Almost a year after the launch of the Pharmacy First service in England, the sore throat clinical service pathway is the clear front runner in customer popularity. How has it gone down with pharmacy teams?

“The sore throat clinical pathway has been hugely successful, accounting for almost a third of all Pharmacy First consultations conducted by members to date. Use of the clinical pathway will invariably grow this winter,” says Malcolm Harrison, chief executive at the Company Chemists’ Association (CCA). 

“Pharmacists really value the opportunity to use their clinical skills and to complete episodes of care. The Patient Group Directions (PGDs) offer pharmacists an additional solution to offer patients, where it is appropriate to do so. 

“Our data shows that pharmacists are supplying antibiotics only when absolutely necessary. We’re glad to see that concerns, expressed before the service’s launch, have been quickly allayed.

"There was also a concern that patients would find themselves going back and forth between pharmacy and GP surgery. This isn’t the case – 92 per cent of Pharmacy First patients receive the care they need within a pharmacy.”

The service is reducing the number of GP appointments for sore throat too. “We estimate that the Pharmacy First service saved up to 1.5 million GP appointments as of October. It is likely that the sore throat service alone will have saved up to 430,000 GP appointments,” says Harrison. 

James Davies, Royal Pharmaceutical Society (RPS) director for England, says: “The sore throat service was the most common Pharmacy Service between February and May, with 35.6 per cent of consultations for acute sore throat. As we move into the colder months, we expect it to become more popular.

"This service empowers pharmacists to use their clinical skills within the NHS, offering patients accessible treatment at their local pharmacy.”

Alistair Buxton, director of NHS services at Community Pharmacy England, says: “Pharmacy First has already helped many millions of people and numbers appear to be rising, but the winter season will bring the biggest test yet for the service.

"The operation of the service across its first full winter period will provide the best opportunity yet to demonstrate just how valuable it can be for patients, the public and the wider NHS.”

What do pharmacists think of the sore throat service? 

Lindsey Fairbrother, pharmacist at Goodlife Pharmacy in Hatton, Derbyshire, says: “It’s been popular so far via self-referral. We mostly get children and young people coming in with suspected tonsillitis. Increased awareness of the fact we offer this service would be good.”

Jainil Patel, deputy superintendent pharmacist and head of professional services, Hollowood Chemists, Manchester, says: “The sore throat service has been really popular for us. There was a bit of a lull over the summer, but from October onwards it’s been busy. It’s definitely resulted in more patients coming to us with sore throats and fewer going to see their GP. A greater collaboration with GP practices would help, as referrals are still slow at coming through.”

Rob Severn, pharmacist at Rowlands Pharmacy in Warsop, Mansfield, says: “The sore throat service has been really popular for us, though it is seasonal. We have worked with local schools to promote the service and the schools now signpost students to us for this and the other Pharmacy First conditions. School-aged children are the main users of our sore throat service.”

What do patients like about the new service?

“The speed of access to advice and treatment are what our customers like about it,” comments Fairbrother.

“Patients love the convenience of the service and the easy access they have to health professionals and treatment. And if needed, they have fast access to antibiotics. They can also come back to see us again if they need to,” says Patel.

“Speed of access and being able to see a healthcare professional quickly and be provided with antibiotics if necessary are what our patients like about it. We’ve noticed the service is most popular on Saturdays. Where would these patients have gone before? Most likely a walk-in centre or A&E,” says Severn.

What has your experience of delivering the service been so far?

“It’s been a good experience, although of course we’ve been advising patients on how to treat sore throats for many years. We have a good understanding of the clinical pathway and have got to grips with the FeverPAIN score system now. It’s also a good opportunity to use other resources, such as Target RTI leaflets and signposting. It’s a good chance to remind customers to get their flu and Covid jabs too,” adds Patel.

“It’s a great service and we really wish we could deliver it on more minor conditions. That’s quite frustrating for us,” comments Fairbrother.

“It’s been a good experience for us. Learning to examine patients’ throats was a process but we’ve mastered it, using tongue depressors and a pen light really helps,” says Severn.

What challenges have you faced?

“The main challenge we’ve found is that we will examine a patient who has a sore throat which is clearly caused by Strep A, but the 10-day course of antibiotics they need is outside of the PGD, so we then have to advise them to go and see their GP. It seems like a waste of time for the patient. As pharmacists we are clinically trained and capable of instigating the treatment if appropriate and then reporting it,” says Fairbrother.

“Managing patients’ expectations regarding antibiotics can be a challenge as some do expect it. We do get some who aren’t happy and will still go to their GP to see if they can get them. Generally, as long as you explain the reasons why they are not needed, patients will accept the decision,” says Severn.

“One of the challenges for our staff has been patients coming in obviously with contagious infections, but not being mindful of this," says Patel.

"Initially, due to the way the service used to be, we had some misunderstanding that patients would just be referred back to their GP.

"The most important thing to stress to other health professionals is that we have to follow the clinical pathway to even consider recommending antibiotics and we have to follow the PGD if we do prescribe them.

"Also, we don’t have to give out antibiotics in order to get a fee for the service."

How is the referrals system working?

“GP referrals remain relatively low, we need NHS England to do more to drive these. It is also up to integrated care boards to facilitate greater collaboration between GP surgeries and pharmacies locally,” says Harrison at the CCA.

At the RPS, Davies says: “Implementing GP Connect access nationally for the NHS Pharmacy First service would greatly improve the referral process, eliminating the need to rely on NHS email.”

“The GP Connect platform has helped. However, a more formal process would help. Some GPs refer patients to us electronically, others do it verbally via the patient. A secure electronic referral is vital for us, and GPs need to understand this,” says Patel.

“The referrals system is problematic in that there isn’t really one at the moment. There is no proper mechanism to fast track patients that have Strep A and we need to be able to do this,” highlights Fairbrother.

“The referrals system still needs some work to make the process easier for GP practices to use. Very few are filling in the electronic referral forms as they take too much time and it’s much quicker for them to just say ‘go and see your pharmacist’. However, if it’s a verbal signposting then there is no record or evidence of this, which isn’t helpful for us,” believes Severn.