Blog: First week thoughts on Pharmacy First

I understand the sacrifices that teams have made to be ready — the many hours spent doing training, reading paperwork, and working out how to deliver this new service on top of an already busy day job. 

I know, as a sector, we are good at stepping up at scale and pace – but at what cost to us? Pharmacy is always the sector that’s left to ‘get on with it’ by itself and I know just how hard and exhausting it has been.

I’ve personally been feeling a mixture of nerves and excitement ever since the service launched. The nerves are because I’ve done so much training, taken in so much information, am using new software and now have new patients in front of me with higher expectations than before. I also feel the pressure of this service needing to succeed for all the political and funding implications this will have on future negotiations.

The excitement is because I know I can do this. I have got the skills and the knowledge, and now I can help patients and complete episodes of care without needing to always refer on. The excitement has also been heightened by the feedback we have received from the first patients who have used the service. 

Grateful

My patients have been grateful to see me so quickly and conveniently and, if their symptoms get worse, they have the peace of mind that they can easily return to see me the same or next day. 

This is a brilliant service for the NHS – overnight it has created over 10,000 NHS mini walk-in centres. And it is great that NHS patients have faster access to healthcare professionals, considering all the current problems we know patients have getting appointments.

One of my concerns is, as this service expands, will we become like GP practices? Will we need a receptionist who answers the phone and books appointments? And will we have to turn away patients when we reach capacity, saying: “Sorry 
we’re full”?

Another issue with Pharmacy First is I’ve lost control of my day. I can’t plan my workload, especially with walk-in patients. We have time-sensitive cut-offs in pharmacy for certain activity and if we have a queue of patients waiting to see us, this now has the potential to create a backlog of work. Sadly, due to the current ad hoc nature of the service, the funding doesn’t justify the expense of employing new staff or investing in tech to support some of these activities yet.

Tips for delivering Pharmacy First

During the first few days of providing the service I learned a few things that may help others:

• See patients face-to-face: We are doing this initially with all our patients until we get more comfortable with the service and then we will consider offering telephone and virtual consultations in the future

• Manage public expectations: This involves honest conversations with patients, giving them some context about the service and that the potential outcome may be supply of a product, advice on self-care or an onwards referral 

• Build a rapport with patients: The dynamic has changed and we are taking a full clinical history in a consulting room, rather than asking WWHAM questions over the counter 

• Remember, this is a ‘common’ conditions service: With any presentation that isn’t ‘common’, use your clinical judgement and intuition, and refer on as appropriate 

• Speak to local GPs: It is really important to make them aware of the service and create a feedback loop in case you, or they, refer inappropriately, or you need support to escalate a patient

• Consider creating appointment slots for referrals: This is to allow ownership of your day. For example, we have appointments from between 10am-12pm and 2pm-4pm

• Don’t feel pressured by the unknown: Familiarise yourself with the paperwork and IT before you invite a patient into the room. Afterwards, you can ask a patient to wait in the waiting area while maybe their medication is being dispensed by your team, and this gives you time to write up your notes and confirm you’ve covered all the salient points, especially while we are all trying to find our feet with the pathways and criteria 

• Use digital tools: I’d recommend using software like Accurx to message patients with all the signposting and safety netting information.

Pharmacy First is a big moment for community pharmacy, so keep calm and carry on being brilliant!

Reena Barai is a community pharmacy owner in Sutton, Surrey.