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.
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. 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 they may receive similar payments depending on the terms of their contracts. Appliance contractors and dispensing doctors are also not included in the scheme.
Deemed Eligible List
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).
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.
Applications for review should be made using the NHS England PhAS review application form. Once complete application forms should be sent to email@example.com.
Cases that qualify for a review
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
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 if a PhAS pharmacy permanently relocates during the duration of the scheme?
Our understanding is that the PhAS eligibility criteria are fixed to the location of the pharmacy, and for that reason pharmacies would lose eligibility to the PhAS were they to permanently relocate. Exceptions will be considered for pharmacies that have to make temporary arrangements for a reason/s outside of their control such as a flood, fire etc
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.