Community Pharmacy England (CPE) is concerned that local pharmacies may walk away from delivering Pharmacy First consultations if they cannot reach the thresholds for the £1,000 monthly payment.

Speaking at the Avicenna Heathrow conference this weekend (8 September), CPE's director of NHS services Alastair Buxton said the number of clinical pathway consultations required for the monthly payment was 'the biggest issue' that concerned contractors and CPE.

He said the negotiator had so far been unable to persuade the government to make any changes to the monthly thresholds beyond the reduction put in place for August.

'The DHSC are very much saying: "Well, we are still continuing to see growth in clinical pathway consultation, so let's see where we go from there,"' Mr Buxton told delegates.

But he said the negotiator was 'continuing to push' the issue.

'Our great concern is that people walk away from the service, if [they are] not going to get the £1,000 payment,' he added.

Mr Buxton suggested that the seasonality of ailments like sore throats 'will hopefully help meet the monthly thresholds'.

But he acknowledged that pharmacies also 'get busy during the winter', and suggested that delivering Pharmacy First consultations alongside other demands like Covid and flu vaccinations could be challenging.

Despite the pressures, Mr Buxton told contractors that it was 'strategically important' that the sector continue to provide the Pharmacy First service, and 'demonstrate that we're doing that well' to local parliamentarians.

'It is a key service, as well as the contraception service and as well as the hypertension case finding service,' he said.

And he advised contractors to 'apply skill mix' to the hypertension service, suggesting that 'a good margin' could be made if they were able to have 'support staff providing the majority of it'.

CPE is due to recommence negotiations 'soon' on the delayed 'interim' pharmacy contract for the current financial year 2024/25.

Mr Buxton said that in this round of negotiations, CPE intended to tell government that 'the NHS can't have any more services until they sort out the underpinning funding'.

'We need to be paid properly for dispensing, [for] all the other essential services, and ensure that we've got a sufficient room in the budget to pay for the clinical services that you're already providing,' he told contractors at the Avicenna conference.

'We say this to ministers: We've got lots of financial problems, but if you can sort those out, we've got the potential to develop and deliver more services effectively, as we've demonstrated with Pharmacy First, in a way that perhaps nobody else in the NHS currently has. And they are, after all, [as] the new government, looking for solutions. But they've got to fix the funding.'

Also during the conference, Mr Buxton said the negotiator would consider 'all options' if it didn't 'get the right answers from DHSC' during negotiations.

'We can look at what the GPs have done in terms of working to rule and how that could potentially work, for example,' he told delegates.

'Potentially, legal action could be something that could be considered as well.'

At the latest count, 96.5% of community pharmacies in England are signed up to deliver Pharmacy First, CPE has said.

Recent analysis by The Pharmacist found that in May, around three in 10 participating pharmacies did not meet the then minimum threshold of 10 clinical pathway consultations.

And the number of pharmacies failing to reach the monthly threshold to be eligible for the £1,000 payment is increasing month to month as the thresholds rise.

NHS England (NHSE) has said that in September, it will review the trajectory of its goal to reach 320,000 Pharmacy First clinical pathways consultations in 2024/25, when it had a better idea of public uptake of the service so far.

The Pharmacist has contacted NHSE for comment on CPE's concerns and on the status of this review.