Exclusive: CPE pushes for new service caps to avoid ‘over commissioning’ draining the contract sum

Discussions over how to cap services to prevent ‘over enthusiastic’ commissioning from draining contract funding are ongoing, The Pharmacist has learned.

During contract negotiations, Community Pharmacy England (CPE) pushed for capping on some clinical services which were previously uncapped and an adjustment to the New Medicine Service (NMS) cap, according to briefing slides seen by The Pharmacist.

This included capping Pharmacy First services and the Hypertension Case-Finding Service (HCFS) in order to prevent the NHS trying to commission more activity than budgets allow.

CPE confirmed that the precise mechanism for any cap has yet to be agreed with the Department of Health and Social Care (DHSC).

It said: ‘During the negotiations, CPE was concerned that the NHS is trying to commission more activity from the pharmacy sector than its budget allows – this includes both the provision of clinical services and the dispensing of prescriptions, which are both funded from the same pot.

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‘Ways to address this “over commissioning” could be increasing the funding available to commission said activity, or reducing the amount of activity that the NHS expects to commission.

‘Both of these approaches were discussed during negotiations, and as part of the settlement it was agreed that capping would be introduced on some clinical services which were previously uncapped.

‘The precise mechanism for these still has to be agreed in ongoing implementation discussions.’

CPE also told The Pharmacist that changes to HCFS and Pharmacy First Minor Illness services will see caps set at a ‘high level’, which aim to restrict delivery where volumes are exceptionally high.

The new Community Pharmacy Contractual Framework (CPCF) for 2026/27 will increase funding for the sector by £340 million and introduce independent prescribing (IP) as an extension to the Pharmacy First programme.

Under the new contract, DHSC has also agreed to reduce the cap from 1.0% of prescription items to 0.9% – meaning that the number of NMS consultations pharmacies will be paid for is subject to a cap of 0.9% of their overall monthly prescriptions.

The NMS allows community pharmacists to provide support for people with long-term conditions who have been newly prescribed a medicine with the goal of improving medication adherence.

CPE said this is unlikely to impact the vast majority of contractors.

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It added that any money saved by this change will be redirected back into the contract sum, allowing fee rates for activities such as dispensing to be slightly higher than they otherwise would have been.

It was CPE’s view that, given the ‘tightness’ of the contract funding, it was better to channel funding as much as possible into core activities such as dispensing.

It has stressed that accepting the new funding deal ‘does not mean we think it is enough’ and warned that pressures on pharmacies will mean continued closures, reduced opening hours, deteriorating quality of service and the risk of unavoidable harm to patients.

The new settlement was only accepted on the condition of a shared programme of reform with the government and NHS England, which is due to begin ‘very shortly’.

During a press briefing yesterday, the negotiator’s chief executive Janet Morrison told reporters: ‘If a large portion of [the contract funding] is going to pharmacies with independent prescribers, there will be some pushback from those pharmacies who are not yet on that path – that’s just one of the tensions we live with all the time during negotiations.’

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Contractor Kevin Simpson, who owns several pharmacies in the north east of England, said he was concerned about rural pharmacies or pharmacies in deprived areas that rely more on dispensing than clinical services.

He said: ‘Pharmacists will awaken to the hard reality that, in many cases, there will be little to no return from their core business. If they operate in deprived locations, they cannot survive on services alone.

‘This is a slippery slope for community pharmacy, and I fear we may well be some way down this slope at present.’