Analysis: Pharmacy First – one year on

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An expanded Pharmacy First service in England could free up 40 million GP appointments a year, according to a report from the Company Chemists’ Association (CCA), published last month.

Marking the first anniversary of the service, the CCA’s The Future of Pharmacy First report says pharmacies provided nearly 1.5 million consultations in the first nine months following the launch of the service on January 31 last year. It estimates this number could hit 2.5 million by its current end date in April. 

The CCA analysis is based on data collected from more than 3,000 member pharmacies since the start of the service. The analysis found: 

• Almost a third (30 per cent) of all consultations have been for urinary tract infections – peaking at nearly 40 per cent in September
• This is followed by sore throat (28 per cent), infected insect bites (13 per cent), ear infections (12 per cent), sinusitis (9 per cent), impetigo (5 per cent) and shingles (3 per cent)
• More than a quarter (27 per cent) of consultations have been provided in the 20 per cent most deprived communities
• Patient demand has been consistent with spikes in activity around bank holidays, and demand for consultations on Sundays double the average of that during the week.

Data on outcomes and treatment choices was published by the CCA last year (see tables below).

Expanding the service

In its current guise, the CCA predicts Pharmacy First has the potential to free up some 9 million GP appointments a year. However, with more than 10,000 community pharmacies (96 per cent) signed up to offer the service, the report says there is “potential for further growth”. 

According to YouGov polling, 78 per cent of the public in England support expanding pharmacy roles to treat conditions like chest infections and skin issues. Indeed, similar services in Scotland and Wales already give patients access to help for a greater range of conditions, such as acne, thrush, backache, eczema, headache and hay fever.

The CCA therefore proposes adding more conditions to Pharmacy First in England, including:

• Lower back pain, which it says could divert up to 5.5 million appointments from other parts of primary care
• Eye infections, which could save up to 3 million GP appointments each year
• Migraine, which could free up to 2.5 million GP appointments a year
• Chest infections in adults, which could save 2.5 million GP appointments annually.

“Pharmacy First is allowing patients to be seen in a timely manner and freeing up vital GP capacity so that they can focus on more acute and complex care but there is, however, still significant room for growth,” says CCA chief executive Malcolm Harrison. “The NHS must now allow [the sector] to expand the service to deliver greater patient access into primary care.”

The report urges policymakers to expand the eligibility criteria of the current seven conditions to allow more patients to be treated. It also advocates a move from a patient group direction-led service to an independent prescribing-led service. 

“An expansion of conditions covered and, wherever possible, a broader range of treatment options available would allow pharmacies to address an even wider scope of patient needs, particularly for chronic condition management or minor injuries,” says Numark chair Harry McQuillan. 

“Alongside this, we would like to see a more unified approach across the UK to ensure all patients can benefit from a consistently high standard of service, regardless of location.”

Concerns remain

Despite support from patients who have used it, public awareness of Pharmacy First remains low, making this another aspect of the service to be addressed. “While all the Pharmacy First services [across the UK] have been transformative, we have encountered variability in how well patients understand what the service offers and when they can access it,” says McQuillan. 

A disappointing aspect of the service in England has been the inability to ensure the allocated funding has flowed to the pharmacy network, McQuillan adds. Workforce pressures are another concern. “

The success of Pharmacy First relies heavily on sufficient funding, staff capacity and recognition of the workload in pharmacies,” he says. “Without continued investment and support, there is a risk of burnout among teams and limitations on service reach.”

Pharmacy leaders are calling for more long-term support for the service. With Community Pharmacy England now deep in new contract negotiations, its chief executive Janet Morrison stresses: “Pharmacies have done an incredible job delivering this service under immense financial and operational pressure. To sustain this, they need greater support and further investment.”

Nick Kaye, chair of the National Pharmacy Association, adds: “It is clear that when the Government invests in community pharmacy, it can deliver exceptional clinical care for patients and take pressure off the rest of our overstretched health system. So we now need to look to a future where pharmacies are trusted to deliver more clinical services, with the right funding to achieve this.”

Chief executive of the Independent Pharmacies Association Leyla Hannbeck agrees. “The main concern for community pharmacy remains the lack of adequate core funding,” she says. “The sector needs the headroom to be able to manage debt then move forward with a remuneration model that gives both stability and the potential to invest, plan and prepare for the future.”