Provisions for a Pharmacy First service in England were announced in early May, which will see the most significant investment in community pharmacy in the country for many years. In this article, Editorial Manager Siobhán Kane provides an overview of the plan, including reaction from pharmacy organisations, and details on the next steps to making it a reality.
The NHS and English Government have announced a major expansion of pharmacy services under a plan to improve access to primary care. £645 million has been pledged to community pharmacy over the next two years to support a pharmacy common conditions service, along with the NHS Pharmacy Contraception and NHS Hypertension Case-Finding services.
When making the announcement on 9 May, the NHS said; “the plan will mean that for the first time ever, patients who need prescription medication will be able to get it directly from a pharmacy, without a GP appointment, for seven common conditions”. It is hoped that it will be rolled out by this winter, however, negotiations are now needed over the details of how it will be enacted.
The seven conditions are earache, UTIs, sore throat, sinusitis, infected insect bites, impetigo and shingles. Oral contraception will also be available directly from the pharmacy, and it is estimated that almost half a million women will utilise this route of supply, reducing accessibility barriers. It is intended that the hypertension service will allow 2.5 million blood pressure checks to be carried out in pharmacies.
It is envisioned that the actions set out in the overarching primary care plan will free up around 15 million GP appointments over the next two years, by enabling GP teams to redirect patients to other specialists, including pharmacists.
The plan was widely praised by pharmacy associations in England, in addition to many patient organisations. Janet Morrison, Pharmaceutical Services Negotiating Committee (PSNC) CEO, said: “Thousands of people already rely on their local community pharmacy every day, and these new plans from the NHS and Government will allow pharmacies to do even more to help the public from next year . . . These plans are a very welcome step towards putting pharmacies even more at the heart of primary care and prevention – where they belong – and making better use of pharmacists’ clinical skills.”
Rachel Power, Chief Executive of the Patients Association, said: “This plan responds to many of the issues we have raised on patients’ behalf over the last few years, and we welcome the changes detailed in it, which will improve patients’ experience of primary care . . . The expansion of services within pharmacy is welcome. The local pharmacy is already a source of great information for many patients. Enabling pharmacists to prescribe more and initiate treatments, expands choice for patients.
Finally, Chair of the Royal Pharmaceutical Society in England Thorrun Govind said: “The plans announced today are a real game-changer for patients as they will provide better access to healthcare, helping to reduce the strain on other parts of the NHS and provide patients with the care they need, when they need it . . . Providing treatment to help prevent common conditions from becoming worse and requiring more complex treatment later on is better for patients and also cost-effective. Patients can expect to receive trusted advice from pharmacists in their local pharmacy.”
The plan builds on the idea of a ‘Pharmacy First’ programme, which had been generating increasing momentum in England, especially since a similar programme was introduced in Scotland, in July 2020. The Scottish service offered anyone living in Scotland the opportunity to visit a pharmacist as their first port of call for minor illnesses, such as urinary tract infections, impetigo and acne. Through the service, patients can access assessment, referral and free treatment for their ailment. Pharmacies receive a base payment of £1,250 each month for the service, and an activity payment from a funding pot of £785,000 if they provide a minimum of 100 consultations per month.
At the end of March 2023, the PSNC published poll results that showed the extent of the public backing in England, for a Pharmacy First approach, with 68% of people agreeing that they would find it easier to seek health advice for common conditions, such as skin conditions or indigestion, at a community pharmacy rather than a GP surgery. 75% of people also said that they would like to see community pharmacies offering more healthcare services, such as treating urinary tract infections or sore throats.
Pharmacy First is similar to the Minor Ailments Scheme, which the IPU has been strongly advocating for in recent years.
The PSNC had warned that without any further funding to the sector, closures of pharmacies in England were increasingly likely. Separately, the Company Chemists’ Association revealed that 670 pharmacies had closed in England since 2015.
Pharmacy First was a key component of the PSNC’s ‘Four-point plan’, which was a political advocacy campaign they launched in late 2022 to highlight “the risks to pharmacy services that the current pressures on the sector are causing”, in addition to showing politicians “the scope of what pharmacy has to offer”. Alastair Buxton Director of NHS Services at the PSNC told the IPU Review that the challenges patients had in accessing GPs in England were significant and had become a political issue: “Community pharmacy offers one of the few solutions to help address these issues, so we ran a significant influencing campaign for many months to promote this message, building advocates in Parliament and raising awareness in the media as well as trying to persuade Government officials with our proposals and case studies.”
Mr Buxton said many pharmacies already made these services available: “Some national services have always been optional, but most English pharmacies do provide them, including the Community Pharmacist Consultation Service. We expect the Pharmacy First service will augment that service and would expect most pharmacies will wish to provide Pharmacy First, particularly as it relates to a core role of pharmacy teams supporting people to manage minor illnesses.”
As is often the case, funding was one of the mains sticking points in getting proposals across the line. Mr Buxton said: “Additional funding was a big sticking point with Treasury having a tight hold of the purse strings, and some GPs have raised concerns since the announcement about the potential risks regarding antimicrobial stewardship – we are working to address misconceptions around pharmacists’ expertise and supplies of antibiotics.”
Service details and funding allocations will now be subject to negotiation between PSNC, the Department of Health and Social Care and NHS England. These discussions, which will also look at the cost of IT integration and marketing of pharmacy services to the public, have already commenced and the PSNC say they hope to be able to report back to the pharmacy sector with an update, over the summer months.
Speaking on the negotiations, Mr Buxton said: “We will need to make sure funding is allocated appropriately and the service is commissioned in a way that makes implementation easy for pharmacy teams, and the provision of the service fits well into existing pharmacy processes.”
He added the new proposals are “part of an ongoing strategy to increase the provision of more clinically focused services, which support patients and also formalise the collaborative working relationship between community pharmacy and general practice teams”.
Similar to the Irish experience, Mr Buxton says the English public already knows they can trust their local pharmacies, and want the Government to enable them to do more: “The public already has an overwhelmingly positive view of pharmacy, particularly following the pandemic and we know they would welcome a Pharmacy First service. This tells us they want – and expect – to receive more services from their local pharmacy in future.”
Siobhán Kane
Editorial Manager, IPU
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