Pharmacy First gateway changes to help increase payments

Changes will be made to the gateway points used under Pharmacy First in a move to make it easier for pharmacies to achieve the monthly payment for the scheme, Community Pharmacy England (CPE) has announced.

Draft versions of revised Pharmacy First clinical pathways have been published on the NHS Business Services Authority (NHSBSA) website, showing movement of some of the gateway points and the addition of eight further gateway points.

The drafts have been published to give advanced notice to pharmacies of incoming changes, and the commencement date for its use will be announced by NHS England in due course.

It follows a clinical review by NHS England of the Pharmacy First clinical pathways and patient group directions (PGD), informed by pharmacy teams, CPE and other stakeholders.

Related Article: ‘Precautionary’ recall of breast cancer medication batch

CPE said the ‘substantive’ changes to the clinical pathways had been argued for by the negotiating body to ‘better align payments for consultations with the work that pharmacists are undertaking’.

Within the seven clinical pathways, the gateway points are used to determine when in the process a pharmacy can claim payment for the consultation.

But surveys carried out by CPE and the Independent Pharmacies Association (IPA) last year suggested the gateway points were too restrictive.

The IPA’s survey in April 2024 saw six in 10 (59.5%) independent pharmacy owners report that ‘less than 50%’ of initial Pharmacy First consultations passed the gateway point for a claimable Pharmacy First consultation. 

According to the draft publication, the number of gateway points across all seven clinical pathways is to double – from eight to 16.

As part of the changes, each clinical condition has at least two or more gateway points – currently only the sore throat clinical pathway has more than one gateway point.

In a statement on its website, CPE said: ‘We argued for these changes to better align payments for consultations with the work that pharmacists are undertaking when consulting with patients with one of the seven clinical pathway conditions.

Related Article: Customer complaint prompts recall of Omeprazole oral solution batch

‘Once implemented, the changes to the pathways should increase the number of patients for whom a consultation fee can be claimed.’

Contractors who reach the target of 30 or more clinical pathway consultations a month get a £1,000 monthly payment.

As of June, a £500 interim payment was introduced for contractors who deliver 20-19 consultations a month.

CPE explained that final versions of the clinical pathways will be published on the NHS England website prior to the commencement date.

The negotiator stressed that for now, ‘the service has not changed, and pharmacy owners and their teams must continue to provide the service in line with the current documentation published on the NHS England website’, and not the new draft documents.

Related Article: Scotland pharmacies to receive 4% global sum uplift

It is understood that IT suppliers are currently in the process of updating their systems and NHS England will provide a go-live date for the revised service in due course.

In terms of PGDs, CPE said incoming changes would be ‘mostly minor’ and address ‘minor errors in the current PGDs and amending wording to provide greater clarity for pharmacists providing the service’.