The way in which Integrated Care Boards (ICB) and Local Authorities (LA) commission services
from local community pharmacies in England is driving an unnecessary postcode lottery of access, a new CCA analysis finds.
Read the report on local commissioning
The CCA conducted an extensive freedom of information exercise of ICBs and LAs. Key findings were as follows:
ICB commissioning
- 37 ICBs commissioned 27 unique types of services. Over half of ICBs (64%) commissioned minor ailments services.
- The majority (37) of those who responded commissioned local services on top of the nationally-agreed Community Pharmacy Contractual Framework (CPCF).
- Overall, ICBs are estimated to spend over £10m annually on the commissioning of additional local services from pharmacies.
- The average pharmacy spend per ICB was £13,200 per 100,000 population.
- However, there was a 224-fold difference between commissioning in North East and North Cumbria (£56,000 per 100,000 population) compared with South West London (£250 per 100,000 population).
LA commissioning
- 79% of local authorities commission services from community pharmacies.
- Total LA spend was an estimated £19.2m across the whole of England.
- Of the 115 local authorities analysed, the top three services commissioned were for: sexual and reproductive health (61%), smoking cessation (48%) and substance misuse (38%).
- Despite covering a much smaller footprint than ICBs, there was a significant variation in commissioning amongst local authorities.
- Whilst the average population-adjusted spend per local authority was £33,000, Gateshead spent five times this (£218,500) but Walsall spent 12,000 times less than the average (£2.74).
- Concerningly, there was significant variation between nearby local authorities – whilst Gateshead County Council spends over £218,500 per 100,000 population, less than 20 miles south in Hartlepool, the Council spend just £5,500 per 100,000 population. This is despite both areas having significantly deprived populations.
The analysis suggests that both ICBs and LAs are failing to fully grasp the patient benefits provided by the accessibility and convenience that local pharmacies offer.
In the current financially strained environment, the commissioning of local services from pharmacies could also be the difference between helping pharmacies to stay afloat or them going under altogether.
Moreover, patients continue to face a ‘postcode lottery’ – in some cases with differing pharmacy provision between where they may work or study and where they live.
Malcolm Harrison, Chief Executive of the CCA said: “Local commissioning of services across England currently resembles a patchwork quilt of care. Patients face a postcode lottery depending on where they live, work or study. For some, their local community pharmacy can offer a wide range of valuable care services free at the point of use. Unfortunately, we have found that often their close neighbours cannot benefit from the same opportunities.
To realise the full opportunities offered by a ‘neighbourhood health service’, all ICBs and local authorities must endeavour to seize the benefits offered by the local pharmacies on their doorstep.
The Government must ensure the most important services are offered nationwide so that patients can understand what to expect of their local pharmacy, and more care can be delivered in the community”.
__________________________________________________________________________________
Case study: London
Across London, 32 London boroughs and the City of London have responsibility for commissioning sexual and reproductive health services. However, access is highly dependent on where you live.
An individual under the age of 25 living in the borough of Bromley can access chlamydia screening kits and treatment from a local pharmacy. However, in Lambeth, they would either have to access online testing services or go to a sexual health clinic, despite Lambeth having the highest chlamydia diagnostic rates in England.
__________________________________________________________________________________
The CCA is urging the Government to harness community pharmacies to help shift more care into the community and deliver a broader range of preventative and public health services.
With over 10,000 pharmacies across England, conveniently located where people work and live, and open outside of typical working hours, the community pharmacy network offers the NHS 10,000 ready-made ‘urgent care centres’.
The CCA is urging policymakers to:
- Introduce nationally-defined service specification and contracting arrangements for the most common services.
- Review variation in local commissioning and challenge areas with low commissioning to better harness the benefits pharmacies offer – to end the postcode lottery patients currently face.
- Invest in community pharmacy public health services, to help place the NHS on prevention-first footing.
Notes to editors
- Freedom of Information requests were used to collect data from all 42 ICBs in England for the 2023/24 financial year. All ICBs responded, although some withheld certain details (usually financially).
- Freedom of Information requests were used to collect data from upper-tier local authorities, 115 of which responded. Most provided financial expenditure for the 2023/24 financial year. However, some were not able to separate by service. A number of LAs also contracted the NHS or voluntary organisations as the lead-provider, who subsequently sub-contracted community pharmacies. Some of these LAs were unable to separate out spend on community pharmacy, and this data has not been included in financial estimates.