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CPCS: Embedded in general practice or overlooked?

What does the latest QOF tell us about the importance of referrals to pharmacy?

Leela Barham examines recent changes to the Quality and Outcomes Framework for GPs that links to community pharmacy. The changes don’t name-check community pharmacy. Why not?

The NHS is under pressure, and general practice is no exception. In the latest version of the Quality and Outcomes Framework (QOF) – a points-means-pounds incentive scheme for surgeries – there are “access requirements.”

NHS England (NHSE) has explained these requirements by updating the GP contract to make it clear that “patients should be offered an assessment of need, or signposted to an appropriate service, at first contact with the practice.” Access requirements also include a deadline to give patients access to their health information online by no later than 31 October 2023, as well mandating use of cloud-based telephony.

No name check

Community pharmacy doesn’t get a name-check in the letter sent to GP practices outlining the changes to the 2023/24 QOF. Readers could assume that the references to signposting to an appropriate service includes the Community Pharmacy Consultation Service (CPCS). Unfortunately, NHSE did not respond when asked to clarify. The CPCS has money attached for community pharmacies when there is a formal referral from a GP practice to the community pharmacy.

Last year, community pharmacy was name-checked in QOF changes – including the CPCS – as part of the efforts to optimise capacity in general practice. It’s hard to know why community pharmacy is not name-checked this time.

Use of CPCS

Optimists may view this as a positive development – perhaps all GP practices are already making best use of CPCS? After all, last year’s QOF saw a big push to optimise capacity and included practices having to conduct reviews to “better understand the skills available… to better match demand and optimise the use of capacity”.

NHSE suggested that practices look outside their own teams and explore options like “the use of wider primary care services e.g. the CPCS” as part of their capacity reviews. How to tell if this is the case though? PSNC/Community Pharmacy England produces a dashboard that includes CPCS activity, with the most recent version covering data from April 2021 to December 2022. It looks like things picked up from April last year – when the 2022/23 QOF efforts on optimising capacity were incentivised – jumping by around 90 per cent. However, it’s hard to know for sure because there has been a steady increase over time in any case.

The cumulative number of CPCS consultations is also far short of publicly stated ambitions; it has suggested in the past that up to 40 million consultations could shift from GP practices to community pharmacy in a year.

It’s important to remember too, that even the peak of more than 158,000 CPCS claims in December 2022 is a drop in the ocean that is general practice activity. That same month saw surgeries deliver more than 27 million appointments.

Real incentives matter

On the face of it, there is a win-win-win for GP practices to refer patients who are best dealt with to community pharmacy using CPCS. Yet the real incentives are muddier, as P3pharmacy has covered before. GP practices need to invest to ensure that CPCS referrals are made, and there might not be enough spare capacity to do that.

It’s also unlikely that busy practices are making best use of CPCS just because of the 2022/23 efforts on QOF, or that all patients who are referred to community pharmacy accept that course of action.

There could be untapped lessons here. It’s often the case that when money is involved, paperwork is generated. To get the money for optimising capacity, practices had to fill in a template to say where they focused their quality improvement (QI) efforts, their aim, changes tested, changes adopted, improvements achieved, and how network peer support meetings and patient participation influence the practice’s QI plans on optimising access. Could a sample of those be revealing? And who will take the time to look?

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