A new report by the Company Chemists’ Association (CCA) outlines how pharmacists are acting responsibly as antimicrobial stewards through the NHS Pharmacy First service.
The report examines six of the common clinical conditions: earaches, bladder infections, sore throats, sinusitis, infected insect bites, and impetigo. Shingles is also included in the service but has been excluded from this study because it is a viral infection and cannot be treated by antibiotics.
Read the CCA’s report on Pharmacy First and antimicrobial resistance here
The analysis finds that:
- On average, 66% of patients who attended a pharmacy through the Pharmacy First Service, for one of the six conditions were provided with antibiotics.
- Actual antibiotic supply rates are even lower as many patients attending pharmacies are ‘pre-screened’ before consultations.
- Pharmacists are strictly adhering to the treatment guidelines outlined to them. 88% of antibiotics supplied are first line treatments.
- Whilst not directly comparable, rates of antibiotic supply were lower than or in line with prescribing rates in general practice for four of the five conditions (infected insect bites were not included in the GP study).
- 94% of eligible Pharmacy First patients received a ‘complete episode of care’, receiving the treatment or advice they needed within a pharmacy without onward referral. This is a slight increase from 92% as outlined in a previous CCA analysis[1].
- Antibiotics are only one of the treatment options that patients can receive through Pharmacy First. When alternatives were available, less than half of patients received oral antibiotics. Pharmacists can manage patient expectations for antibiotics and provide the most appropriate treatment.
- The data shows that antibiotic supply is lower where there are a range of different treatment options available.
The CCA analysed data from 150,000+ anonymised patient consultation records from 3,000+ member pharmacies for August and September 2024.
The analysis found that pharmacists are closely adhering to the pathways set out by the Patient Group Directions (PGDs), and only supplying antibiotics when appropriate. PGDs are inherently restrictive, as they set out detailed criteria for patient eligibility, as well as whether and how they should be treated if they are eligible.
To be eligible for any of the seven Pharmacy First clinical pathway consultations, patients must reach a ‘gateway point’. Many patients do not pass this point – as their symptoms do not match the criteria for the service, they’ve not been experiencing symptoms for long enough or as they do not meet age or gender criteria. In such cases they may receive advice, but the consultation is not recorded. As a result, rates of antibiotic provision are likely to appear higher as many of those individuals that do not meet the ‘gateway’ criteria are excluded before data is collected.
The CCA is now urging NHS England to:
- Expand the number of treatment options into the existing seven clinical conditions, further embedding pharmacists’ role in antimicrobial stewardship.
- Integrate Independent Prescribing into the service, giving pharmacists and patients greater choice in the treatments supplied.
- Expand Pharmacy First to include a range of other conditions which could include lower back pain, respiratory tract infections, skin conditions, and conjunctivitis.
- Commission pharmacies to capture information on patients attending pharmacies who do not meet ‘gateway’ criteria. This would enable a richer understanding of antibiotic provision through Pharmacy First. It would also account for the significant unfunded workload associated with the service.
Malcolm Harrison, Chief Executive of the CCA said: “Pharmacists are treating their role as antimicrobial stewards with the utmost importance, supplying antibiotics only when appropriate.
Pharmacies have done their bit – NHS England need to now lift their ambitions. Pharmacists should be trusted to offer more treatment options. We also need independent prescribing integrated into the service as soon as possible – the clock is ticking on the first cohort of prescribing pharmacist registrants in 2026.
We need expansion beyond the seven conditions – especially as patients are already visiting their pharmacy for a whole range of other conditions.
Lastly, pharmacies must be commissioned to capture information on patients attending pharmacies who do not meet the inclusion criteria. This accounts for a large and rising, but ultimately unfunded workload to pharmacy teams. Collection of this data will allow us to measure the impact of this unfunded work but also develop our understanding of antibiotic provision.
It’s time to remove the training wheels from the Pharmacy First service. The service is working as envisaged but it’s clear there’s so much more room for growth”.
[1] CCA, Pharmacy First: Meeting Patient Need, May 2024