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Pharmacy First

A fully-fledged Pharmacy First service would free up 30m+ GP appointments each year in England, modelling by the CCA shows. 

Below you can read how the service, despite its relatively recent launch, is already delivering for patients and the NHS.

Background

From 31st January 2024, pharmacists can give advice and, where appropriate, supply prescription-only medicine, for seven common conditions:

The service offers people with a range of common conditions quicker and more convenient access to high quality NHS healthcare. The service also frees up GP appointments for patients with more complex clinical needs.

How can the public and patients access the service?

Members of the public and patients can access the seven aforementioned clinical pathways via referrals, including GPs and NHS111, or by simply attending or contacting a pharmacy directly. Distance Selling Pharmacies (DSPs) can provide remote consultations for all but one of the conditions (acute otitis media).

The patient experience

Patients can be seen in pharmacies’ private consultation rooms without the need for an appointment. Pharmacists provide a thorough consultation, check the patient’s record and recommend the best course of action on an individual basis. A record of the consultation will be made and can be sent directly into general practice workflow.

How the service is delivering for patients so far

Despite being launched only a few months ago, the Pharmacy First service is already delivering tangible benefits to patients with over 9,000 pharmacies (87% of the network in England) delivering the service.

  • Our data shows that 92% of eligible patients get the care they need within a pharmacy without needing onward referral [1].
  • Nearly a third of consultations are provided outside of typical working hours (Monday – Friday, 9am – 6pm) [2].
  • Use of the service increases when other parts of the NHS are under pressure, as seen during the CrowdStrike IT outage (a +15% uplift in volumes) and spikes during bank holidays.
  • Additionally, almost a third of all consultations are provided in the 20% most deprived communities [3].
 

92%

of eligible patients get the care they need within a pharmacy without needing onward referral

 

Nearly a third

of Pharmacy First consultations are provided outside of typical working hours (Monday – Friday, 9am – 6pm)

Turbo-charging Pharmacy First

In the short term, Pharmacy First can free up further GP capacity if there is:

  • Greater NHSE support to drive GP referrals which currently account for fewer than 1 in 5 consultations [4].
  • Higher-quality and regular marketing campaigns to drive patient behaviour change and get them to think ‘Pharmacy First’ – patient awareness remains low and the previous marketing campaign unfortunately had little impact.
  • ICB-level activity to support and promote the service given that significant regional variation in Pharmacy First activity [5].
  • Ongoing activity by LPCs to drive collaboration between GPs and pharmacies, train GP staff, and promote the service.

In the medium-to-long term, we need:

  • NHSE to commission the service beyond March 2025.
  • Expand eligibility of the seven existing conditions.
  • Add more conditions to the service.
  • A roadmap on how Independent Prescribing will be integrated into the Pharmacy First service.

How Pharmacy First could free up 30m+ GP appointments each year

Research has identified that nearly 20 million ‘self-care’ GP appointments could be safely transferred to community pharmacy[6] [7]. With the new skills introduced as part of Pharmacy First, this could be much higher, dramatically increasing access.

Expanding Pharmacy First could involve three pillars:

Expand the eligibility and scope of the existing seven conditions – examples include:

  • Remove the age criteria to allow treatment of earaches in adults, or sinusitis in children between 1 and 12 years old.
  • Broaden the types of cases that can be treated within the conditions e.g. adding Otitis Externa, inflammation of the outer ear, given pharmacy teams already see people with this but cannot treat them under Pharmacy First.

New urgent care conditions to free up an additional 12m+ GP appointments annually

Pharmacy First could be expanded to cover several other common urgent care conditions.

Pharmacists could be empowered to:

  • Provide steroid creams, emollients, or antibacterials for dermatology conditions, such as eczema flare ups, urticaria, and rosacea.
  • Supply stronger painkillers, anti-inflammatories, and antibiotics for dental pain.
  • Give lifestyle advice, painkillers, and direct physio referrals for lower back pain.
  • Provide antibiotics, steroids, and inhalers for respiratory conditions, including respiratory tract infections and asthma exacerbations.
  • Supply antibiotics for minor eye infections, including conjunctivitis and blepharitis.

Safely and effectively treating all these conditions is within the core expertise of community pharmacists. There are already examples of local minor ailment services that include many of these conditions.

It is estimated there are over 600,000 GP appointments, and 200,000 A&E attendances annually for dental pain[8]. This is expected to grow with continued challenges to accessing NHS dentistry[9]. There is similar demand with lower back pain, as approximately 60% of adults (27.6m) suffer with Lower Back Pain, of which 5.5m consult their GP each year. Infective conjunctivitis alone accounts for approximately 1% of all GP consultations (3.5m annually)and adult chest infections a further 2.5m GP appointments annually[10].

Taken together, these conditions easily exceed 12 million GP appointments annually, each with clear treatment options that pharmacists could safely deliver.

Minor injuries

Pharmacy First offers a route to establish over 10,000 “urgent care centres” across England, with an expanded role in treating minor injuries key to this.

There have been previous examples of local services that would provide a useful starting point. This may include sprains, dressing cuts and grazes, or managing superficial epidermal burns.

Treatment, including the cleaning and dressing of wounds, is an important part of managing these patients. However, community pharmacy would also offer an important triaging source for low level injuries.

References

 

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