What is Pharmacy First?

The UK government has set out an ambitious plan to improve access to primary care and enhance patient convenience through a major expansion of services offered by community pharmacies. With a £645 million investment over two years, patients will now have quicker and easier access to NHS care from their local high street pharmacy. This revolutionary initiative, known as Pharmacy First, aims to transform the way healthcare is delivered, freeing up valuable GP appointments and empowering patients to take control of their health.

The Pharmacy First Service

The Pharmacy First scheme, set to launch on 31st January 2024, will provide consultations and NHS-funded treatment for seven common conditions/minor illnesses. These conditions include sinusitis, sore throat, acute otitis media, infected insect bites, impetigo, shingles, and uncomplicated urinary tract infections (UTIs) in women. Under this service, patients can seek advice and treatment directly from a pharmacist eliminating the need for a GP appointment in certain cases.

Consultations can be initiated by patients who self-refer to the pharmacy or those referred by NHS 111, GPs, or other healthcare professionals. The service will also incorporate the existing Community Pharmacist Consultation Service (CPCS), ensuring a seamless integration of care and continuity of service.

Advantages and scope of Pharmacy First

The Pharmacy First service brings numerous advantages to patients and the healthcare system as a whole. By providing direct access to advice and treatment for common conditions, Pharmacy First aims to reduce the burden on GP services and help free up approximately 15 million GP appointments over the next two years. This means that patients with more complex or urgent healthcare needs can receive the attention they require without unnecessary delays.

Not only does Pharmacy First improve access to care, but it also promotes patient empowerment and self-care. By providing patients with the necessary information and treatment options, pharmacists enable individuals to take control of their health and well-being. This approach aligns with the government’s vision of a patient-centric healthcare system that encourages individuals to actively participate in their care.

Digital systems and remote consultations

To support the launch of the Pharmacy First service, pharmacy owners will have access to clinical services IT systems. These systems will facilitate the creation of clinical records for the service, ensuring accurate documentation and efficient management of patient care. Additionally, the systems will automatically send data on service provisions to the NHS Business Services Authority’s MYS portal, streamlining payment claims and administrative processes.

Distance Selling Pharmacies (DSPs) will also play a vital role in delivering the Pharmacy First service. While they may not provide clinical pathways consultations on their premises, DSPs will be able to offer six of the seven clinical pathways remotely through video consultations. This technological advancement allows patients to receive consultations and treatment conveniently from the comfort of their own homes, further enhancing accessibility and reducing barriers to care.

Addressing antimicrobial stewardship

One of the key considerations in designing the Pharmacy First service is to ensure responsible antimicrobial stewardship. The clinical pathways and associated Patient Group Directions (PGDs) have been developed in collaboration with experts from various fields, including AMR Consultant Pharmacists, Infection Control Specialists, and the UK Health Security Agency’s ESPAUR team. This multi-disciplinary approach ensures that the service allows for the appropriate supply of antimicrobials while minimizing the risks of antimicrobial resistance (AMR).

The clinical pathways for the service outline specific requirements that patients must meet to determine their suitability for receiving antimicrobial treatment. These requirements include signs, symptoms, diagnostic criteria, and prior medical history. Pharmacists, as highly trained healthcare professionals, carefully assess and consider these criteria before deciding whether to supply an antimicrobial or recommend an alternative treatment option.

Pharmacists have been actively involved in antimicrobial resistance efforts for several years, and their cautious approach to prescribing antibiotics has been demonstrated through initiatives such as the Pharmacy Quality Scheme (PQS). By leveraging the expertise of pharmacists and implementing robust protocols, the Pharmacy First service aims to contribute to the global fight against antimicrobial resistance.

Collaborative digital systems

The successful implementation of the Pharmacy First service relies on the integration of digital systems and interoperability between healthcare providers. Pharmacy owners will have access to clinical services IT systems that facilitate the creation of comprehensive clinical records, seamless data sharing, and automated updates to GP records. These advancements in digital technology foster collaboration between pharmacists and GPs, enabling efficient communication and streamlined referrals.

