Slow progress with cancer pilots

Eighteen months after NHS England announced a landmark cancer pilot, Leela Barham discovers that fewer than 10 pharmacies have been signed up.

NHS England (NHSE) announced the community pharmacy cancer pilots in June 2022 as part of “radical action” on early cancer diagnosis¹ that included trialling community pharmacy direct referrals to diagnostic services. The anticipation was that community pharmacies could spot the signs of cancer in people who might not have noticed symptoms, such as a cough that lasts for three weeks or more, difficulty swallowing or blood in their urine.

P3pharmacy reported on progress a year after NHSE’s upbeat press release announcing the pilot,² but found little at that time, and even less willingness from NHSE to share details. Responses to freedom of information (FOI) requests have been more revealing 18 months on: just seven pharmacies are currently involved (or maybe nine, depending on who you ask) and only between one and five patient consultations took place up to September 2023.

Timeline has slipped 

NHSE CEO Amanda Pritchard launched the pilot in June 2022 at the NHS Confed Expo conference in Liverpool, triggering a raft of national media stories. Pritchard’s announcement came 11 months before the NHS Business Services Authority (NHSBSA) said the pilot would run as a Locally Enhanced Service with a start date of May 2023.³

Timelines appear to have slipped: the Service Level Agreement (SLA) and Service Specification for the Peninsula Cancer Alliance is dated November 2023.⁴ Service delivery covers 2 January 2024 to 29 March 2024, with the option for NHSE to extend up to 28 June 2024.

Pilots in four Cancer Alliance patches

NHSE said in an FOI response on 24 January this year that it is “currently working with four Cancer Alliances (East of England North, Greater Manchester, Peninsula and South East London)”. It seems Thames Valley has dropped out.

Participating Cancer Alliances received up to £65,000 in the 2023/24 financial year to support the implementation and delivery of the pilot, but not all are actively working with pharmacies.

An FOI response received in January explained that the East of England Cancer Alliance is “not working with any pharmacies directly as part of this pilot. This work is being undertaken by Norfolk and Waveney Integrated Care Board.” It further added: “The pilot is not currently live.”

Community pharmacies participating in the pilot

In its FOI response, NHSE described the pilot as being in the “early stage”, adding that “seven community pharmacies went live in Peninsula in July 2023”. That’s six months later than it said in a news item in December 2022.⁵ And the dates also don’t tally with the SLA.

Based on P3pharmacy’s analysis of NHSBSA pharmacy claims data from June and July 2023, pilot participants have included six Boots and two Day Lewis branches. It’s not clear why it was a total of eight then and seven now.

More will join these seven. NHSE said “more pharmacies [are] preparing to go live across the other Cancer Alliance geographies by Spring 2024”.

Maybe a couple more already have; an FOI response sent on 12 February from the NHSBSA said that, as of January 2024, there were nine pharmacies registered. It also said that it couldn’t confirm the number of claims made because of how it receives data.

Our number crunching of NHSBSA claims data found that in June and July, £3,120 was claimed under the pilots, made up of eight pharmacies claiming £390 each. That looks like the pilot set up fee claimed twice; it should be a one-off payment. No claims were made in August, but one pharmacy claimed £328.62 in September, the most recent claims data available. That presumably equates to £260 for the submission of data and between one and five consultations with patients that month for the extra £68.62, reflecting the structure of payments set out in the Peninsula SLA.

Evaluation to come

An evaluation is planned of the pilots. According to NHSE, the NHS Midlands and Lancashire Commissioning Support Unit is working with it to evaluate the programme.

The evaluation will use pharmacy system data, according to the NHSBSA. This will “facilitate robust review and financial appraisal for NHS commissioners”. Not only that but it will also “look at the role of community pharmacies in referring individuals with suspected cancer symptoms and carry out an assessment of both patient and pharmacy staff experience.”

The Peninsula SLA notes that “all participating pharmacies and pharmacy staff must participate in the evaluation”.

But just how long will it take for there to be something meaningful to evaluate? The delays and lack of clarity are a pity, as there appears to be demand for the service. Although Community Pharmacy England and the National Pharmacy Association declined to comment for this article, Company Chemists’ Association chief executive Malcolm Harrison voiced his support for the pilot.

“Community pharmacies are well placed to support the NHS and public health authorities in their efforts to deliver accessible health screening and early diagnosis,” Mr Harrison told P3pharmacy, adding: “This pilot is important as it will help to establish how the sector can play its part in the combined efforts of the health system to battle cancer.” Let’s hope it does.

References

1 NHS England. (15 June 2022) High street pharmacies spot cancers in new NHS early diagnosis drive. Available at: https://www.england.nhs.uk/2022/06/high-street-pharmacies-spot-cancers-in-new-nhs-early-diagnosis-drive/

2 P3pharmacy. (June 2023) Digging for detail on pharmacy cancer pilots. Available at: https://www.flipsnack.com/ciglondon/p30623/full-view.html

3 NHS Business Services Authority. (Undated) NHS Supporting Early Diagnosis of Cancer (Community Pharmacy) Pilot Registration Available at: https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/dispensing-contractors-information/nhs-supporting-early-diagnosis-cancer-community-pharmacy-pilot-registration#:~:text=Service%20aims%20and%20intended%20outcomes,reduce%20health%20inequalities

4 NHS England. (November 2023) Supporting early diagnosis of cancer (Community pharmacy pilot) Service level agreement & service specification. Available at: https://www.nhsbsa.nhs.uk/sites/default/files/2024-01/Supporting%20Early%20Diagnosis%20of%20Cancer%20%28Community%20Pharmacy%20Pilot%29%20SLA%20%26%20Service%20Specification%20v1.6%20Peninsula.pdf

5 NHS England. (30 December 2022) Nine in ten patients positive about NHS community pharmacies. Available at: https://www.england.nhs.uk/2022/12/nine-in-ten-patients-positive-about-nhs-community-pharmacies/