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What does Pharmacy First mean for you?

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What does Pharmacy First mean for you?

Arthur Walsh hears from a variety of voices about how they have geared up for the launch of the much-anticipated Pharmacy First service in England and what they believe it means for the future of community pharmacy teams

Pharmacy teams across England have begun delivering a service billed as the biggest event to hit the sector in at least a decade. Primary care minister Andrea Leadsom announced on January 15 that more than 90 per cent of England’s pharmacies had signed up to deliver Pharmacy First from the end of the month – a landmark achievement for the sector, given that the launch date and fee structures were only made public in mid-November, with questions around IT suppliers barely resolved in time for kick-off.

There are understandable concerns on the ground, many of which are voiced eloquently by the contractors I spoke to. A survey conducted by the Pharmacists’ Defence Association (PDA) in January found that almost two thirds of respondents had yet to get to grips with the Pharmacy First training, while half were worried that their pharmacy did not have adequate staffing levels to manage their existing workload safely.

But there is also a palpable sense of expectation, and a belief that this is a make-or-break moment for the sector to demonstrate that it can step up to the plate. The same PDA survey identified strong support for the service as a means of improving patient care and professional fulfilment.

Ade Williams’ insight that the service should be viewed as an observational study is particularly insightful. With so much important work being asked of England’s pharmacy teams, it will be incumbent upon the Government and the NHS to monitor the roll-out closely, adapt the service as needed and ensure that pharmacies are supported in a dynamic way as a clearer picture emerges.

Pharmacists know that this is the direction of travel
Shilpa Shah, chief executive, Community Pharmacy North East London

“Pharmacy First is keeping us really busy at the LPC – which is a good thing because we want to do all we can to support our contractors. Out of 375 pharmacies in our area, 355 have signed up [as of January 18] and it’s been great to see how engaged they are. People are asking detailed questions about how this or that aspect of the service would work in practice, which shows they’re reading through the training and getting to grips with it.

We have always said that community pharmacy is the gateway to the NHS and should be patients’ first port of call. Pharmacy First is really important because we are now being paid to do that and being clearly recognised by NHS England and the Department of Health and Social Care as healthcare professionals who need to be paid for the consultations we do. The incentive payments have the benefit of really getting people on board, getting them trained and up to speed with pace.

You can see from the rate of sign-ups nationally that pharmacies are fully behind this, which gives GPs the confidence that it’s not just a handful taking part. And for contractors, the payments – needed to cover training needs and equipment in the first instance – go on until September, giving us the confidence we need that this isn’t just a short-term winter pressures initiative. It’s a year-round service that we really want to embed.

Pharmacists understand that this is the direction of travel and they don’t want to get left behind. There’s nothing more frustrating than when someone does come to you with an infected insect bite or impetigo and you know exactly what treatment they need, but you can’t provide it because you’ve got to refer them on to the GP. Pharmacists love the fact that they can now offer an end-to-end solution for their patients. I think adding UTIs is brilliant. That one is probably the most popular one that we can help people with. When all the PGDs landed on contractors, of course they were fazed by having to read and sign off on all those documents in a short space of time. But actually, we find that people are going through the paperwork and realising they know most of the clinical content already and it’s just about following the right SOPs.

We do really well for CPCS in North East London. That means that a lot of people, including GPs, are now worried about the transition with CPCS stopping on January 31, but because of the IT platform we use, it’s no change whatsoever. You just have the seven conditions added on top, so it’s a real positive.

The most frequent queries from contractors have been about IT, but in fact it’s a seamless transition for us because we have EMIS integration into PharmOutcomes and nearly all of our surgeries have got EMIS.

GPs have been asking whether they will still be able to refer in the same way and how they will receive information back from the pharmacy, while pharmacies have had questions around otoscope training sessions – which we as an LPC have provided – and about putting locums on training courses. We’ve managed to put on some extra sessions via CPPE, and the ICB have kindly paid for this, so it’s not costing the LPC or contractors any money.

We need to think as a sector about how we deploy our pharmacy teams. I’ve been thinking about how we as an LPC can support pharmacies by making sure we have enough support staff and offering them training so pharmacists can delegate. I’d love to see two pharmacists in every pharmacy – perhaps funded by the NHS to secure service provision. Eventually, we are going to need that as more and more people understand what we can do.”

