Guidance

Community Pharmacy Contractual Framework: 2024 to 2025 and 2025 to 2026

Published 31 March 2025

Applies to England

Dear community pharmacy contractors, 

We write to update you on the agreement reached between the Department of Health and Social Care (DHSC), NHS England and Community Pharmacy England (CPE), on the funding arrangements for both the Community Pharmacy Contractual Framework (CPCF) for 2024 to 2025 and 2025 to 2026, and Pharmacy First.

Our discussions have been detailed and productive and we believe the distribution of the funding available to community pharmacy reflects our joint ambition to focus on stabilising medicines supply and pharmacy funding for this core function. This funding also provides an uplift to key clinical service fees, while supporting Pharmacy First to continue to grow and embed at the pace it has this year. 

Funding guaranteed to the sector through the CPCF rose to £2.698 billion (4.1%) for 2024 to 2025 to cover the activity delivered by the sector and will rise to £3.073 billion in 2025 to 2026. This represents a 19.7% increase on 2023 to 2024 funding levels on a like-for-like basis and 15% on 2024 to 2025, compared with a 5.8% increase across the NHS as a whole in 2025 to 2026.

In addition, funding for Pharmacy First and other Primary Care Access Recovery Plan services is confirmed at £215 million and can be earnt in addition to the CPCF funding. DHSC and NHS England further agreed to write off £193 million of historic medicines margin over-delivery, which was primarily accrued during the pandemic when we were actively supporting the sector to continue to supply medicines.

At the same time as this substantial increase in investment is announced, we recognise the economic pressures facing the sector are significant. The independent economic analysis of the sector undertaken by Frontier Economics, published on 28 March 2025, spells those out and its findings are acknowledged by all parties. This consultation agreement, and the offer to pharmacy of the highest uplift across the NHS, signals the government’s commitment to stabilising the sector. All parties now want to work towards a sustainable contract and operational model for community pharmacy, to underpin a clearly defined role for the sector and harness its potential to further support the NHS in future.

Community pharmacies, the government and the NHS have already delivered much together, and community pharmacy continues to demonstrate all that it can do. Pharmacy First clinical pathways, which have delivered over 1.9 million consultations to date, offer just one example. We have also seen a continued increase in the number of Pharmacy Contraception Service and Hypertension Case Finding Service consultations, with over 0.25 million and 2.5 million being delivered in each respectively between January and November 2024. Alongside this the sector has continued to dispense increasing numbers of medicines, with over 1.2 billion prescriptions forecast to be dispensed in 2025 to 2026.

The prioritisation of funding for community pharmacy in 2025 to 2026 highlights the government’s recognition of this contribution to the health of communities and the importance of community pharmacy. It marks an opportunity to jointly secure and enhance its role in supporting the NHS. The government is committed to continuing to work with the sector to deliver what we all want - a service fit for the future.  

CPCF funding 

As outlined above, funding in 2025 to 2026 for the CPCF will rise to £3.073 billion, from which £900 million will be allocated to margin. This is a 19.7% like-for-like increase on 2023 to 2024 funding levels. We have also agreed to a one-off write-off of £193 million of medicines margin over-delivery. The increase in margin and the impact of the write-off will both be reflected in the drug tariff from April 2025. This uplift recognises the increased activity and costs associated with the supply of medicines, and aims to move towards stabilising this core pharmacy function.

The following changes have been agreed to the fees from April 2025. 

Single activity fee

The single activity fee (SAF) will increase from £1.27 to £1.46. 

Pharmacy Contraception Service

The fee for both initiation and continuation Pharmacy Contraception Service (PCS) consultations will increase from £18 to £25.  

Pharmacy First

The fee for Pharmacy First minor illness and clinical pathways consultations will increase from £15 to £17.  

New Medicine Service

From April 2025, the payment structure for the New Medicine Service (NMS) will be simplified, moving to a split fee with £14 paid for completion of the initial intervention consultation and a second fee of £14 for completion of the follow-up consultation.

Hypertension Case Finding Service

This service was introduced to identify people aged 40 and over with high blood pressure, with the aim of preventing cardiovascular disease (CVD). The fees have been restructured to better support this outcome, recognising the potential for increased use of skill mix in the service since 2023. The fee for a clinic check consultation will reduce from £15 to £10. The fee for an ambulatory blood pressure monitoring (ABPM) consultation will increase from £45 to £50.85.

