Pharmacy First: Withholding Payments
(2 days, 5 hours ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Dr Luke Evans (Hinckley and Bosworth) (Con)
(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the withholding of Pharmacy First payments to pharmacies.
The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)
It is a pleasure to take the traditional Department of Health and Social Care urgent question before recess—I would not miss it for the world.
Since coming into office, we have reversed the decade of cuts to community pharmacy with the biggest uplift for the sector in years and frozen prescription charges to help our constituents with the cost of living, and women can now get the morning-after pill free of charge across the country. Earlier this week, I spoke to the National Pharmacy Association’s winter reception to pay tribute to its members for their work and to assure them that I have their back, as does the Minister for Care.
The hon. Member for Hinckley and Bosworth (Dr Evans) raises the important issue of payments made via Pharmacy First. As he knows, pharmacy contractors receive a monthly fixed payment if they meet certain requirements. We agreed to reduce the claim window, in conjunction with Community Pharmacy England, as part of our deal for 2025-26 to introduce a new Pharmacy First fixed first payment of £500. That has supported a broader range of pharmacies and has meant that more pharmacies have become eligible for payments. We are in discussions with Community Pharmacy England to consider where improvements to the claiming process can be made, address concerns raised by contractors and aim for a more consistent approach to remuneration. We will also consult with Community Pharmacy England shortly on the contractual framework for next year.
There are issues relating to contractors being suspended from providing Pharmacy First that are for separate consideration. When concerns are raised, NHS England can suspend individual contractors from providing the service pending a full investigation. There are a number of reasons why that might be necessary, but the measures are there, first and foremost, as the House will appreciate, to protect patient safety. I am a clinician, as is the hon. Member for Hinckley and Bosworth, and I am sure that he will agree that patient safety should be at the forefront of everything we do.
Finally, funding for the core community pharmacy contractual framework has been increased to over £3 billion—the largest uplift of any part of the NHS in the last two years. As part of this year’s contractual framework, we have agreed to keep the current cost control mechanism linked to Pharmacy First that we inherited from the previous Government to ensure that the money is spent within that envelope. I thank the hon. Gentleman for his question.
Mr Speaker
Order. May I just say that you did not summon the Minister? I granted an urgent question. Think about the language you choose, Dr Evans, and think that we have given you something.
Dr Evans
I of course withdraw that remark, Mr Speaker, and I thank you for summoning the Minister on my behalf. It seems to have had the desired effect, because the outstanding parliamentary questions have, strangely enough, been answered this morning. I hope to get some clarity as this is really important.
The issue has been explained simply by the chair of the National Pharmacy Association:
“The work was done. Patients were treated. The NHS benefited. Yet payments are being withheld on a technicality.”
What makes that worse is that many pharmacies do not even realise that some of the money is missing. He goes on:
“Statements appear ‘successful’, yet Pharmacy First payments are absent. Contractors are only discovering the issue long after the window has closed, when it’s already too late.”
Will the Minister tell the House how many pharmacies the Government think are impacted? What is the total value of the outstanding payments? What steps are the Government taking to rectify this, and would they consider a late payment mechanism to help solve the issue?
There is a wider concern. Payments are administered by the NHS Business Services Authority. The chair of the NPA labelled the behaviour of NHSBSA “outrageous”. That already follows repeat concerns about NHSBSA’s performance, including multiple serious delays in NHS pension processing and several urgent questions on the Floor of the House. Does the Minister still retain confidence in NHSBSA? Given the ongoing concerns from multiple fields, will he commission a review of the operational performance of the entire NHSBSA?
Community pharmacies are already under intense pressure from this Government, with tax rises on employment and business rates and with increases in costs, and now they appear not to be being paid for work already done. I hope the Minister will act quickly to put this right.
Dr Ahmed
As the hon. Gentleman will know—or should know—the current remuneration method was agreed in conjunction with the sector. The adjustment was agreed with the sector’s representative body, Community Pharmacy England. Advance notice of the change was provided to those contractors by letter and in an article published by the NHS Business Services Authority in May 2025. In addition, Community Pharmacy England knows that, should this be a priority issue for it to negotiate in the next contract, we will take that on board and use it as an option.
There are of course always extenuating circumstances, such as IT not working. Officials have reassured me that, following discussions with Community Pharmacy England, we have introduced specific provisions in the drug tariff that will allow pharmacy contractors to receive payment for claims that were delayed due to IT issues outside of its control.
I can appreciate why the hon. Gentleman wants to expand the remit of the urgent question across primary care—well, let me tell him. I know he had neck surgery recently; I did not realise they put a brass neck in him as well when they did it. He knows what kind of NHS decline and decay over which he and his Government presided over the past 15 years: primary care where people are left wandering around asking for GPs, and the Conservatives left GPs on the scrapheap, unemployed. This Government ensured, when they came into office, that—
Mr Speaker
Order. Minister, one of us is going to sit down, and it is not going to be me. Please can we have a little bit more calm? You have come in as the supporting Minister to the Secretary of State. I want you to set the example and not be the naughty one.
