Independent thinking on the pharmacy contract

For an access obsessed government, keen to shift care out of hospitals and into neighbourhoods, community pharmacy is the gift that keeps on giving.

It serves as a centrally located ‘front door’ to the NHS, with direct access to highly trained clinicians, committed to serve patients and invested in the success of their business.

And the DHSC knows it. As evidenced by the comparatively generous 10.3% uplift indicated in last Friday’s announcement of the Community Pharmacy Contract Framework 2026/27.

The government wants more of the good stuff. More of that access, more of that expertise and the key way they plan on getting it is through independent prescribing.

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But it needs to be paid for.

As our coverage highlights, one of the biggest but not entirely unexpected moves, is that Independent Prescribing (IP) will be included in Pharmacy First.

On the one hand this is a good idea. For pharmacies who were part of the IP pilots, running the two services in tandem was confusing and the clear synergies of treating patients seemed to point toward combining the two streams of work.

However, as always, the devil is in the detail.

While there is a £500 set up fee for IP, and a £525 monthly infrastructure fee, the Pharmacy First consultation fees are not rising to take account of extra IP consultations.

In fact the framework states that: ‘The Pharmacy First fixed payment arrangements for clinical pathways will be maintained, with new IP clinical pathway consultations counting towards fixed payment thresholds. Fixed payments will remain at £500 for contractors delivering 20 to 29 consultations in a month and £1,000 for those delivering 30 consultations or more’

So, if a pharmacy is hitting those limits already through PF where is the incentive to go for IP?

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And if you do want to train up an independent prescriber is there a designated prescribing practitioner (DPP) to support them – there are concerns they are in short supply. Perhaps the new allowance for training can address this but closing up is also not good for business.

And what if you’re not an independent prescriber? A Nuffield Trust analysis of General Pharmaceutical Council (GPhC) data found that in March 2025 just under a third (32%) of pharmacists in England were IPs. So most pharmacists in England are in this position at the moment.

Most concerning of all, this focus on IP has completely sidestepped much of the day to day pressures facing pharmacists around drug pricing and reimbursement rates. 

In the year since taking on the role of Editor for The Pharmacist, I’ve yet to meet a community pharmacist who says their business is in good financial health. Business rate rises, minimum wage rises, margin squeezes and medicines price volatility all stack up.

Yes, there are the skills and the appetite to take on more clinical work but who then is left to dispense? The evaluation of the IP pilots points towards needing two pharmacists on site to support IP but this would be unaffordable for many.

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So, while both parties do want the same thing - pharmacists to provide more clinical services - getting it to happen will take more that good will.

There must be funding for additional pharmacists, incentives for DPPs in community, and stability around medicines supply and pricing. Without this the government can dispense with the notion community pharmacy will carry the neighbourhood load and look to manage its access addiction another way.