The proposed funding for the independent prescribing (IP) pathfinder service does not adequately consider the cost of running the service, sector representatives have told NHS England (NHSE).
The pilot, which was launched last month, will test how pharmacist independent prescribing could be used in the community.
A total of £12m in funding was allocated to the programme, a portion of which will be available to pharmacies involved in delivering pathfinder sites, The Pharmacist recently exclusively revealed.
But the National Pharmacy Association (NPA) and Community Pharmacy England (CPE) have now raised concerns that the funding proposed for pharmacies delivering the pilot is inadequate.
In a letter to integrated care boards (ICBs), seen by The Pharmacist, NHSE said that participating community pharmacies would be able to claim for set up costs, including IT support, as well as operational readiness and the cost of evaluating the success of the programme.
But the director of corporate affairs at the National Pharmacy Association (NPA), Gareth Jones, said that the NPA had told senior NHS officials that the proposed fee – which has not been publicly announced, but the NPA said was understood to be £49 per hour – was ‘unviable’.
‘It fails to take into account the total cost to the pharmacy, which includes staffing and the opportunity cost of an occupied consultation room,’ he said.
And he added: ‘This programme is a once-in-a-generation opportunity to push the boundaries of community pharmacy clinical practice – but a demotivating fee structure will get things off to the worst possible start.’
Mr Jones also said that local integrated care systems needed to work with local pharmaceutical committees (LPCs) and contractors ‘to make pragmatic decisions that set a fair direction of travel’.
‘This pathfinding exercise is firmly supported by NPA and across our sector, but some further common-sense frontline delivery decisions are required to ensure it commences positively without genuine financial concerns getting in the way,’ he added.
But Alastair Buxton, director of NHS services at CPE, said that local commissioners may not have the scope to adjust the funding offered to contractors for the programme.
He explained that the pathfinder sites were being commissioned as a local enhanced service, meaning that they were commissioned by a local ICB rather than NHSE at a national level.
However, the funding levels for this service have been dictated by NHSE, he said.
‘The ICB, as commissioner, has a duty to consult the LPC on the contractual terms, but we do not consider a proper consultation can be undertaken, where the funding levels are being fixed by NHS England,’ Mr Buxton told The Pharmacist.
And he suggested that if a national level of funding were to be set by NHSE, it should have been discussed with the sector’s negotiator.
‘If there was no scope for the local commissioners to modify funding within the programme, it would have been more appropriate for NHS England to have considered commissioning it as a National Enhanced Service, with the terms and funding being discussed with us,’ Mr Buxton said.
He added that the pathfinder programme has ‘great strategic significance for the future of community pharmacy’, with the use of independent prescribing within future services ‘at the heart’ of the vision for community pharmacy published this week by the Nuffield Trust and The King’s Fund.
But he said that the proposed funding and other aspects of the IP pathfinder programme had raised concerns for CPE, pharmacy owners and LPCs, and was discussed at CPE’s recent committee meeting.
‘We have fed back these concerns to NHS England, with particular emphasis on the low level of funding, which we do not think adequately reflects the costs and wider economic consequences of participation in the programme for pharmacy owners,’ Mr Buxton said.
Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies (AIMp), told The Pharmacist that the fee for the service should be closer to £89 per hour, in order to cover the cost of backfilling staff and training prescribers in the appropriate clinical area.
And she said that the timeframes for providing the service were 'extremely tight', with contractors expected to be ready to provide the service from 30 November.
'Remembering the disastrous start to the Covid campaign, this is a ridiculous timeline and one that we can’t see being achieved,' she added.
In January 2023 all ICBs submitted an expression of interest to be part of the pathfinder programme.
A number of prescribing models and pathways were proposed by ICBs and NHSE undertook a moderation process working with regional colleagues and through the national Independent Prescribing Oversight Group.
The pilot is intended to include up to 210 community pharmacy sites across all 42 ICBs, although the allocation of the actual number of sites in each ICB will be based on proposed prescribing models, geography and population, and how the ICB proposes to support the sites.
The Pharmacist approached NHSE for a response to the sector’s concerns, but it declined to comment.