Mr Speaker
Order. We are going to learn the rules between us, Minister. Dr Luke Evans, I have granted you this urgent question. Quite rightly, I wanted your question to be heard by the Minister; I did not want any interruption. I expect you to listen to the answer without interruption.
Dr Ahmed
This Government take our responsibilities seriously in providing an effective 21st-century primary-care NHS, free at the point of care. That is why when we came into power we ensured that the pharmacy sector had the largest uplift of any part of the NHS in the past two years—£3.1 billion. To support primary care further, we ensured that GPs who could not find employment found it under this Labour Government. It is only this Government that can modernise the NHS, make it free at the point of care and ensure that it is a high-quality service going forward.
Liam Conlon (Beckenham and Penge) (Lab)
My constituent Raj Matharu runs the brilliant Westchem pharmacy in West Wickham, is CEO of Community Pharmacy South East London, and last year was shortlisted for community pharmacist of the year. I have heard from residents across West Wickham how his pharmacy provides trusted and frictionless access to healthcare and advice across a range of issues. Pharmacy First can both provide a quicker, easier service for patients and relieve pressure on primary care. What support have the Government put in place for community pharmacies, especially in relation to funding?
Dr Ahmed
As I have stated, we have given pharmacies a record £3.1 billion settlement. We absolutely endorse the need for pharmacies to do more in our communities. We are enabling pharmacists up and down the country to expand their repertoire, and we are ensuring that Pharmacy First remuneration is a dynamic process, month on month, that reflects the activity that each pharmacy is doing.
Helen Morgan (North Shropshire) (LD)
Pharmacists play a crucial role in supporting the health service by reducing the pressure on overcrowded hospitals and GP surgeries. They also play a crucial role in local communities by providing access to treatment when appointments remain hard to come by elsewhere. But pressure on pharmacists is severe and has been getting worse, as shown by closures in my constituency and across the country. Those closures hit hardest in rural and coastal areas and in the most deprived areas, where they are most needed. This vital service needs to be supported and not undermined so that our constituents can rely on being able to access the medicines and treatment they need.
Has the Minister considered a new late payment mechanism to ensure that if contractors miss the deadline, they can still receive compensation for the work they have undertaken, especially in the interim as pharmacists adapt to the changes that have been introduced? What discussions has he had with NHSBSA to resolve the technical difficulties being experienced?
Dr Ahmed
I can assure the hon. Lady of our commitment to an effective primary care system up and down the country, in both rural and coastal communities. My hon. Friend the Minister for Care, whose portfolio includes pharmacy, takes his responsibilities seriously and is exploring all avenues to ensure equity of access and funding, including through the Carr-Hill formula.
The hon. Lady asks what mitigations can be employed to ensure that payments are made in extraordinary circumstances. I can assure her that I have had those discussions with my officials this morning, and they reassured me that there will be a degree of flexibility, particularly in circumstances outwith the control of individual pharmacies.
James Naish (Rushcliffe) (Lab)
I am very grateful for the fact that this urgent question was granted, because pharmacies have been in touch with me about their concerns. I must put another thing on the Minister’s to-do list: independent prescribing. Evans Pharmacy in my constituency has been part of the independent prescribing pathfinder programme, and only 5% of patients seen by the prescribers subsequently require GP prescribing. However, no clear funding or arrangement will be in place after March this year. Will he provide Evans Pharmacy and similar prescribers with clarity about what will happen next?
Dr Ahmed
My hon. Friend is absolutely right. Independent prescribers are a key and expanding part of our workforce, providing a sustainable primary care service. I am very happy for the Minister for Care to write to him with the exact funding plans for the next financial year.
Mr Gagan Mohindra (South West Hertfordshire) (Con)
In the past year, I have spent time visiting pharmacies across my constituency, undertaken work experience at Riverside pharmacy in Rickmansworth, and communicated regularly with Community Pharmacy Hertfordshire. It is clear that our pharmacies are under unsustainable pressure from rising costs, especially following the Government’s increase to employer national insurance contributions. Pharmacy First was a great Conservative initiative to reduce pressure on our GPs. Why are this Government hurting pharmacies and patients by delaying payments?
Dr Ahmed
Pharmacy First is indeed a great initiative. It is not the first in this country; it has been developed in other parts of the country. When we came into office, we worked with the sector and stakeholders, and agreements on remuneration and pricing were reached in conjunction with the sector. What is more, we are addressing the pricing structures and payment mechanisms that are not working and need improvement with a dynamism that was lacking under the previous Government.
Lincoln Jopp (Spelthorne) (Con)
The Trio Pharmacy in Shepperton told me that there are two problems with Pharmacy First. The first is that pharmacies are simply not getting the referrals that they should from GPs. The second is that remuneration for their services does not take into account the amount of time needed for examination, diagnosis and prescription. The Nebel Pharmacy in Sunbury, near where I live, says that the work needs to be looked at as a vocation, because it simply makes no money. That is not sustainable, is it?
Dr Ahmed
The hon. Gentleman is absolutely right: we need to unblock the referral pathways. The neighbourhood health service is all about ensuring that the process between general practitioner and pharmacist feels seamless. On payments, we are cognisant of the fact that as demographics change, population needs in different parts of the country vary, so different payment mechanisms must apply. We are closely working with colleagues and stakeholders in the sector to ensure that we get that right.
