In Analysis

Follow this topic

Bookmark

Record learning outcomes

The BMA is to lose its position as the exclusive negotiator for GPs. Could pharmacy be facing a similar shakeup? Leela Barham investigates

Negotiations are important; it follows that who negotiates is important too. With Health Secretary Wes Streeting opening up negotiations when it comes to the GP contract beyond the British Medical Association (BMA), what could it mean if the same change applied to community pharmacy? 

BMA position weakend

The government has decided to change the way it decides the GP contract terms starting from next year. The change includes ending the BMA’s position as the sole negotiator. Instead, there will be consultations with others, including the Royal College of General Practitioners (RCGP), the National Association of Primary Care (NAPC), Healthwatch England, National Voices and the NHS Confederation. 

Community Pharmacy England (CPE) negotiates with the government on the contract framework. Its committee includes 10 elected regional members, as well as representatives nominated by the sector’s main trade bodies. A recent refresh saw the Independent Pharmacies Association gain more places on the committee in a bid to make it more representative.

With the BMA’s power to influence negotiations set to diminish, could CPE be facing changes to its role? 

Could it happen?

The government’s desire to work with more stakeholders than the BMA alone is because they’ve found the BMA hard to work with. Revealed preference suggests that they think it will be easier to deal with many more organisations and their perspectives than the BMA alone.

Perhaps that is not the case for community pharmacy in England? Plus, CPE has a track record of joint work with others in primary care, for example. CPE has also been part of joint submissions to the government on the 10-year plan and the government spending review. More cynically though, it may signal that the government doesn’t find CPE to be a tough negotiator.

Should it happen?

There could be benefits of hearing from those who are both directly affected (patients) and indirectly affected (the rest of the NHS and wider society). It could offer a fresh perspective and push negotiations into new areas, especially if all parties have a real place around the table to effect change.

Adding new voices to negotiations and breaking the hold CPE has on the contract is the hope of one sector insider who spoke to P3pharmacy based on anonymity. “CPE will resist the changes that the contract needs. CPE is a barrier to reform,” they said.

A new contract is needed, the sector insider insists, because of the move to independent prescribing (IP). “In the current contract, one of the most controversial issues is retained margin. It’s controversial because it’s inconsistent with IP.” They added, “If there were more consultees on a future community pharmacy contract, consultees need to ask, if a pharmacist is paid on the profit from the supply of medicines, and they are prescribing, is that a good idea?”

A new contract needs to work when incentives shift; more IP in community pharmacy, especially moving into chronic conditions and to fit with the NHS 10-year plan, means dealing with the perverse incentives that he argues are in the current contract. A contract that is grounded in medicines optimisation, is the hope – not a rerun of the current volume-based contract. 

The sector insider believes it’s financially possible: “The York [Health Economics Consortium] study shows that reform of the contract could save billions for the NHS.” 

Bringing in others could help bring in more frontline perspectives, something that the GPCE has already, the insider argued: “GPCE is all frontline clinicians; they see patients. That’s one of CPE’s key failings. As an IP, I see patients all the time, and I can see how the current contract is not compatible for an IP future.” 

Reality check

Yet there is a reality check. The sector insider concedes: “Other stakeholders might not be able to challenge CPE.” The need for fundamental changes to the contract are not necessarily going to be understood by those outside of the complex inner workings of today’s community pharmacy business models. 

That view could be argued to be supported by the work of the contenders to bring into negotiations, should the Streeting model for negotiation in the GP contract be applied to pharmacy. Many of the stakeholders have done work on community pharmacy. In June 2025, HealthWatch released its ‘one year on’ report looking at Pharmacy First and called for the sector to have greater support in delivering consultations. 

Others are already working with the sector, including those that have a seat around the negotiating table. National Voices is already a partner with the National Pharmacy Association. 

While there could be more radical thinking within these groups, it doesn’t look like it from the outside. But could they bring that in if allowed to really shape the future contract? 

The Confed set up a new Community Pharmacy Leaders Forum in November. The forum is in addition to the primary care network, which already includes community pharmacy members. Could that be a forum that could do some new thinking, and presumably a less sector-centric point of view, given that it’s hosted within the Confed?

It’s not clear if the government or CPE would want to change the approach to negotiations. But when more of the same isn’t delivering results, it could be worth exploring.