What’s on your CPCF wishlist?

With the current five-year CPFC set to come to an end next year, four sector stakeholders share their wishlists for what the next community pharmacy contract should look like. By Saša Janković

As the current five-year Community Pharmacy Contractual Framework (CPCF) heads into its final furlong, sector leaders are beginning to ramp up calls for significant additional funding and support to protect the future of community pharmacy.

At a recent Parliamentary Summit on community pharmacy’s role in the imminent Primary Care Recovery Plan, PSNC/Community Pharmacy England chief executive Janet Morrison urged MPs to take “firm and decisive action to invest in our community pharmacies in order to safeguard safe and reliable access to medicines for patients and the public”.

But aside from extra funding, what do pharmacy stakeholders think should be in the next CPCF? We hear from some well-placed commentators about what their ‘ideal’ CPCF would look like.

Reduce health inequalities

Hemant Patel is past vice-chair of PSNC and has decades of experience across the pharmacy landscape. He says: “I have been analysing health policy for a while and have been preparing my thoughts for the next version of CPCF.

“My proposed CPCF aims to achieve measurable health outcomes for patients, improve patient safety and quality of care, and reduce health inequalities.

“The framework aligns with the priorities of the NHS, promotes digital healthcare solutions, supports integrated care, addresses medication safety, and addresses health inequalities. The CPCF will use outcome-based metrics to evaluate the performance of community pharmacies, with higher levels of funding awarded to pharmacies that achieve better outcomes for patients and improve access to healthcare services.

“My proposal also includes additional contributions to accessible urgent care and the reduction of pressure on GP surgeries and hospitals. Community pharmacies will offer extended hours and a wider range of services, including screening, counselling, and follow-up care for mental health, as well as support for patients transitioning from hospital to home. 

“The CPCF will also promote the use of digital health tools, electronic prescribing, telemedicine and data sharing to improve patient self management and access to healthcare services. By promoting integrated care and medication safety, the CPCF aims to reduce the number of avoidable hospital admissions and improve patient outcomes.”

Make it outcomes-based 

Bedfordshire, Luton and Milton Keynes Integrated Care Board (ICB) has the benefit of having a pharmacist – Felicity Cox – as its chief executive. She and chief pharmacist Shabina Azmi have a clear view of what a new pharmacy contract could look like. 

Azmi explains: “There is a pressing need to reform health and social care services across systems to address health inequalities and to mitigate access and capacity challenges.”

She says the sector has seen massive evolution in recent years, “but could do so much more with different policy support and funding mechanisms in place”. One approach is “to move away from the traditional fee-for-service model to a more outcomes-based model that focuses on achieving targeted health outcomes for patients”.

Cox says the traditional items-versus- services way of thinking creates a false dichotomy: “Community pharmacy needs security of income, and the population needs timely medications from a reliable supply chain, which are delivered with understandable advice from an expert.

“Additionally, the NHS needs pharmacists – and indeed all its professionals – to be operating at the top of their licences; that is to say, where they can use their skills and capabilities to add the greatest value.”

Cox says a “longer-term collaborative approach” is needed to navigate the new reality in which ICBs are responsible for contracting with pharmacies, but many services are commissioned on a national basis.

There is also scope for a national contract to facilitate the growing local commissioning agenda, she says, adding that a move to an outcomes- based contract might necessitate a new “neighbourhood team-based contract” with a standardised pharmacy component that can be customised to meet local needs. She says this might require a new approach, “especially from multiples”.

For Azmi, a new contract would be predicated on increasing collaboration between community pharmacies and other providers “to support patients to receive the right care from the right place, across the entire healthcare system”. 

Indeed, this underlines the integrated approach advocated in the Fuller Stocktake. “Using an outcomes-based model, community pharmacies would be required to meet specific performance targets related to patient health outcomes, such as reducing hospital admissions, improving medication adherence, and managing chronic conditions,” says Azmi, adding that the consequent culture shift would “deliver a more integrated approach to care”.

“Community pharmacy is the most accessible healthcare service in the system,” she says. “So the contract needs to recognise and invest in this ‘accessibility’ to truly unlock its full potential. Locally commissioned services and/or incentives with a focus on prevention, providing urgent care, public health promotion and de-medicalising care are some additional things that could be included [but] overall, the new community pharmacy contract should focus on enhancing the role of community pharmacists in healthcare delivery and ensuring that they are rewarded for the outcomes they achieve, rather than for the medicines or services they provide.”

The potential in Healthy Living Pharmacies 

Graham Phillips is the director and superintendent pharmacist of iHeart Pharmacy Group, and founder of the ProLongevity health management programme. He has a keen eye on the value for money returned in NHS spending.

“The NHS budget now is £165 billion,” says Phillips, “with the total for NHS GPs £10bn, drugs £20bn and the cost of all the pharmacies is less than £3bn.

“The leading cause of death is cardiovascular disease, followed by cancer, and then medicines misadventure. Life expectancy is going backwards, according to all-cause mortality, and health span has been declining for a decade, with the UK having the poorest health and lifespan in Europe. At the same time, everything we do is driving up the £20bn drugs bill, so the question to ask is ‘do you want more drugs or fewer?’ 

“My argument is that if this £165bn was generating value, you’d measure that as a decrease in all-cause mortality and an increase in health span, but both are going backwards. Almost no healthcare professionals know this, and meanwhile, the whole of society – not just in areas of high inequalities – is getting fatter, sicker and more diabetic. The root cause is healthcare professionals not getting any training in nutrition, exercise and sleep and, instead, being trained to identify symptoms and support them with drugs – but we can clearly see this is simply not working.

“If we maximised the potential of Healthy Living Pharmacy (HLP) to be able to educate and support patients with diet and nutrition advice, we could reduce the drugs bill by a minimum of 50 per cent, hospitalisations by 50 per cent, and GP visits by 75 per cent. Every HLP could drive this entire agenda forward, saving the NHS billions of pounds that could be reinvested in pharmacy, giving us a decent income.

“I believe we should have a national contract as every area needs certain things in common, such as weight management, smoking cessation and sexual health services, so we need a national menu with core services for everywhere, along with specific tailored services that are optional for your area and can be commissioned locally.

“Dispensing should be a financially feasible thing to do and around that, we build proper level 3 clinical reviews, with full access to patient information, proper medicines management and deprescribing, and remuneration around proactive and preventative public health – and that would free up more money in the system.

“Of course, you will always need medicines, and need them well done, but we want proper clinical commissioning. So instead of our income being driven from more prescriptions making us more payments, we should be paid far more for deprescribing than prescribing. Then healthier people would mean less income from prescribing and more from services and other activity. 

“Community pharmacy is a three legged stool – clinical value, public health value and social capital value – which, with the right funding, can leverage all three of those to the maximum.”