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Pharmacy First was launched by the government and NHS England on 31 January 2024, as part of the primary care access recovery plan. The scheme enables community pharmacists to supply prescription-only medicines for seven common health conditions, so that patients can more easily access clinically-appropriate care without having to make a GP appointment.

More than 10,000 pharmacies in England (over 95%) are already signed up, and on the first day of the scheme they provided 9,800 patient consultations according to NHS England. With a publicity campaign running until the end of March 2024, greater patient awareness is expected to gradually increase use of the service, helping to relieve pressure on GPs.

So, what does Pharmacy First offer, and will it really help to reduce GP workload?

What services does Pharmacy First provide?

Pharmacy First aims to free up 10 million GP appointments a year by this winter, by enabling patients to consult a pharmacist instead of a GP for certain common ailments.

The service is in three parts: 1) minor illness consultations and 2) supply of urgent medicines (and appliances) – previously part of the Community Pharmacist Consultation Service (CPCS) – and 3) the new clinical pathway consultations. GPs can refer patients for minor illness consultations and clinical pathway consultations.

With the launch of Pharmacy First, patients can access a clinical pathway consultation, and receive prescription-only medicines where clinically appropriate, for the following seven common health conditions:

  • Acute otitis media (1–17 years) – this service is not provided by Distance Selling Pharmacies
  • Impetigo (≥1 year)
  • Infected insect bites (≥1 year)
  • Shingles (≥18 years)
  • Sinusitis (≥12 years)
  • Sore throat (≥5 years)
  • Uncomplicated urinary tract infections (women 16–64 years).

The scheme also includes the previously launched expansions to pharmacy blood pressure checks and oral contraception services.

How do patients access the service?

Patients can access Pharmacy First services by walking into a pharmacy, via video consultation, or by referral from NHS 111, the NHS app, urgent care or urgent treatment centres, A&E, 999, or general practice.

As most people in England live within a 20-minute walk of a community pharmacy, this will enable quick and convenient access to treatment. The service will be of particular benefit for people who often face barriers to accessing GP appointments, including working adults and those with children, as well as people living in deprived areas. However, patients can still visit a GP for these conditions if they choose to.

What protocols do pharmacists follow in clinical consultations?

A clinical pathway for each of the seven conditions determines whether a patient should be seen by a pharmacist as part of the Pharmacy First service or referred to another healthcare provider. Where the consultation is with the pharmacist, people with relevant symptoms can receive advice and, if clinically appropriate, a prescription-only treatment.

Pharmacy contractors must ensure that pharmacists providing the service have the relevant knowledge and competence to comply with the clinical pathways. NHS England has provided clinical examination skills training, including in the use of otoscopes, to enable them to provide high-quality care.

Some GPs have raised concerns about antimicrobial resistance when community pharmacies are allowed to prescribe antibiotics. However, the clinical pathways were designed to incorporate principles of antimicrobial stewardship, and NHS England confirmed that the impact will be monitored.

Pharmacists delivering the consultations must check patients’ GP records (with consent), unless there is a good reason not to do so. They should also record the consultation in the community pharmacy IT system, which will automatically send a structured message via GP Connect, so that the information can be easily reviewed and added to the GP record. In the case of any temporary problems with the system, the notification should be sent via NHSmail or hard copy.

Are concerns about workload justified?

Pharmacists expressed fears that early demand for the Pharmacy First service would exceed capacity while staff are still developing the necessary skills, especially when pharmacies are already under pressure. However, both capacity and uptake of the service is expected to increase gradually during the first year. Also, some pharmacies will not be able to offer consultations for otitis media until 1 April, while awaiting otoscope equipment.

GPs also had concerns about additional workload from checking patient record updates made by pharmacists. However, NHS England confirmed that IT systems would be updated in February so that practice staff are able to review and add the information to the patient record with one click of a button. This could be done by trained administrative staff, so in most cases GPs will not need to review the updates. Where specific action is required by the GP team, this should be communicated by an Urgent Action communication.

With time, it is hoped that any initial problems with the service in England will be ironed out. It is worth noting that in Wales, where the similar Clinical Community Pharmacy Service (CCPS) scheme was introduced in 2022, over 400,000 GP appointments were freed up in one year as pharmacists undertook additional training and began to offer advice and treatment for common illnesses such as urinary tract, ear, and skin infections.

If you need medico-legal advice about interactions between the GP team and the Pharmacy First service, please get in touch at Medical Defense Society.