The Company Chemists' Association head of policy Nick Thayer told the Pharmacy Show that Pharmacy First must be led by independent prescribers and expanded to include at least four more conditions.

Thayer insisted expansion of the service had to be considered because of its successful impact since it launched on January 31 this year, describing it as "arguably the most succesful start to any national service across the UK."

He called for minor eye infections, dermatology, respiratory conditions and pain relief to be added to the current seven conditions.

"I think it's important to think beyond infections. We don't want to be seen a the infection treatment service. It's more about urgent care," he said.

"Pain relief is a particularly interesting one. Dental pain is an obvious example, mainly because NHS dentistry is in a difficult situation at the moment. And also, lower back pain is an example because of the number of people (who suffer from it)."

He also said about 1.2 million Pharmacy First consultations have been provided across England since it launched and, depending on "how winter is going to go," projected pharmacies will have provided between 2.5 million and three million consultations by March 31 next year.

Insisting the service had gone "phenomonally well," he said: "What's interesting is that it shows linear growth pretty much week in, week out. So, every week, you get around a one per cent growth on the week before. Most pharmacy services we've seen so far have shown exponential growth."

Thayer said almost a third of all consultations have been delivered in deprived communities and 84 per cent were "walk-in consultations."

He also revealed 91 per cent of walk-in consultations met gateway criteria compared with 93 per cent of referred consultations, while urinary tract infections in women was the most common consultation of the seven conditions under the service.

However, Thayer said GP referrals "are really not helping Pharmacy First" and added: "Some GPs are referring hundreds a month, a bulk of them (are not). Against that backdrop, hitting targets is a challenge."

Fundamental problem with confidence among GPs and patients 

However, a pharmacist in the audience said there is "a fundamental problem with confidence" among GPs and patients who "don't see pharmacy as a source of information and treatment on conditions."

He also suggested some GPs cannot diagnose impetigo or shingles and as a result, questioned the point of having a patient group direction on the conditions.

"I still locum in pharmacy occasionally and what concerns me there is because I teach dermatology in a medical school, they leave all the dermatology to me on a Saturday," he said.

"But they can't diagnose impetigo, so what's the point of having a PGD if you can't diagnose impetigo? There are two or three referrals to me on a Saturday for shingles. They can't diagnose shingles.

"It seems to be putting the cart before the horse. Independent prescribing, which it's been suggested is going to come in and cover all of this, it's a major danger. There are major dangers in the future."

A GP in the audience said she was concerned pharmacies were misdiagnosing rashes as a "standard" insect bite. "It's very very difficult in my experience to differentiate an insect bite from a rash," she added.

"We had several cases over the summer where patients did feel they were misdiagnosed from a pharmacy in the same way they can be misdiagnosed by the GP or a nurse. But it is really important to get that within the protocol.

"I know at the moment it specifically says 'if you think it's Lyme disease, you send it to a GP, but it's often not a bullseye and my feeling is that question should be at the very top.

"If you didn't feel an insect bite, it may well be a tick bite and it needs a much more detailed history. It's a very important area that pharmacists need to be aware of."