Just 456 out of 11,222 community pharmacies in England signed up for the new Pharmacy Contraception Service within the first two days of the option being available to contractors.

According to the NHS Business Services Authority (NHSBSA), the figures – which represent around 4% of community pharmacies in England – were correct as of 23:59 on 25 April 2023.

The Pharmacist understands that multiple Day Lewis is among those not offering the service amid concerns over inadequate funding for the sector.

Sign up for the service opened on 24 April, just 10 days after its start date was announced by NHS England.

Sector opposed to new services within current global sum

Funding for the service will come out of the £2.592bn annual global sum allocated to the sector as a whole.

Concerns have been raised that this funding has already been allocated to other pharmacy services and operations, and that contractors across the sector will feel the impact of any payments made for the contraception service as this money is ‘clawed back’ from other payments.

When the start date for the service was announced, the Pharmaceutical Services Negotiating Committee (PSNC) said that the ‘imposition’ of the launch was ‘in direct contradiction’ to its warnings that rolling out additional services was ‘neither feasible nor affordable’.

And yesterday the National Pharmacy Association (NPA) added its calls for the service to be paused, saying that both patients and pharmacies would lose out if the service continued.

Writing on Twitter on Tuesday evening, the NPA said: ‘We can’t tell pharmacy owners what they can and can’t do. But we can tell them the facts; fact number one is that with no new funding currently available everyone will be a loser from the implementation of this service on the current terms.’

Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies (AIMp), said that AIMp was ‘very much opposed to more services being introduced within the current global sum’, but ‘will not be telling our members what to do, it will be their own business decision’.

The Pharmacist understands that Day Lewis, which owns over 260 pharmacies across the UK, will not be implementing the service.

In a statement issued yesterday and seen by The Pharmacist, executive director Jay Patel said in January 2023, Day Lewis had invested £100k in locum backfill to train pharmacists to deliver the service ‘assuming it would be fairly funded by NHSE’.

He said: ‘All our pharmacists are now trained. However, we will not be launching the service until progress is made with pharmacy funding.

‘Day Lewis have always been keen and proactive to deliver pharmacy services, but the current model where pharmacies are asked to do more for less, and services coming from the existing global sum is unsustainable and cannot continue.

‘As a family business it’s distressing that NHS England has forced us to ration services to a few patients so that we can continue to support our critically ill and chronic patients, whose lives depend on us.’

Many pharmacies don’t have capacity to do more

Independent community pharmacy contractor Rifat Asghar-Hussain told The Pharmacist that the service was the kind of initiative that community pharmacies ‘would absolutely love to run’ if they were able to.

‘It’s so good for patients to be able to not have to make an appointment with the doctors,’ she said, while adding that delivering the ongoing management of oral contraception through community pharmacy ‘makes sense’ for patients and provides interesting clinical work for pharmacists.

But she believed pharmacies were not going to be paid enough to run the service.

NHS England will pay pharmacies a £900 set up fee – paid in instalments – as well as an £18 consultation fee per patient.

But the technology that pharmacists like Ms Asghar-Hussain would need to free her up to spend clinical time with patients would cost at least £4,000, she said.

And taking the patient’s blood pressure and BMI would be a lengthy process, cutting into the £25-30 per hour ‘minimum’ that locums charge, she added.

Delivering both clinical services and dispensing would require at least two pharmacy professionals, she said, but wages have increased in line with minimum wage beyond what many pharmacies can afford. The Pharmacists’ Defence Association (PDA) suggests a model where at least two pharmacists are working in each community pharmacy.

And in February, transitional payments were reduced to zero. ‘Which means about £1,500 gone overnight,’ said Ms Asghar-Hussain.

‘You need to get that money back by doing services. But then you can't do the services because it impacts on your checking.’

Ms Asghar-Hussain said that community pharmacies provide a vital service to patients but were becoming ‘overstretched’ and were struggling to make ends meet due to increased workloads and reduced funding.

Since Covid, ‘patients are really isolated’, so when they come into the pharmacy, ‘they want to talk’, she said. ‘Everything takes twice as long as normal,’ she added.

‘Patients are struggling and have no one to turn to, and they are turning to pharmacies, because our doors are always open,’ said Ms Asghar-Hussain.

But supporting patients was taking its toll on overworked pharmacy teams who felt ‘rushed’ and ‘half-hearted’, she said.

‘We are now struggling, it's affecting our mental health because how do we cope with all this has been thrown at us? It's very, very difficult,’ she told The Pharmacist.

‘We've coped with all the funding cuts, but to the point where people are thinking enough is enough – we can't do any more,’ she said.

And she said that the government seemed to be ‘completely blind’ to the real-terms cut that pharmacies were facing.

A Department of Health and Social Care (DHSC) spokesperson said that it was ‘supporting pharmacies to provide a range of clinical services’ and was ‘increasing the services pharmacists – who are degree qualified medical health professionals – can provide to their community including managing oral contraception’.

They added: ‘The Community Pharmacy Contractual Framework (CPCF) 2019-24 five-year deal agreed with the PSNC in 2019 commits £2.592 billion annually to the sector.

‘In September we announced what more community pharmacy will do during the remainder of the 5-year deal until the end of 2023/24 and provided an additional one-off investment of £100 million in the sector.’

In September 2023, DHSC and PSNC agreed a one-off £100m excess margin write-off for contractors.

A statement published by Will Quince, minister of state for health and secondary care, in January, set out the real-terms value of the flat funding deal, accounting for inflation. It showed that £2.592bn in nominal funding was worth £2.498bn in terms of inflationary costs in 2017/18, but just £2.154bn in real-terms funding in 2022/23.

A spokesperson for the Company Chemists’ Association (CCA) said that ‘pushing through the roll out of this service, despite the warnings of the negotiator, representative bodies, and contractors shows a worrying disregard for the reality within the community pharmacy sector’.

‘The existing contractual agreement was finalised before the pandemic, rampant inflation, ever growing workloads, and continuing pressures on businesses.

‘Whilst many pharmacies will no-doubt do their best to meet patient needs, the funding of community pharmacy is broken and needs to fundamentally change.’

Meanwhile, community pharmacist and England chair of the Royal Pharmaceutical Society (RPS) Thorrun Govind said that improving access to contraception and advice through community pharmacy would make good use of the clinical skills of pharmacists.

However, she said ‘pharmacists are under huge pressure, many are at breaking point’.

Ms Govind warned that ‘adding more pressure isn’t sustainable’ and the service must be ‘backed and enabled by appropriate extra government funding and technology to allow pharmacists the time and space to deliver great care to patients and the public’.

And other pharmacists have voiced their frustration on Twitter, with one urging 'all contractors to consider the other non-funded services that have been added during the current contract’.

This story was updated on 3 May 2023 to reflect the most recent figures from the General Pharmaceutical Council which show the total number of community pharmacies in England as 11,222.