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As NHS England opens the door to walk-in Pharmacy First consultations, will it back it up with investment and system support to make the model sustainable? By Saša Janković

NHS England (NHSE) has said it would welcome a walk-in minor ailments service for England’s pharmacies in a seeming reversal of its long-held policy. At The Pharmacy Show in October, NHSE’s director for pharmacy Ali Sparke indicated that his team ultimately wants patients to be able to access Pharmacy First consultations without needing a GP referral. NHSE wants “patients to be turning up, walking in to access those services,” Sparke said as he explained that the referral model currently in place was “never a goal” or an “endpoint”. 

NHSE has also signalled that it is preparing to sit down with Community Pharmacy England (CPE) to discuss a prescribing service.  

In a letter on 30 October setting out the timeline for the Independent Prescribing in Community Pharmacy Pathfinder Programme, including exit planning and actions for integrated care boards (ICBs), Sparke and chief pharmaceutical officer for England David Webb said that from April 2026 onwards (post-Pathfinder), “learning from the programme will continue to inform any potential service models where prescribing could be part of national community pharmacy services”, and that NHSE “will consult with CPE to determine what will form any part of a national service offer”.

 A walk-in service could be a boon for pharmacies by compensating work that goes unpaid and freeing them from red tape, as well as offering a boost to professional development.

“Over 90 per cent of current Pharmacy First Clinical Pathway consultations are ‘walk-ins’ already,” points out Company Chemists’ Association (CCA) chief executive Malcolm Harrison. “We calculate that there have been over four million walk-in clinical pathway consultations since the service was first launched.” 

But how would it work in practice? A walk-in Pharmacy First service is likely to mirror much of what’s already occurring within the existing service and local minor ailments schemes already in place. “Patients would be allowed to ‘self-refer’ for the treatment of minor illnesses,” explains Harrison.

 “Those who meet eligibility criteria would then receive appropriate NHS-funded treatment. A walk-in service would also likely identify people unable to afford over-the-counter medicines through prescription levy exemption.” 

What’s the cost?

While this may prove economically beneficial for patients, the question remains: can the government afford to fund a walk-in service? Alastair Buxton, director of NHS services at CPE, says the design of the current Pharmacy First service was “driven by affordability” for the NHS. 

“CPE has always believed that a walk-in Pharmacy First service is what would work best for patients, the NHS and pharmacy teams,” he says. 

“That is what we originally proposed to NHSE and DHSC during negotiations in 2022.” 

Harrison agrees that Pharmacy First “offers great value to taxpayers, the government and NHS”, and adds that: “If the government wish to realise their vision of more preventative care delivered in the community, they simply can’t afford not to transition the service to a walk-in model covering a broader range of conditions.” 

Indeed, both Wales and Scotland have similar systems in place, providing a basis for estimating cost, and by treating minor conditions promptly, capacity is freed up in the wider system for those with more severe or complex care needs.

As moving care to community settings is part of the government’s ‘left shift’ outlined in the 10- year plan, Mark Pedder, commercial director of HubRx and pharmacy chain Pharmacy+Health, says the real question is: “Can they afford not to do it, since we need to move from a reactive model of treating illness to one focused on prevention and early intervention.” 

Luvjit Kandula, director of strategy and pharmacy transformation at Community Pharmacy Greater Manchester (CPGM), agrees that patients need to be treated regardless of whether it is affordable. 

“The question is, does the government want patients to attend urgent care, out of hours etc and block much needed capacity to treat complex cases at a higher cost?” says Kandula. “If we are serious about left shift and prevention, then supporting the sector to deliver minor illness support and other contractual framework services is the first step to make the shift happen.” 

GP opposition 

Despite the ‘left-shift’ agenda, with some overstretched GPs increasingly resentful of pharmacy services, and Sparke noting that “a quarter of GP surgeries in England are still not making Pharmacy First referrals”, would such a move encounter opposition?

“I would like to think that the majority of GPs are supportive of Pharmacy First, but as with all new services or changes in services there is always going to be some opposition,” says Shilpa Shah, CEO of Community Pharmacy North East London. 

“I hope that the GP contract is also looked at so that we are more aligned in what we are trying to achieve for the public together, but I think that there is enough work for everyone. General practice has a patient list that they are paid for. If we help those patients with walk-in Pharmacy First, vaccinations etc and they still get paid for that patient then surely that’s a win-win?” 

While it’s easy to focus on objections around access to patient records via GP Connect and whether Pharmacy First funding should be diverted to primary care, Pedder warns that this can give the impression there’s “only a combative relationship between GP and pharmacies”, but he says: “I don’t think that really represents how many are working together locally. We’ve got strong relationships with many of our local GPs and we’ve worked hard to make sure Pharmacy First works for us, for patients and for GPs.” 

Kandula, too, says many GP colleagues have been “very supportive” and have “worked collaboratively with community pharmacies to support service delivery, utilising each other’s strengths to maximise delivery, reduce pressures and improve patient access”.  

Overall, she says: “Our experience in GM has been very positive. Of course, there are some GPs who have voiced concerns, but we have an established system and local relationships to try and address these issues constructively.” 

Pharmacy stretch 

With community pharmacy stretched beyond capacity, is there also the risk that similarly overstretched pharmacists and their teams may not be enamoured with the possibility of a fully walk-in Pharmacy First? An early-adopter example comes from Cornwall, which has had a walk-in consultation service (WICS) for almost four years now, complementing Pharmacy First by allowing self-referral for a wider range of conditions.

The service is managed via PharmOutcomes, and patients can self-refer or be informally referred by another healthcare provider or identified as suitable while in the pharmacy. The service must be delivered by a pharmacist in the consultation room with access to PharmOutcomes to support the consultation with red flags and so on. Each completed consultation generates a fee of £14 payable to the pharmacy, with a further fee added if a patient group direction is accessed. 

Nick Kaye is chief officer of Community Pharmacy Cornwall, as well as superintendent pharmacist at Kingsley Muti pharmacy in Ballasalla on the Isle of Man. He says people in Cornwall are used to asking to speak to the pharmacist and, on the whole, don’t mind being told they may have to wait for a consultation. 

“I don’t think we need to worry too much about capacity because we can only do as much as we can do, and in our experience patients are quite good at understanding that now,” says Kaye.

“Pharmacists are experienced at managing their workflow and if they’re overwhelmed then they’ll tell the patient that the wait is 10 minutes or 20 minutes or an hour, and the person will either decide to leave or they’ll say ‘that’s fi ne, I’ll go do something else and come back’.” 

Finding funding 

Patients may be on board, but a key requirement for a walk-in Pharmacy First service to work is funding, since introducing new responsibilities without additional remuneration could simply exacerbate existing challenges. 

“Pharmacy teams are committed to accessible patient care and already manage a high volume of walk-ins,” stresses Amandeep Doll, Royal Pharmaceutical Society director of England. “Any expanded service must be matched with the right workforce support and investment.” 

For now at least, money – or lack of it – remains an obstacle, but Kandula is adamant that it should not be an excuse to hold back progress. 

“I agree that more investment is needed and we are overstretched,” she says. 

“But if we can meet the thresholds through a walk-in service then that will help the pharmacy longer term to establish relationships with patients, support behaviour change and ensure it’s sustainable to continue delivering the service and to support independent prescribing in the future. 

“Overall, the sector needs to be empowered to deliver the services without the dependency on other care settings to succeed.”