The forthcoming requirement to provide a ‘bundle’ of three clinical services to receive threshold payments could lead to unintended consequences, a new analysis by the Company Chemists’ Association (CCA) warns.
Pharmacies will shortly be required to provide a ‘bundle’ of services to qualify for monthly threshold payments, following the agreement of the recent funding deal. The new contract introduces the concept of payment ‘bundling’ for Pharmacy First, the Hypertension Case-Finding Service, and the Pharmacy Contraception Service. This is intended to encourage pharmacies to offer all three services thus providing a universal offer to patients across England.
Read the report on the unintended consequences of bundling
The CCA recognises that the new contractual framework has been designed to incentivise pharmacies to offer a broad range of services.
However, the CCA is concerned that the requirements for bundling activity for threshold payments could lead to unintended consequences.
The challenge of providing regular Ambulatory Blood Pressure Monitoring (ABPM) checks could prove insurmountable for many pharmacies – meaning lost threshold payments and a risk that pharmacies stop providing the Pharmacy First service altogether.
The CCA’s analysis finds that less than a third (30%) of pharmacies currently meet the new threshold requirements to access the full funding.
As of January 2025, the breakdown for the bundled services was as follows:
- 90% of community pharmacies provided Pharmacy First
- 77% of pharmacies provided blood pressure checks
- 52% of community pharmacies provided the contraception service
Pharmacy teams can continue to provide and be paid for delivering only one or two of the three services. However, this will mean they would be ineligible for threshold payments – previously only linked to Pharmacy First.
If threshold payments are consistently missed, pharmacies may reconsider the sustainability of offering Pharmacy First. This could lead to pharmacies stopping this important element of primary care.
This change was seen when the Pharmacy First threshold requirements increased in August 2024. In that month, over 15% of pharmacies (1,842) missed the new threshold. Of these, 130 (7%) recorded no consultations at all the following month.
Providing at least one ABPM every month is expected to be challenging with demand low and a high number of opportunistic blood pressure checks required to identify suitable patients. There is a wide variance in current use of ABPM testing. One factor is that patients may not be willing to undertake an ABPM, and return for a follow-up appointment at a pharmacy, especially when most patients are used to accessing a pharmacy as and when they require.
The CCA recommends that the government change the requirement for ABPM, allowing Home Blood Pressure Monitoring (HBPM) as an alternative to support patients who do not wish to have ABPM.
HBPM is an easier commitment for patients who may be unwilling to wear a measuring device overnight and return to the pharmacy for a follow up appointment. Additionally, research indicates that there are no significant differences in the effectiveness of ABPM and HBPM1.
CCA Chief Executive Malcolm Harrison said: “The premise of bundling makes absolute sense for patients.
With only 30% of pharmacies currently providing all of the three services, many pharmacies are at risk of missing out on future threshold payments.
There is a real risk that pharmacies who do not meet threshold payments in the future will rethink delivery of the three services.
We urge the government to ensure there is flexibility in the Hypertension Case Finding service to allow for Home Blood Pressure Monitoring in addition to Ambulatory Blood Pressure Monitoring. This simple change will ensure more pharmacies are able to deliver the service and receive threshold payments which are vital to ensuring that pharmacies are able to stay afloat.”
Notes to editors:
- Threshold payments are a core part of the financial viability of the Pharmacy First. Pharmacies that provide a set number of consultations each month receive funding to support ongoing costs such as premises, staffing, and training. Currently, pharmacies providing at least 20 consultations each month receive an additional £500, and those providing more than 30 receive £1,000.
- ABPM checks have been available from pharmacies as part of the Hypertension Case Finding service since October 2021. Over this time, over 5 million patients have received screening to identify possible high blood pressure.
- The data and analysis presented in the report relate to bricks and mortar pharmacies only, i.e., Distance Selling Pharmacies have been excluded from the totals.
- A nationally commissioned Emergency Contraception Service provided by the NHS is set to launch in October 2025. It is expected that there will be considerable patient-led demand for the contraception service rising the number of pharmacies who participate in the Contraceptive Service.
- Pharmacy First was launched from pharmacies across England at the end of January 2024. Community pharmacies are now commissioned by the NHS to provide advice and treatment for seven common conditions, including the appropriate supply of some prescription-only medicines — previously only available to patients by visiting a GP. Pharmacy First covers: earaches, bladder infections, sore throats, sinusitis, infected insect bites, impetigo, and shingles.
- Pharmacy First was introduced as part of the NHS Primary Care Delivery Plan to support access to general practice. Moving millions of patients into community pharmacy will free up appointments for more complex care in general practice. The CCA estimates that an expanded service could free up to 40 million GP appointments annually2.
References:
- M. Lee, “When and how to use ambulatory blood pressure monitoring and home blood pressure monitoring for managing hypertension,” Clinical Hypertension, vol. 30, no. 10, 2024.
- The Company Chemists’ Association, The Future of Pharmacy First – Maximising Patient Benefit, 2025