This site is intended for Healthcare Professionals only

Two years in, is it time CPCS got a tweak?

Running Your Business

Two years in, is it time CPCS got a tweak?

By Leela Barham

The current Community Pharmacy Contractual Framework (CPCF) in England is designed to be progressive over the course of its five years. It got off to a fast start. In October 2019, the Community Pharmacist Consultation Service (CPCS) launched as an advanced service.

This move to integrate community pharmacies into local NHS immediate care services began with referrals in from NHS 111. Since November 2020, GP practices have been able to refer patients to community pharmacies too, via the GP-CPCS.  

NHS England & NHS Improvement (NHSE&I) has encouraged GP practices to sign up, linking that with funding for practices. Yet progress can best be summarised as disappointing, with the former chair of the British Medical Association’s GP committee the latest key figure to be calling for reform. 

Meanwhile, the Pharmaceutical Services Negotiating Committee (PSNC)sees much promise for the future, estimating that the service could free up appointments in GP practices to the tune of an equivalent net saving of £640m. 

Incentivising GPs 

NHSE&I has been promoting the engagement of GP practices with community pharmacy as part of the same integration effort. The network contract Directed Enhanced Service (DES), published in September 2020, includes collaboration with non-GP providers, including community pharmacies. This is part of the Investment and Impact Fund (IIF), worth £150m in 2021/22.1

The CPCS gets a more explicit mention as part of a package of support for general practice – the £250m Winter Access Fund announced in October 2021.2 The CPCS is cited as a way to reduce pressure on GP appointments and the 800 practices already signed up to the service are highlighted. Participation in CPCS is needed for practices to receive any money from the Winter Access Fund. Practices had to have formally signed up by December 2021. 

December 2021’s Primary Care Bulletin from NHSE&I again highlighted the CPCS and called for GP practices to avoid making informal referrals to community pharmacies. “Informal referrals into community pharmacy may result in some patients not accessing the care they need and prevents pharmacy teams from identifying patients that need to directly speak to the pharmacist at this very busy time,” said NHSE&I.3

Informal referrals also mean that pharmacies don’t get paid. 

A burdensome extra

For CPCS to be successful on a large scale, clearly GP practices have to buy in fully. On the face of it, while it has been suggested to GP practices that they should make better use of their local community pharmacists, the offer that this will free up their scarce time might not have been sufficient incentive for most of them to do so, thus far.  

Dr Richard Vautrey, the former chair of the British Medical Association’s GP committee, provided a GP perspective of the CPCS to P3pharmacy’s sister magazine Independent Community Pharmacist recently.4 His comments were not a ringing endorsement; instead, Dr Vautrey called for an immediate review of the service.

He suggested that major problems with the way NHS England set up the service makes it harder, not easier, for GPs to refer to community pharmacies. “They have put in place a referral process which adds to the burden on general practice,” he said, adding “[CPCS] isn’t as good as what we had before, when we had various minor ailment schemes where we effectively just directed patients to the pharmacy next door or over the road.”

PSNC agrees that the CPCS has added to the burden on GP practices. “PSNC has always been aware that implementing the GP referral pathway to the CPCS would require sustained NHS support for practices and that the referral processes used needed to be efficient for GPs and their teams,” it says. “In our regular discussions with the GPC, we have heard that the service in its current form is bureaucratic for GPs and can take up significant admin resource.”

Dr Vautrey also pointed to the fragmented funding encouraging GPs to engage with pharmacies, including the Winter Access and Investment and Impact Funds. “We need less targets and goals and bits of money in this pot and that,” he said. “We just need to be given the proper resource to get on and deliver the service, similar with pharmacy, rather than having piecemeal funding and various strings attached to different funding streams.”

Talking ‘savings’ 

Despite the challenges with the current CPCS, the PSNC suggests that greater use could generate savings of up to £640m. PSNC’s calculations take the accepted wisdom that, properly organised, community pharmacy could assist more in the treatment of minor ailments.

Transferring 40m GP appointments to community pharmacy would cost £560m (at £14 a consultation), while saving GP practices £1.2 billion in delivering those same 40m appointments (at £30 a consultation). The difference: £640m. The figure of 40m appointments comes from applying an estimate that 13 per cent of GP appointments are for minor ailments – the figure appears in a 2015 BMJ Open paper5 – to the 312m GP appointments delivered in 2019.

Setting aside the merits of using a point estimate from a dated study and applying it to a more recent figure – a back of the envelope calculation if ever there was one – the major flaw in equating the £640m to ‘savings’ is that it’s unlikely that the GP appointments lifted and shifted into pharmacy would ‘stop’. Rather, given the pressure on general practice, clinic appointment lists would still be full and, even if GP capacity was freed from appointments, other activity would likely happen. That’s not a reason not to do it, of course.  

To be fair, the PSNC recognises the limitations of its estimate. A spokesperson told P3pharmacy: “The words ‘up to’ are important – the calculations give an estimate of the scale of the savings possible, but they are a simplification based on the latest available data. 

“They do not take into account the unknown impact of a variety of variables, such as how Covid-19 has affected patient behaviours already, and whether GP consultation costs have changed during Covid.”

Call for reform

PSNC is also seeking changes to how the CPCS works, and has called for a walk-in approach closer to NHS Pharmacy First Scotland, launched in July 2020, which was recently extended to cover more conditions: “It would be better if GPs could informally refer patients, with all patients able to access the service just by walking straight into their local pharmacy. We will continue to seek such a walk-in approach to the service in our discussions with NHSE&I and the Department of Health and Social Care.”

Clearly, the NHS is keen for the CPCS to work as part of its plans for more integrated approaches to primary care and to improve access to immediate care for patients and the public. The question now is whether the Government and NHS England are open to discussing a major reform in the way the service works?


5 Watson, M.C., Ferguson, J., Barton, G.R., et al. (2015). A cohort study of influences, health outcomes and costs of patients’ health-seeking behaviour for minor ailments from primary and emergency care settings. BMJ Open. Available at:, using the paper title in the search function

Copy Link copy link button

Running Your Business