Medicines margin  

In addition to the funding uplift for medicines margin set out above, while over-delivered medicines margin is being recouped, concessionary prices will be constrained so as not to undermine the recouping. Should there continue to be further over-delivery of medicines margin requiring downward adjustments to reimbursement, consideration will be given to further strategies to stabilise category M, such as moving funding for margin between categories or increasing the branded discount deduction percentages.

A range of actions will also be progressed, including:

• changing category C reimbursement price-setting arrangements (where there are multiple source products) and introducing a process for early entry to category M of high-volume generics that come off-patent
• exploring whether speeding up the category M reimbursement price-setting arrangements would be better (in other words, would more fairly reflect contractors’ purchase costs and reduce concessionary prices) than the current timetable
• gaining a better understanding of the impact of local prescribing activities (such as the use of branded generics) on community pharmacy medicines margin, and to consider any actions we could take as a result
• improving and validating the medicines margin survey to underpin work on medicines margin distribution

With regard to medicine supply, DHSC and NHS England are currently considering the recommendations for us in the Royal Pharmaceutical Society’s Medicines Shortages: Solutions for empty shelves report and will look to encompass any appropriate actions within the joint NHS England and DHSC shortages workplan. CPE is a key stakeholder in this work and in working groups looking at resilience, diversification and better use of data to support this work. Separately, DHSC and NHS England will, with CPE, identify gaps where that workplan does not cover challenges that pharmacy contractors or CPE think need to be addressed.

Expansion and amendments to existing services 

During the 5-year deal and over the last year as the Pharmacy First service has been implemented, the sector has significantly increased the range of clinical services pharmacies offer to support patients and the wider NHS. We are keen that the focus in 2025 to 2026 is to embed these services. To increase the delivery options, we aim to introduce 2 expansions of existing services from October 2025:

• expanding the NMS to introduce depression as a further therapeutic area for which patients can receive support. The expansion of the NMS recognises the value delivered for patients in effectively managing their medication, increasing the scope of the potential offer pharmacies may provide
• expanding the PCS to include emergency contraception (EC). This service expansion will allow all community pharmacies across England the opportunity to provide equitable access to EC for patients. This expansion will move away from the regional variation seen to date. Contractors will have the opportunity to maximise the service’s benefits by initiating a patient on oral contraception as part of an EC consultation and claim payment for both services. The fee for an EC consultation will be £20

We will explore with CPE the digital capabilities needed at service launch to ensure that there’s minimal burden for contractors and efficient systems in place when delivering and claiming for the service.

Additionally, we have agreed to enable better use of skill mix for the smoking cessation service and the PCS to enable the delivery of parts of these services by registered and non-registered pharmacy staff. This includes enabling the delivery of patient group directions (PGDs) by pharmacy technicians. For the smoking cessation service, we have agreed the introduction of PGDs in 2025 to 2026 to enable the provision of varenicline and cytisinicline (cytisine), and for the PCS the addition of drospirenone to be supplied under PGD.

Updates to the Hypertension Case Finding Service specification will be made to further align the service to National Institute for Health and Care Excellence (NICE) guidelines, which will place explicit restrictions on the number of funded clinic check consultations a patient can have within a specified time period. Changes will also be made to clarify when it is appropriate for general practices to refer patients to the service for a clinic check consultation. NHS England has also committed to re-look at home blood pressure monitoring to further support the diagnosis of hypertension.

Further information and updated service specifications to reflect these changes will be published in due course.

Pharmacy Quality Scheme  

We have seen the success of the Pharmacy Quality Scheme (PQS) across the last CPCF 5-year deal (2019 to 2024) but recognise that uplifting fees to start to stabilise services had to take priority. We have therefore agreed that a targeted PQS will be reinstated with a value of £30 million from 1 April 2025, recognising the tight funding envelope available. The criteria focus on key priority areas building on the previous success of the scheme and will include the following: 

Gateway

Being signed up and registered to deliver Pharmacy First clinical pathways and the PCS.

Palliative and end of life care

Pharmacies must develop or update a palliative and end of life care action plan and, if they stock the 16 palliative and end of life care medicines, update their ‘directory of services’ profile to confirm this. 

Respiratory

Referral of patients aged 5 to 15 years who do not have a spacer and all patients using 3 or more short-acting bronchodilators without any corticosteroid inhaler in 6 months.  

Pharmacy First

Completion of a clinical audit and all registered professionals must have completed Centre for Pharmacy Postgraduate Education (CPPE) sepsis training.

Emergency contraception

All pharmacists, and other registered pharmacy professionals intending to provide the service, must complete CPPE emergency contraception training.

NMS depression training

All pharmacists must complete CPPE consulting with people with mental health problems online training.

