Pharmacies will shortly be required to provide a ‘bundle' of services to qualify for monthly threshold payments, following the agreement of the recent funding deal. The new contract introduces the concept of payment ‘bundling' for Pharmacy First, the Hypertension Case-Finding Service, and the Pharmacy Contraception Service. This is intended to encourage pharmacies to offer all three services, therefore providing a universal offer to patients across England.

However, the Company Chemists' Association (CCA) is concerned that the requirements for bundling activity for threshold payments could lead to unintended consequences.

The challenge of providing regular ambulatory blood pressure monitoring (ABPM) checks could prove insurmountable for many pharmacies, meaning lost threshold payments and a risk that pharmacies stop providing the Pharmacy First service altogether.

The CCA's analysis finds that less than a third (30%) of pharmacies currently meet the new threshold requirements to access the full funding.

As of January 2025, the breakdown for the bundled services was as follows:

• 90% of community pharmacies provided Pharmacy First
• 77% of pharmacies provided blood pressure checks
• 52% of community pharmacies provided the contraception service.

Pharmacy teams can continue to provide and be paid for delivering only one or two of the three services. However, this will mean they would be ineligible for threshold payments, previously only linked to Pharmacy First.

If threshold payments are consistently missed, pharmacies may reconsider the sustainability of offering Pharmacy First, which could lead to pharmacies stopping this important element of primary care.

This change was seen when the Pharmacy First threshold requirements increased in August 2024. In that month, over 15% of pharmacies (1,842) missed the new threshold. Of these, 130 (7%) recorded no consultations at all the following month.

Providing at least one ABPM every month is expected to be challenging with demand low and a high number of opportunistic blood pressure checks required to identify suitable patients. There is a wide variance in current use of ABPM testing. 

The CCA recommends that the government change the requirement for ABPM, allowing home blood pressure monitoring (HBPM) as an alternative to support patients who do not want to have ABPM.

Malcolm Harrison, CCA chief executive, said: ‘The premise of bundling makes absolute sense for patients. With only 30% of pharmacies currently providing all of the three services, many pharmacies are at risk of missing out on future threshold payments. There is a real risk that pharmacies who do not meet threshold payments in the future will rethink delivery of the three services.

‘We urge the government to ensure there is flexibility in the Hypertension Case Finding service to allow for home blood pressure monitoring in addition to ambulatory blood pressure monitoring. This simple change will ensure more pharmacies are able to deliver the service and receive threshold payments which are vital to ensuring that pharmacies are able to stay afloat.'