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CPE are finally meeting with Government for contract talks. But are we made of the same steel as the medics?

As the 47th President of the United States of America takes the helm, somewhere in a secret London location Community Pharmacy England’s (CPE) crack negotiating team is finally coming face to face with the Department of Health and Social Care to bash out the hugest, bestest deal the sector has ever seen (we can only hope). 

It’s now 10 months since the end of the last funding settlement, and six months since the last general election. The new chancellor of the exchequer is still telling anyone who will listen how little money there is whilst at the same time working behind the scenes to settle outstanding labour disputes. 

Teachers, junior doctors, railway workers, nurses – and more – have all concluded wage negotiations and industrial action has been averted. Just pharmacy left then? Oh – and general practice. 

The medics are much better at beating the war drums than us and have a track record of securing the largest slice of recent investments into primary care. And there have been a not-insignificant number of billions of public money chucked at primary care by recent health secretaries. 

Increasing news coverage of struggling hospitals and care systems don’t look likely to abate any time soon, in concert with Wes Streeting repeatedly saying out loud what would only ever whispered around the corridors of power. 

What will the government do to fix it? Throw more money at it, obviously. There will be some form of settlement for general practice and community pharmacy soon. Interim, temporary and fudged, but a settlement nonetheless. 

In anticipation of such, the National Pharmacy Association (NPA, formed in 1921, if you’ve never been on X/Twitter) recently announced five tests that any settlement would need to meet for it to be acceptable (and presumably avert their threat of collective action): 

• An above inflation increase in the global sum for pharmacies that makes significant progress towards mitigating devastating real terms cuts over the past decade and covers real terms cost increases in 2024-25 and 2025-26, including National Insurance and National Living Wage increases 
• Pharmacies to receive payment in arrears for 2024/25 as a matter of urgency in one lump sum to prevent further financial damage and closures – and there are no further clawbacks for the 2024/25 period 
• Core funding from 2025/26 to be delivered equitably and transparently and is not dependent on the actions of other health providers 
• A clear roadmap to reform of the sector and the Drug Tariff to be set out – enabling it to deliver the government’s NHS 10 year plan ambitions to move care into the community and restore pharmacies to a sustainable financial position as outlined in the forthcoming independent economic review of community pharmacy. 

Yes, that looks like only four, but if you’re an NPA member and try really hard, you’ll find an extra 25 per cent in there somewhere. 

Are they reasonable? Realistic? Certainly from community pharmacy’s perspective they are. General practice colleagues are feeling confident their settlement will cover the increases in National Insurance and the minimum wage, so all things being equal?  

But, of course, they are not equal. General practice funding is much more easily linked to a practice’s headcount and it’s easy to identify what are realistic amounts of money to cover staffing costs.

Pharmacy’s income is all fees and margin, abstracted from a head count and hard for bean-counters to reverse engineer a reasonable cost. 

The old principals of what’s funding fit for an independent is fit for everyone won’t stick in the days of automation and large dispensing hubs.

What of the other tests then? Payment in arrears and no clawback – are they two tests? Be careful what you wish for. If there are payments in arrears to be had – and CPE certainly believes there to be – there will also be clawback on the other side of that balance sheet. The Treasury doesn’t like spending money, but it really doesn’t like over-spending money. 

The third test seems simple, but as has been demonstrated with the life cycle of the Community Pharmacist Consultation Service, it is really hard to deliver funding through services when the services are not equitably delivered.

Gatekeeping your shiny new service behind someone who doesn’t understand, believe in, or is openly antagonistic to that service, is not a robust way of distributing funding. 

Finally, Drug Tariff reform! Such sweet, sweet words. Well, a roadmap to Drug Tariff reform at least. Imagine a land of lush green grass, rolling hills and fair payment for measuring and fitting a truss!

The use of the term roadmap leaves a lot of wriggle room for later, but progress is progress. 

That both general practice and community pharmacy are holding the prospect of collective action over the heads of these negotiations genuinely has the leaders of Integrated Care Systems quite worried.

If those worries are heard in Whitehall maybe the NPA’s tests will be met, though that’s perhaps as likely as the NPA collective action going ahead. Let’s see who blinks first. 

Outsider is a community pharmacy commentator