The gateway criteria that enables community pharmacies to claim payment for Pharmacy First should be relaxed, a member of the Community Pharmacy England (CPE) committee has urged.

The comment came in response to criticism of the Pharmacy First deal agreed by CPE, as part of a panel discussion last week at the Sigma Conference 2025 in Baku, Azerbaijan.

Community pharmacies have previously reported spending time on consultations that they do not get paid for because patients do not meet the 'gateway point' set out in the Pharmacy First clinical pathways.

A survey by the Independent Pharmacies Association (IPA) previously found that 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. 

A separate poll carried out by CPE in September 2024 saw more than two-thirds (67.89%) of the pharmacies surveyed suggest that the gateway points in the clinical pathways were too restrictive.

Contractor Has Modi said he and fellow CPE committee member Prakash Patel would ‘be making inroads’ to ensure the gateway criteria for the service were 'reduced', as well as more conditions added to the service in the longer time.

‘CPE had to negotiate the Pharmacy First scheme, because it was the first time that we were actually allowed to do clinical conditions. It was a game changer for pharmacy,’ Mr Modi said, highlighting that the service built on the success of community pharmacy delivery of Covid-19 vaccinations.

‘The reason why you had all this gateway criteria was to ensure the safety of the patient and that there was compliance. But now... by doing over a million consultations, we have proved that Pharmacy First can be done in a pharmacy,’ he said.

‘At the CPE we will be making inroads to actually ensure that not only those gateway criteria are reduced, however, also long-term wise, that more conditions are added,’ Mr Modi added.

Adding more conditions to Pharmacy First was ‘definitely in the pipeline and on the menu of the government, because they want to see a lot more consultations’, he said.

‘They want to free up the GPs… [and have pharmacies be] the first port of call, because we are the most accessible part of the NHS at the moment. I think they recognise that,’ Mr Modi said.

The new pharmacy contract confirmed that funding for Pharmacy First would be continued for 2025/26, and that an interim payment threshold is set to be introduced for pharmacies delivering clinical pathway consultations under Pharmacy First from June.

'Discriminatory' treatment of pharmacies

Also speaking on the panel, Mr Patel said that he would ‘take back to CPE’ concerns that community pharmacies were not funded for IT or business rates in the same way that GP surgeries are.

‘GPs get funded for their IT systems, their telephone systems and for video conferencing. This is something that will be taken back to the CPE to say that, why are we being discriminated by the primary care services in not allowing our IT systems to be integrated and to be provided by the NHS? We are part of primary care. We should be given that,’ Mr Patel said.

And he suggested that community pharmacies should be enabled to make more use of video consultations, particularly for patients unable to travel to their local pharmacy.

‘GP practices have all their rates and all their expenses paid. That should be the norm for pharmacy as well,’ Mr Patel added.

And he suggested that pharmacy consultation rooms should be exempt from business rates.

Pharmacy staff should be enabled to do more

Mr Patel also raised the issue of making better use of different pharmacy team members.

‘We should amplify our staff so the pharmacist can now provide more services, [and] we should be able to increase the responsibilities of our staff to look after the dispensing process, but also now to be able to come into a position whereby lots of services can be offered by our ACTs (accuracy checking pharmacy technicians) – those who are qualified,’ he said.

Mr Patel added that a defined role needed to be set out for pharmacist prescribers.

Should the CPE committee vote be kept secret?

The panel at the Sigma conference also debated whether the way that CPE committee members vote on the contract deal should be made public.

Currently, committee members decide in a secret ballot whether to accept or reject the deal offered by government.

Mr Patel said that there was a need for confidentially during the negotiations, while the committee came to a collective view.

But he suggested that in his personal view, once negotiations were concluded, ‘it will be good for transparency sake to have each member's view’.

However, he questioned: ‘How would that help each individual contractor?’

Also speaking on the panel, contractor Uma Patel commented: ‘Confidentially during negotiations is important, otherwise you cannot negotiate. I accept that. However, who voted 'yes' and 'no' should be available.’

And contractor and panellist Simon Harris said: ‘I would hope that anyone who sits on the CPE board is doing their absolute best for us as pharmacy contractors, and it doesn't matter to me whether I have transparency in that moment or not, as long as those representatives are doing best for individual pharmacy contractors who are working their hardest to provide the best possible service.’

And Mr Modi suggested that in his personal view, while there was merit in having ‘collective responsibility’ for the decision, knowing how each individual committee member voted could help the sector consider whether it had the right people representing it.

In an update on its most recent committee meeting, CPE said: ‘Permanent changes are being proposed to the composition of the committee, and we are seeking views on proposed changes to the LPC model and Community Pharmacy England constitution for use in the next four-year term of office.’

And it said that further updates will be provided in due course.