Work is also underway to enhance digital triage systems, allowing electronic referrals from NHS 111 and Urgent and Emergency Care settings to be directed to community pharmacies instead of GP practices. This ensures that patients receive the appropriate care promptly, without unnecessary delays or burdens on GP services. Furthermore, efforts are being made to streamline referrals from GPs to community pharmacies, reducing reliance on traditional communication channels like NHSmail.

The integration and interoperability of digital systems represent a significant step forward in healthcare delivery, fostering closer collaboration between primary care providers and setting the stage for further advancements in community pharmacy services.

Expansion of Pharmacy Services

Pharmacy First is just one aspect of the government’s plan to expand the role of community pharmacies in delivering primary care services. In addition to the seven clinical pathways, Pharmacy First will incorporate the existing Community Pharmacist Consultation Service (CPCS). This integration ensures a comprehensive range of services, allowing patients to access advice, treatment, and support for a wide range of healthcare needs.

Furthermore, the plan includes expanding access to oral contraception through pharmacies, eliminating the need for patients to consult with a practice nurse or GP. This change empowers women to take control of their reproductive health and provides a convenient and confidential option for accessing contraception.

Another significant expansion is the increase in the number of people who can access blood pressure checks in their local pharmacy. The NHS aims to more than double the number of blood pressure checks conducted in pharmacies, from 900,000 last year to 2.5 million. This initiative plays a crucial role in identifying individuals at risk of heart attacks or strokes and provides early interventions to mitigate these risks.

What will happen to locally commissioned Pharmacy First services?

Locally commissioned services have included treatments for minor ailments such as aches and pains (sprains and strains), athlete’s foot, bites, cold sores, conjunctivitis, constipation, contact dermatitis, coughs and colds, diarrhoea, ear wax, fever, hay fever, headache, head lice, heartburn, indigestion, itching (chicken pox), minor burns and scalds, mouth ulcers, nappy rash, nasal congestion, nausea and vomiting, sore throats, stings, teething, threadworms, and thrush.

Where these locally commissioned services include one or more of the 7 clinical pathways announced, it is expected those elements of the local services will be discontinued.

Empowering patients through self-referral

To further enhance accessibility and streamline care, up to half a million people per year will be able to self-refer for key services without seeing their GP first. This self-referral option applies to services such as physiotherapy, hearing tests, and podiatry. By removing the need for a GP appointment as a prerequisite for accessing these services, patients can receive timely care, reducing waiting times and improving overall patient experience.

The expansion of self-referral services recognizes the importance of patient autonomy and choice. It empowers individuals to seek the appropriate care directly, without unnecessary barriers or delays. This approach not only improves patient satisfaction but also optimizes the use of healthcare resources, ensuring that GP appointments are reserved for those who truly require them.

The future of primary care

The Pharmacy First initiative represents a significant step forward in transforming primary care and improving access to healthcare services. By leveraging the expertise of community pharmacists and integrating their services into the primary care landscape, the government aims to create a more patient-centric healthcare system that meets the evolving needs of the population.

As the NHS approaches its 75th milestone birthday, the Pharmacy First service aligns with the organization’s legacy of innovation and adaptation. Primary care services, including community pharmacies, are continuously evolving to address the changing healthcare landscape and provide efficient, accessible, and high-quality care to patients.

Through collaborative efforts between pharmacy owners, NHS England, and the DHSC, the Pharmacy First service will continue to evolve and expand, ensuring that patients can access care close to home and receive the support they need to manage their health effectively.

Conclusion

Pharmacy First represents a paradigm shift in primary care delivery, empowering patients and revolutionizing access to NHS services. With the launch of this service, patients will benefit from quicker, more convenient access to advice and treatment for common conditions. By working in collaboration with pharmacists, patients can take control of their health and well-being, freeing up GP appointments for those with more complex healthcare needs.

The integration of digital systems, remote consultations, and self-referral services further enhances accessibility and streamlines the delivery of care. By utilizing the expertise of community pharmacists and expanding their role in primary care, the government is driving positive change and setting a new standard for patient-centric healthcare.

As the Pharmacy First service expands and evolves, it will continue to shape the future of primary care, ensuring that patients receive timely, convenient, and high-quality care from their local community pharmacy. With the commitment of all stakeholders involved, the vision of a modern, accessible, and patient-centered healthcare system will become a reality.

Sources

• Treatments and services – Your Pharmacy First – NHS