The challenge of providing regular Ambulatory Blood Pressure Monitoring (ABPM) checks may mean lost payments and a risk that pharmacies stop providing the Pharmacy First service altogether, the Company Chemists’ Association (CCA) has warned.

In a new report, it outlines concerns that the requirements for bundling activity for Pharmacy First threshold payments could lead to ‘unintended consequences’ and challenges with ABPM could prove insurmountable for many pharmacies.

As of yesterday (1 June), the Pharmacy First ‘bundling requirements’ came into force, meaning pharmacies must be registered to deliver the Pharmacy Contraception Service, Hypertension Case Finding Service and Pharmacy First – in addition to delivering the minimum number of clinical pathway Pharmacy First consultations – to receive a fixed monthly payment.

And from October 2025, contractors will also be required to deliver one ABPM per month.

However, the ABPM requirement is expected to be challenging according to the CCA, with demand low and a high number of opportunistic blood pressure checks required to identify suitable patients. One factor is that patients may not be willing to undertake an ABPM, and return for a follow-up appointment at a pharmacy, it says, especially when most patients are used to accessing a pharmacy as and when they require.

If threshold payments are consistently missed, pharmacies may ‘reconsider the sustainability of offering Pharmacy First’ and ‘could lead to pharmacies stopping this important element of primary care’, the CCA said.

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‘Additional hurdles to Pharmacy First thresholds risk pharmacies withdrawing from the service entirely, undermining consistent patient access,’ it added.

The association is recommending a change in the requirement for ABPM – allowing Home Blood Pressure Monitoring (HBPM) as an alternative to support patients who do not wish to have ABPM.

In its report today, the CCA suggests only 30% (3,429) of pharmacies provide each of the three services bundled for payment, as of February 2025.

And while pharmacy teams can continue to provide and be paid for delivering only one or two of the three services, if they do not deliver all three, they would be ineligible for threshold payments – previously only linked to Pharmacy First.

As this is a core part of the service funding, delivering Pharmacy First may become ‘financially unviable’, the CCA warned.

It said that as of January 2025, 90% of community pharmacies provided Pharmacy First, 77% of pharmacies provided blood pressure checks and 52% of community pharmacies provided the contraception service.

CCA chief executive Malcolm Harrison said: ‘The premise of bundling makes absolute sense for patients.

‘With only 30% of pharmacies currently providing all 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.’

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He added: ‘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.’

The CCA says that 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.

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.

But the CCA said the proportion of patients who subsequently receive ABPM testing ‘varies widely from less than 1% to over 50%’.

Henry Gregg, chief executive of the National Pharmacy Association, said: 'Providing a comprehensive and consistent package of NHS pharmacy services makes a lot of sense for patients, but we need to make sure this is rolled out in a way that pharmacies can manage.
'It’s important to maximise the services pharmacies can offer which means listening carefully to issues with implementation and ensuring that we don’t place barriers to pharmacies offering services that would limit the take-up of brilliant services that patients really value.'

A DHSC spokesperson said: 'After years of neglect, we inherited a pharmacy sector on the brink of collapse – and delivered the first real funding increase since 2014, investing £617 million over two years.

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'Community pharmacies are now receiving an enhanced payment for Ambulatory Blood Pressure Monitoring (ABPM), with fees increasing by 13% to £50.85, strengthening pharmacies' role in early detection of cardiovascular disease.'

'As we deliver our Plan for Change to rebuild the health service, pharmacies will remain a priority, so people get the care they need close to home.'