The service specification for the Pharmacy First service, which is due to commence at the end of January 2024, has been published following agreement between the Department of Health and Social Care, NHS England and Community Pharmacy England.

Alongside the service specification, the clinical pathways for the seven conditions which will be included in the service have also been published.

These flow charts indicate how patient consultations should be structured, and specify the gateway point at which patients become eligible to be treated under the new service. They should be used for patients presenting with symptoms potentially associated with:

• Uncomplicated urinary tract infections (UTIs) in women
• Shingles
• Impetigo
• Infected insect bites
• Sinusitis
• Sore throat
• Acute otitis media.

The final outstanding documentation for the new service - the 23 patient group directions (PGDs) and one protocol which will be used to authorise supply of medicines at NHS expense - are expected to be published in draft form later this week.

Community Pharmacy England stresses that all these documents will be essential reading for pharmacy owners and pharmacists who want to provide the service.

Contractors will need to notify NHS England that they intend to provide the Pharmacy First service by completion of an electronic registration declaration through the NHS BSA Manage Your Service (MYS) portal.

An NHS assured Pharmacy First IT system which meets the minimum digital requirements of the service must be used by contractors. When choosing an IT supplier, contractors should refer to the NHS CPCS IT Buyers Guide.

Participating pharmacies must have a standard operating procedure (SOP) in place covering the provision of the service and include this service in their business continuity plan. The SOP must include the process for escalation of any clinical and non-clinical issues identified - guidance on this is given in the service specification.

Contractors will have to ensure that the Pharmacy First service is available throughout the pharmacy’s full opening hours, and have a consultation room to provide the service - all face to face consultations must take place there. There must be IT equipment accessible within the consultation room to allow contemporaneous records of consultations.

Where ear examinations are performed within the pharmacy the pharmacist must use an otoscope. Guidance on selecting a suitable otoscope can be found in Annex C of the service specification.

Remote consultations are permitted for six of the seven conditions covered by the service (the exception being otitis media) but they can only be delivered using a live video link.

The Community Pharmacy Consultation Service is being incorporated into Pharmacy First, so patients may bereferred to the service by:

• NHS 111 telephony
• NHS 111 on-line
• an integrated urgent care clinical assessment service (IUC CAS)
• 999 services
• general practice (low acuity minor illness conditions and the seven clinical pathways)
• other urgent and emergency care provider.

CPE says it will be publishing more guidance on the service and resources for pharmacy owners and their teams over the next few weeks. It is also planning a series of webinars on the services and service changes announced following the Recovery Plan negotiations, which are being organised with the support of NHS England and CPPE.