Mr Will Forster (Woking) (LD)
Residents of West Byfleet are frustrated that a new pharmacy that wants to open in their area is not allowed to do so. Be it that unreasonable restriction, the increase in NICs or a lack of funding, this Government’s every action seems to undermine the pharmacy sector. Will the Minister explain why the Government are withholding funding from pharmacies that have signed up in good faith to Pharmacy First, and why they have not introduced a late-payment mechanism?
Dr Ahmed
I am reminded that Liberal Democrat Front Benchers always welcome funding for the NHS, but can never explain where the money should come from. I have already mentioned the record funding that we are putting into pharmacy. I have reiterated that there is ministerial engagement with the pharmacy sector—not just through the Minister with responsibility for pharmacy, but through me, as Minister with responsibility for health innovation. Our relationship with the pharmacy sector is in a good place, and we continue to develop it.
Greg Smith (Mid Buckinghamshire) (Con)
Pharmacy First was undoubtedly game changing. When I visit pharmacies around my constituency, many of them are keen to expand Pharmacy First and to offer more lines. However, I can give an example similar to the one that my hon. Friend the Member for Spelthorne (Lincoln Jopp) gave. The people at Wendover Pharmacy took me through their books, and on many of the services that they offer, they either barely make any money or make a loss. The Minister said in answer to my hon. Friend the Member for South West Hertfordshire (Mr Mohindra) that pricing was set with the sector, so clearly something is going wrong, because the experience of Wendover Pharmacy is quite different.
Dr Ahmed
The hon. Member is right that under the Pharmacy First programme, contractors receive a monthly fixed payment upon delivering a minimum number of consultations, as per the 2025-26 agreement. That can go up and down month to month, in a dynamic process, depending on how many patients are seen in pharmacies. I completely take his point that we are evolving our care system, and ensuring a move from hospital to community, but are not quite there yet; however, I think we are on the road. Through our neighbourhood health programme, we are solidifying the relationships between general practice, pharmacies, opticians and other allied health professionals in primary care.
Claire Young (Thornbury and Yate) (LD)
Not only are community pharmacies in my constituency facing problems with Pharmacy First payments, but pharmacies like Abbotswood Pharmacy tell me that they are not seeing the referrals that GPs are supposedly making. Pharmacies can take pressure off the NHS. Does the Minister agree that this combination of referral failures and payment delays is forcing patients to wait longer for care, and what steps will he take to ensure that both referrals and payments are successfully made?
Dr Ahmed
The hon. Member is absolutely right: we need to unblock some of the referral pipelines between GPs and pharmacies. We are absolutely clear in our instructions to the system that pharmacies are an integral and growing component of primary care provision, and that premise underlies all our discussions with pharmacies and GPs.
Richard Foord (Honiton and Sidmouth) (LD)
Allied Pharmacies has taken over a couple of failing Jhoots Pharmacy branches in my area since Pharmacy First was introduced, which is very welcome. The chief executive said this week that the outlook for elderly people and those without a car in rural areas was stark. Between 2015 and 2025, community pharmacies have seen a real-terms funding cut of about 30%—that is £1 billion less in real terms—and rural Devon and Cornwall have seen a reduction of 90,000 hours of pharmacy time in two years. In that context, will the Minister ensure that full compensation is given to dispensing doctors in rural areas for the cost of medicines?
Dr Ahmed
I am grateful to the hon. Gentleman for adumbrating how 14 years of Tory Government have led to significant decay in the provision of primary care services in some of our communities. He is right to mention dispensing doctors, who are a vital part of the mixture in hard-to-reach and coastal communities. I had many meetings with them prior to my appointment, and my colleague the Minister for Care will continue to meet them to ensure that they continue to be part of the mix of care provision in those communities.
Freddie van Mierlo (Henley and Thame) (LD)
Last year, I visited a pharmacy in Benson in my constituency, where Vik Patel described to me how the pharmacy’s being rural disadvantages it in the Pharmacy First scheme. His pharmacy never meets the threshold to qualify for payment, and that threshold has gone up over and over again, from five patients a month in April last year to 30 in March 2025, so the pharmacy is effectively delivering a service for free. Vik is a lovely chap, and he is happy to do that, but it is not a sustainable business model. What will the Minister do to help rural pharmacies like mine in Benson?
Dr Ahmed
I can reassure the hon. Member that my hon. Friend the Minister for Care is looking at funding and primary care provision in the round in coastal and poorer communities, and I would be delighted to take back his representations about Pharmacy First in rural settings.
Jim Shannon (Strangford) (DUP)
I thank the Minister for his answers. I want to give a helpful suggestion from a Northern Ireland perspective. He will agree that a rural pharmacy will find it more difficult to meet the ever increasing threshold, and that the point of these payments is to take pressure off GPs, not to provide a back-door way of underpaying earned compensation. In Northern Ireland, we have a slightly different system that involves payment per consultation, which I ask the Minister to consider. Perhaps that would be more appropriate, and would give pharmacies, GPs and their patients what they are looking for.