The health system continues to gear up for reorganisation, but the big news in August was two announcements on the Community Pharmacy Contractual Framework (CPCF) in England, and yet another sign of alignment in incentives across primary care
Will pharmacy will be left outside?
Primary care networks – two years on is a new report from the NHS Confederation looking at progress the fledgling groups have made to date. According to the Confed, PCNs have played a leading role in England’s response to Covid-19, administered the majority of vaccinations and made headway in tackling health inequalities. The report serves as a useful primer for those wanting to find out the current state of play, although one challenge that doesn’t make it into the report is engagement with non-medical primary care, reinforcing the notion that pharmacy is in danger of remaining on the outside of future discussions on integrated care pathways.
NHS widens vaccine parameters
The NHS in England extends the Covid vaccination programme to 16 and 17 year-olds, the country’s most vulnerable children and those who live with vulnerable adults, following changes in guidance from the Joint Committee on Vaccination and Immunisation (JCVI). It is later confirmed that first doses would be offered to all eligible teenagers by 23 August.
Flu guidance and PGD published
The 2021-22 community pharmacy seasonal influenza patient group direction (PGD) is produced, to accompany the previously published seasonal influenza advanced service specification. Both are available on the NHS England website
PQS focuses on pandemic recovery
The Pharmaceutical Services Negotiating Committee (PSNC) announces that post-pandemic recovery measures will be a key focus of the 2021-22 pharmacy quality scheme (PQS), with the funding package unchanged from last year at £75 million. Criteria for the year include identifying people who would benefit from weight management advice and referral, implementing health inequality training, producing an action plan promoting Covid vaccination, particularly in black and minority ethnic communities, and training to improve remote consultations. As was the case last year, contractors will be able to claim an ‘aspiration’ payment in advance, which they can keep if they meet their chosen criteria. Further details of the 2021/22 scheme are available here.
Exemption changes are “short sighted”
The charity Age UK launches a campaign to try to force the Government into a u-turn over its plan to raise the age for exemption from prescription charges in England to 66. The charity says nearly 2.5 million people between 60 and 65 will have to start paying for their prescriptions if the proposal, which has been put to public consultation until 2 September, is pushed through.
Age UK describes the plan as “short sighted” and says it risks “piling extra pressure on the NHS if, as is predictable, some older people stop adhering to their treatment regime” because they cannot afford their prescriptions. This view is shared by the Royal Pharmaceutical Society, which had earlier voiced its opposition to the change.
How to provide urgent care to older people at home
The British Geriatrics Society’s new report Right time, right place: urgent community-based care for older people aims to help health professionals navigate the options for providing urgent care to older people at home, avoiding unnecessary emergency hospital admissions. This timely report reflects the evolving situation, where various approaches to delivering urgent care closer to home are currently in progress in the run up to the development of integrated care systems.
Contactless is likely to be king
The Life after Covid: prospects for online retailing, physical stores and how we pay report from VoucherCodes.co.uk and the Centre for Retail Research forecasts contactless spending will become the UK’s most popular medium for payment by the end of 2022, accounting for 47 per cent of all retail purchases. Contactless payments are up by 30 per cent since the start of the pandemic. Between 2021 and 2022, cash payments will account for just 11 per cent of purchases, while almost three quarters (72 per cent) will be paid for by card within the next year.
Pharmacy in plan for women’s health
The Scottish Government’s new Women’s Health Plan proposes a dedicated commissioned service from community pharmacies, which Community Pharmacy Scotland says would build on work currently underway to enhance Scottish pharmacies’ sexual health offering, such as the introduction of long-term contraception.
The plan – billed as the first of its kind in the UK – seeks to reduce inequalities and improve health outcomes for women, and is based on feedback from service users in Scotland. In addition to short term goals within the next year, such as setting up a centralised information platform for women on NHS Inform, the plan sets out a long term ambition of providing more routine sexual healthcare through community pharmacies and other primary care providers “to enable specialist sexual health services to prioritise those most at risk of sexual ill health or unintended pregnancy”.
Third year deal contains some positives
PSNC announces the terms of the third year of the CPCF 2019-24. The negotiator’s appeal for an increase to the £2.592 billion global sum, on the basis that the figure falls “significantly short” of meeting the sector’s costs, was met with a flat rejection.
The New Medicine Service is being expanded to cover 12 additional conditions, including gout, epilepsy and coronary heart disease. The cap on the number a pharmacy can provide is doubling to the equivalent of 1 per cent of monthly prescription volumes for most contractors. There’s also a catch up provision to allow claims for patients prescribed eligible medicines during the pandemic.
The deal also includes two new advanced services: smoking cessation and hypertension case-finding, with funding from outside the global sum incentivising pharmacies to meet monitoring intervention targets. The smoking service specification has yet to be agreed, but contractors will receive a £1,000 set-up fee, £30 for a first consultation, £10 for subsequent consultations and £40 for a final one.
The case-finding service includes a £440 set-up fee, £15 for each clinic check and a fee for each ambulatory monitoring of £45, with incentive payments for pharmacies that reach a rising number of second stage ambulatory blood pressure monitoring interventions over years three, four and five of the CPCF agreement. NHS England & NHS Improvement says community pharmacies could save 2,000 lives over the next five years by offering blood pressure checks to people aged 40 and over.
With progress on the rebalancing of the contract delayed by the pandemic, the transitional payments are being extended by a year, with an agreement this is linked to contractors’ engagement with integrated care systems and primary care networks. Contractors will, however, get 2p more per item in the single activity fee increase and there is a £12.5m addition to retained margin within the contract calculations.
Detail is awaited on what looks like the most interesting element – Health Education England is being commissioned to provide a three-year programme of education and training for community pharmacy professionals, including independent prescribing training for existing pharmacists.
Find further information, including a link to the formal letter to contractors announcing the deal, here.
PCNs look to more local partners
Primary care network plans for 2021/22 and 2022/23 recognise the importance of widening participation in PCNs to local partners such as community pharmacies. In a letter to heads of primary care commissioning, NHSE&I director of primary care Ed Waller and medical director for primary care Dr Nikki Kanani say that £43m is being made available this year to help PCN leadership and management create new capacity in support of the work of PCNs.
The five areas of focus for PCNs over the next 18 months are improving prevention and tackling health inequalities in the delivery of primary care, supporting better patient outcomes in the community, supporting improved patient access to primary care services, delivering better outcomes for patients on medication, and helping to create a more sustainable NHS.
Interestingly, case finding in hypertension – a new service in year three of the CPCF – is identified as one of two service specifications required to be delivered by PCNs in 2021/22. This presents a useful opportunity for local discussions with PCN clinical directors about joining up the services.
CE marks may stay for another year
The Government announces plans to introduce legislation which will enable CE marked goods to continue being placed on the GB market until 1 January 2023. It says it has listened to concerns raised about the previous timetable, and has decided to provide an additional year for businesses in all product sectors, with the exception of medical devices, to get ready for the new UKCA marking.
Covid prompts surge in young smokers
A study published in Addiction and funded by Cancer Research UK finds that the number of 18-34 year-olds who smoke increased by 25 per cent in England during the first lockdown.