Informal referrals from GPs and NHS 111 that could have been made into Pharmacy First have effectively removed more than £115 million of funding from the pharmacy network in England, according to Community Pharmacy England’s 2024 Pharmacy Advice Audit.

The results of the audit, released on October 28, shows that more than 1.3 million unfunded consultations a week – or just over 69 million a year – are now being carried out by community pharmacy teams in England.

This is nearly 50 per cent more than the number of consultations that took place in 2020, when the first Pharmacy Advice Audit was conducted, and comes despite the introduction of Pharmacy First.

For the fourth audit, which was carried out over the summer, pharmacies were asked to record information on all their patient consultations over the course of a day. This provided the data on 61,837 patient consultations which were not part of an NHS-funded service.

The data showed, that on average, a community pharmacy consulted with 21.7 patients per day. By extrapolation across 10,200 community pharmacies, this indicates approximately 1,327,428 consultations per week (6 days per week) or, just over 69 million per year.

This is significantly higher than the first audit carried out during the Covid-19 pandemic where the results showed 48 million consultations per year. Not only are more people attending a community pharmacy daily, but a consistently high percentage are self-referring - 80.8 per cent in 2024 compared to 76.3 per cent in 2021.

Weekly, nearly 922,000 people (69.5 per cent) in 2024 presented to the pharmacy for advice about their clinical symptoms along with a further 19.5 per cent seeking advice about an existing medical condition.

However, over the course of a week, nearly 150,000 informal referrals (2.4 per pharmacy per day) are still being received in the pharmacy from either GP surgeries or NHS 111. These are all referrals that could have been made into Pharmacy First, says CPE, effectively removing more than £115 million worth of funding from the pharmacy network.

Community pharmacies successfully conclude 85 per cent of consultations, with only 15 per cent of patients being referred to another healthcare professional (66 per cent of these were referred to their GP surgery).

Of those patients that were referred to another healthcare professional, 26 per cent were deemed by the pharmacy to require an urgent assessment. This is an increase from 23 per cent in 2022 and provides an insight into the level of acuity of patients visiting pharmacies, says CPE.

The average consultation duration was 6.15 minutes, meaning over 133 minutes per day (2 hour 13 minutes) is now spent providing these clinical consultations.

If the patient had not been able to access their local community pharmacy, in 54.6 per cent of cases they would have visited their GP surgery, which would have resulted in an additional 725,200 appointments per week, or 115.2 per surgery per week.

This is a marked increase from 2021 and 2022, where 74.4 and 94.8 appointments per week respectively were avoided. This represents an avoidance of over 37.7 million GP appointments per year by patients having access to their local community pharmacy, says CPE.

CPE already using audit results in CPCF negotiations

"The findings indicate just how valuable community pharmacies are in saving the NHS hundreds of thousands of GP appointments every week," says CPE. “Overall, the results provide a clear message that community pharmacies are valuable healthcare assets in increasing public demand. However, a significant amount of pharmacies’ capacity is being taken up by unfunded work and that needs to change."

CPE says it “will be seeking to ensure that all the healthcare advisory work the sector is doing is appropriately recognised and remunerated. We have already begun using the audit data in conversations with government and the NHS and will refer to it in the 2024/25 CPCF negotiations and when discussing the future of Pharmacy First”.

Janet Morrison, CPE chief executive, said: “The results of the 2024 Pharmacy Advice Audit show once again just how much the nation and the wider NHS rely on community pharmacies. But community pharmacies are in a desperate state and cannot keep giving this advice for free; they urgently need a funding uplift to prevent further closures. The results of the Advice Audit show very clearly how much is at stake if that does not happen.

"It makes no sense that the core benefit of Pharmacy First – as a walk in service – is not fully funded, and it is simply not fair that pharmacies on the edge of collapse are being expected to offer support for minor illnesses falling outside of its strict parameters for free.

"This week’s Budget is a key moment for this Government to demonstrate its commitment to shifting healthcare from hospital to community, and there’s no better way than investing in the incredibly valuable community pharmacy network.”

An article in iNews on the survey results quotes Fin McCaul, who has owned a pharmacy in Prestwich, north Manchester, since the mid-1980s: “Taking some pressure off GPs and helping more patients through NHS-funded schemes has – alongside Covid vaccinations – ‘been the most clinically rewarding role that I have had as a pharmacist’," the article says.

“And while he maintains that the additional service ‘is not a burden, because we’re here to help patients’, he added that the spike in informal consultations, combined with stock shortages, increased costs and the lack of a real terms pay rise for several years, has led to an ‘unmanageable’ situation.

“ ‘Many of my colleagues, and myself, are trading on the breadline now,’ Mr McCaul told iNews. ‘We are probably technically insolvent, but we’re certainly not making any money running a pharmacy business, and many of us are losing money’.”

Government and NHS figures indicate that every day 1.6 million people visit a community pharmacy in England, equating to around 438 million visits per year for health-related issues.