Enhanced DBS checks

Enhanced Disclosure and Barring Service (DBS) checks undertaken for all registered pharmacy professionals within the last 3 years.

In line with previous PQSs, we have agreed to continue the aspiration payment, increasing this to 75% of the money available, with the claim window being opened in May 2025. Payment will be made on 1 July 2025. Further detail will be provided in the drug tariff part 7A.

Pharmacy First

We are keen to continue to embed and grow the Pharmacy First service, following the success seen to date. Given the importance of the service for both patients and primary care capacity, £215 million has been secured to enable the service to continue to grow.  

In addition to the increased clinical pathways consultation fee, which will change from April 2025, a revision to the fixed payment arrangements has also been agreed from June 2025. These will be implemented as a stepped change to provide time for you to prepare for the following changes to claims that will be necessary:

• from June 2025, a fixed payment will be made of £500 for those contractors delivering a minimum activity requirement of 20 to 29 clinical pathway consultations in a month, with the £1,000 maximum total payment for those who deliver the minimum activity requirement of 30 or more consultations. To enable the variable payment, the claim window for Pharmacy First will be reduced to one month from June 2025
• from June 2025, contractors must be registered and able to deliver the Hypertension Case Finding Service (note: distance selling pharmacies will be exempt from the service requirements), PCS and Pharmacy First service in addition to the minimum activity requirement for delivering the clinical pathways consultations as described above to achieve the fixed payment
• from October 2025, this requirement will increase to require contractors to deliver one ABPM consultation per month, in addition to meeting the above requirements
• from March 2026, this requirement will increase to provide a specified number (on which CPE will be consulted) of PCS consultations (including EC consultations), in addition to meeting the above requirements

As is currently the case, only consultations under the clinical pathways element of Pharmacy First will count towards eligibility for the initial and ongoing fixed payments identified above. Separately from these discussions, NHS England has undertaken a clinical review of the clinical pathways, and the updated pathways will be published shortly. We have agreed to maintain the current cost control mechanism linked to Pharmacy First, which will manage growth of the service to ensure delivery remains within the agreed funding envelope. Details of the cap bands can be found in the drug tariff, with the cap remaining under review between our organisations.

We have also agreed to pay for £30 million of blood pressure and contraception consultations currently funded by the CPCF from this budget. This will release funding within the contract global sum to further support pharmacies’ medicine supply and advice function.    

Regulatory changes 

We have agreed to progress several legislative changes in 2025 to: 

• clarify that from October 2025, distance selling pharmacies can only deliver advanced and enhanced services remotely in line with the delivery of essential services
• amend the regulatory test for contractors’ applications to amend the dates and times they deliver their core hours
• clarify that the NMS, like other services, cannot be subcontracted to other providers
• remove the requirement for practice leaflets
• remove the requirement for references for staff involved in NHS services
• remove the need for people who pay prescription charges to sign the FP10 or EPS token
• remove the clinical audit requirement (nationally chosen audit or a contractor selected audit) for 2025 to 2026
• require engagement in a maximum of 2 national health campaigns and 2 integrated care board (ICB) selected campaigns

We will work together to improve systems to ensure pharmacy NHS websites and ‘directory of services’ profiles, which underpin navigation of patients to community pharmacy services, are comprehensive and accurate. 

Digital developments 

Up to £8 million of funding secured for community pharmacy will be used to support digital developments in 2025 to 2026. We have agreed to continue to work to deliver developments for the pharmacy sector in 2025 to 2026 to better support delivery of clinical services, including the introduction of emergency contraception as part of the contraception service, and patient group direction supplies as part of the smoking cessation service. DHSC and NHS England are committed to continuing to work with the sector and IT suppliers to streamline the ‘Manage your service’ claim process through the use of payment and data application programming interfaces (APIs), for all national clinical services.

Conclusion 

Thank you for the contribution that you have made and continue to make to patient care. The government is committed to working with the sector over the coming years to:

• stabilise community pharmacy
• build on what we have achieved to date
• lay the foundations for an independent prescribing service to harness its full potential in the future

Community pharmacy has a key role in supporting patients in the communities they serve, and this is essential in delivering the government’s ambition to rebuild the NHS and make it fit for the future.

Yours sincerely

Alette Addison, Deputy Director, Pharmacy, Eyecare and Controlled Drugs, Department of Health and Social Care

Ali Sparke, Director, Dentistry, Community Pharmacy and Optometry, NHS England

Janet Morrison, Chief Executive, Community Pharmacy England