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The Ministry of Health in Ontario announced in December 2022 that from January 2023, local pharmacies would become a one-stop shop for 13 common ailments. Leela Barham looks at how well it’s been doing

Apparently, musician Bono once said, “I believe the world needs more Canada.” He was talking about foreign aid I believe, but with Ontario’s community pharmacies having almost two years’ experience providing treatment starting with 13 common ailments, I’m left wondering: does England’s Pharmacy First scheme need more Canada?

Minor ailments scheme

Ontario’s 4,942 community pharmacies (42 per cent of all community pharmacies in Canada) serve over 16 million people.  From January 2023, community pharmacies in Ontario could offer prescriptions for: hay fever; oral thrush; pink eye; dermatitis; menstrual cramps; acid reflux; haemorrhoids; cold sores; impetigo; insect bites and hives; tick bites; and urinary tract infections (UTIs).

Patients need no referral. Pharmacists have to have completed mandatory free orientation training and stay up to date. 

There is a fee of CAN$19 (£10.59) for providing the minor ailments service in person or CAN$15 (£8.36) for virtual delivery of the services. 

The scheme is underpinned by regulations that were developed by the Ontario College of Pharmacists. It told P3pharmacy: “The authorization for pharmacists to assess and prescribe for minor ailments was an important milestone in our health system. This expansion of scope for pharmacists supports an integrated and collaborative healthcare system and improves access for patients.”

Access was a key aim for Ontario, particularly given the size of Ontario and the rurality of the province. The Canadian Pharmacists Association point to how there is no wait time for people, and there is also follow-up by the pharmacist, something it says is rarely seen with standard physician care for minor ailments.

The Ministry of Ontario also highlights the potential to free up doctors’ bandwidth. In turn, waiting times should be reduced too. According to Professor Mark Britnell, the minor ailments scheme could support 30 per cent of the GP caseload in the province. 

It’s challenging to know just how much access has been improved in Ontario; nothing was found in desk research. Joella Almeida, CEO of MedEssist, a digital platform for pharmacies and who works out of Calgary and Toronto, suggests that not all community pharmacies in Ontario advertise their new minor ailment services, so there may still be opportunities to increase access further. That might reflect the desire “not to rock the boat with primary care clinics,” according to Almeida. 

Both Ontario and England seem to face challenges managing tensions locally. English GPs voted for the discontinuation of Pharmacy First at their annual GP conference in November. 

Be more ambitious

Ontario’s list of ailments makes England’s Pharmacy First look very small. “England could have been more ambitious with the scope of the ailments,” said Almeida. 

Kristen Watt, a pharmacy owner who also holds positions on the board at the Ontario Pharmacists Association and PharmaChoice Canada, describes how Ontario went for “the low-hanging fruit early on”.

Ontario has been quick to add to the service. By October 2023, mild acne, canker sores, diaper dermatitis, nausea and vomiting in pregnancy, pinworms and threadworms and yeast infection were added to the scheme.

Yet community pharmacies could do more, according to Watt. “Pharmacists are still underused. There is so much that pharmacists are trained to do,” she says.  Watt would like to see autonomous prescribing in Ontario and across Canada.

The Ontario College of Pharmacists is waiting to hear back on proposals to add even more to the scheme. 

Minimise admin

To make the minor ailments scheme a business success comes down to whether the fees are worth the effort. Almeida thinks the documentation requirements are less burdensome in Ontario than those in use for England’s Pharmacy First. “The smart forms that pharmacies have to fill in aren’t as long in Ontario,” she noted.

Is England more open?

It’s hard to judge the impact of the minor ailments scheme; desk research didn’t yield insights, and the Ministry of Health in Ontario did not respond when asked.

In England, there’s a lot more that can be looked at in terms of routine reporting, as Pharmacy First activity is included in NHS BSA monthly reporting available to anyone, plus ad hoc insights that come from different players. 

For example, patient views were sought by Healthwatch Stockton-on-Tees in an online survey, and patients who had accessed Pharmacy First found it useful, saved them time, and helped them avoid the challenge of accessing GP appointments.

Similarly, GPs in Nottingham reported just a week after the launch that referrals for sore throats and sinusitis were being dealt with under Pharmacy First. That, in turn, allowed GPs to focus on more complex cases. 

A £ 2.4 million academic evaluation will likely reveal more about the success, or otherwise, of Pharmacy First.  The Ministry of Ontario was also asked if there was an evaluation there, without a response. Maybe there isn’t one? Perhaps Ontario could learn from England too?