all community pharmacies to be Healthy Living Pharmacies – were delayed due to the Government focusing on the COVID-19 response. However, the new NHS regulations were laid on 20th October 2020 and PSNC issued a series of 14 Regs explainer articles to help pharmacy contractors and their teams to understand the new requirements – access them all here.
A commitment was made to considering a range of reforms to reimbursement arrangements. A public consultation on reforms to reimbursement ended in September 2019. Following delays caused by the ongoing pandemic, the 2021/22 agreement contains a commitment to progress discussions on and implement reforms to reimbursement.
Education and training
In 2021/22, Health Education England (HEE) will be commissioned to provide a three-year programme of education and training for community pharmacy professionals, including independent prescribing training for existing pharmacists.
Also, from 2022/23, HEE will support the management of the training places in community pharmacy and responsibility for administration of payments to community pharmacy contractors for trainee pharmacists.
During 2021/22, there will be continued discussions on:
- seeking VAT exemption for services delivered under pharmacist supervision;
- methodology for pricing services;
- the regulation of dispensing and supply of medicines, including novel ways of doing this, whilst also ensuring the integrity of the market entry provisions; and
- a suitable process to allow suspected prescription direction issues to be reported and investigated by NHSE&I.
Shortly after the five-year deal was announced, PSNC ran a series of free roadshow events across England to explain the context of the new CPCF agreement and what it meant for pharmacies. A recording of the Digital Roadshow is available to watch on-demand.
For external audiences
The PSNC Communications and Public Affairs Team has created the following resources to help in explaining the five-year CPCF to external audiences. These may be particularly useful for LPCs engaging with local healthcare organisations or other stakeholders.
Community pharmacy presentation – a PowerPoint about community pharmacy reflecting changes to the CPCF.
CPCF summary for external stakeholders (Word document, so it can be edited for localisation)
Summary of the Five-Year Pharmacy Deal for general practice teams (Word document, so it can be edited for localisation)
Template letter to GP practices on five-year CPCF – LPCs may wish to ask their LMC to send this letter/email out to local GP practices.
An infographic describing the five-year CPCF settlement – this outlines the journey that community pharmacy will take between now and 2023/24.
Also see our webpage Community Pharmacy: Information for GPs.
If you have a query that isn’t addressed by this webpage, please email firstname.lastname@example.org
This page will be updated as more details and resources become available.