A local pharmaceutical committee (LPC) in the North East of England has 'strongly advised' contractors to not participate in a locally commissioned varenicline smoking cessation service.

The LPC chief executive has said that the fee offered for the service does not reflect the cost of providing this intervention.

The issue concerns Service Level Agreements (SLAs) for the supply of varenicline by a pharmacist under a patient group direction (PGD), remunerated at just £2-3 per follow-up intervention.

Community Pharmacy South Yorkshire (CPSY) chief executive Vicki Roberts told The Pharmacist the LPC had seen different SLAs for four areas in South Yorkshire, setting out initial consultation fees of between £15-20, with fees for each follow-up consultation and supply set at either £2.50 or £3.

And she said that the local commissioner South West Yorkshire Partnership NHS Foundation Trust had already offered the contracts to pharmacies in Calderdale and Sheffield, against the concerns of the LPC.

The remuneration for follow-up supply is similar to that offered for the supply through the Nicotine Replacement Therapy (NRT) voucher scheme.

But Ms Roberts told The Pharmacist that the pharmacist-led PGD and the NRT voucher service  – which can be carried out by other members of the pharmacy team – are 'not comparable by any means'.

The SLA sets out that the varenicline supply under a PGD must be carried out by a pharmacist, who must make a clinical decision about whether the supply is clinically appropriate for the patients.

'If the pharmacist follows the PGD, and either the patient doesn't meet one of the eligibility criteria, or they meet one of the exclusion criteria, then the pharmacist overrides the decision of the stop smoking advisor [who may have referred the patient to the service],' Ms Roberts said.

'We acknowledge that [the commissioner's] budgets are going to be tight... but pharmacies just cannot deliver the service at those rates,' she added.

The current fee 'would either mean pharmacists trying to deliver the service really, really quickly, which goes against our professional and clinical ethos, or they will take 10 or 15 minutes to deliver that consultation, which means that they're delivering that service at a loss,' Ms Roberts said.

And amid wider concerns about inappropriate supply of weight-loss drugs by online private pharmacies, Ms Roberts suggested: 'We've actually got a commissioner here that is not promoting or working with community pharmacy to enable supply in a professional and clinical manner.'

The local commissioning for varenicline supply follows the introduction of the generic anti-smoking pill last year, after branded version Champix was withdrawn from the UK market in 2021.

Ms Roberts said pharmacy representatives had presented the trust with examples of 'a much more sensible Service Level Agreement', such as a different local smoking cessation service which sets out £15 for all interventions, whether an initial or interim supply of varenicline, and the national stop smoking service which sets out £30 for the initial consultation and £12 for interim consultations.

But she said that the trust had still issued the contracts to pharmacies in at least two local areas, prompting CPSY to advise pharmacies not to engage with the service.

And Ms Roberts wrote on LinkedIn: 'Our strong advice is DO NOT sign up to the pitifully remunerated Varenicline service.'

She told The Pharmacist: 'In these dire financial times for pharmacists, they're having to be quite selective about which service they can do. In the days 15 or 20 years ago, they would probably take on all services, but now they're selecting the services that they're going to provide on the basis of the financial return.'

'Why would you choose to do a service that earns you £2.50 if you can be focusing on Pharmacy First that earns you £15 per consultation?' she said.

Similar concerns have been raised by Community Pharmacy West Yorkshire (CPWY), where contractors in Calderdale have been offered a similar deal, The Pharmacist understands.

CPWY chief executive Nicola Goodberry Kenneally said the LPC was 'very disappointed to see the proposed fee of £3 for the supply of a POM [prescription-only-medication] under PDG'.

'This in no way reflects the time required and clinical skill of the pharmacist to deliver a high quality service,' she added.

'It does not provide adequate time for a consultation with the patient, the safe dispensing of the drug and the written documentation of the service.

'We strongly encourage all contractors to consider the financial losses associated with delivering a service with remuneration as poor as this.'

The latest data suggests that less than half of the pharmacies that originally signed up to deliver Pharmacy First in England were able to meet the monthly threshold in October.

And a recent Pharmacists' Defence Association (PDA) survey suggested that three-quarters of pharmacists do not believe that the pharmacies in which they work are adequately staffed to safely deliver Pharmacy First and other NHS contracted services.

A spokesperson for the South West Yorkshire Partnership NHS Foundation Trust told The Pharmacist: 'We have met with representatives from Community Pharmacy South Yorkshire and Community Pharmacy West Yorkshire, and explained how each of our smokefree services are commissioned separately by the local public health teams in each geographical area.

'This means that contracts and financial arrangements can differ between areas.

'All of the contracts are negotiated based on different timeframes with defined budgets and on the specific needs of the local community.

'This ensures we provide value for money within the financial boundaries which are set, while maintaining service levels that meet local need.'