We should treat this as a mass population observational study
Ade Williams, owner, Bedminster Pharmacy, Bristol

“There is a lot of positive excitement around this – it’s something we’ve asked for over a long period. Of course there are logistical concerns – IT is a big one for some – but it’s going to be transformative, not just for pharmacy but for all primary care stakeholders.

It’s important we all work to make sure this is a positive evolution – you don’t want a service that doesn’t meet the expectations of the patient or your other clinical colleagues.

Some of my younger pharmacist colleagues are anxious about what the service entails, but luckily we are in an area that already has PGDs covering five of the seven conditions, so there’s reassurance there. Our LPC has been running events and programmes to get the key messages out there.

IT concerns have been very topical, but we mustn’t forget that this is about patient care and everything needs to be scrutinised thoroughly before it is rolled out. And as someone who took part in the Covid-19 vaccination programmes, we learned to deliver operationally within a short space of time.

I was surprised to see that from April, the maximum number of monthly consultations is capped at 3,000 per pharmacy – it’s higher than I might have expected. I think it suggests that more conditions could be added to it, which seems like a declaration of confidence, whether intended or not.

The key issue is what it’s going to take to get there. We all need to have a pilot mentality for now and keep doing three per week or month, seeing what works and changing things if we need to. We are engaging in a mass population observational study, and we need to adapt as a picture emerges of how patients want to interact with the service. Pharmacies are very jaded at the moment, and need the reassurance that if something isn’t working as well as intended, they can change it up.

If the consultation numbers do reach those heights, we would certainly look to invest in additional staff – but we mustn’t forget that coming up with that investment is going to be challenging because of the existing funding difficulties.

This national pilot demonstrates the great potential for pharmacy to help the NHS survive. These seven conditions are ones that the system badly needs our support with. What motivates me is the idea that if we deliver this, we can then argue: This is what community pharmacy can do, if you invest in us to create a sustainable structure, it won’t be a handout but part of an ongoing mutual commitment.”

Our GPs never made CPCS referrals – now we have to persuade them to use Pharmacy First
Lindsey Fairbrother, owner, Good Life Pharmacy, South Derbyshire, and CPE regional rep

“We’ve got local NHS services for quite a few of the Pharmacy First conditions. We have experience of doing ear examinations and sore throat consultations, so I don’t feel too behind the curve. The ones that are new for us are shingles and sinusitis.

My locum did her otoscope training last weekend, and I’m confident that when I want her to do something, she’ll do it properly. What has been different is the focus on revving up the wider team. I’ve got two checkers in the team and two others who are currently doing their Level 3 course, as well as a new starter who is doing Level 2 dispensing.

The team already run the dispensary for me – I have nothing to do with ordering or phoning doctors with queries and that’s the way it should be – they’re technically adept for that. But Pharmacy First does up the ante for them and give them a lot more responsibility, which I think they quite like as it recognises their abilities.

I’ve got one who probably won’t be qualified as a checker until March, so we might have a couple of months where we’re a little bit on the back foot and I’m still being dragged into the dispensary. I hope other contractors are thinking like I am and making sure they’re taking themselves out of the dispensary so they’re available for consultations; they’re not going to be able to deliver it otherwise.

They’re saying GP CPCS is going to be replaced by Pharmacy First, but only if the GPs are using the pathways to refer. My issue here is that my local practices have not done GP CPCS at all. I’ve got to try and convince them that they want to do that extra bit of work to send people to me formally.

The frustration I’ve got is I don’t think nationally the system understands that the government and the Department of Health want this to be a solution to winter pressures. One of the big potential blockers is how your ICB sees things. I had a visit from the ICB integration lead as well as the chief executive, who didn’t really know anything about Pharmacy First.

We were thinking ‘Hang on, this is your winter pressures solution and if you don’t know anything about it then you’re not giving the resources within the ICB to support practices to know what it is and why it’s so important’.

I’m busting a gut talking to surgeries and the PCN as well as getting the staff trained and talking to patients, but really the messaging should be led nationally so there isn’t a local lottery.

With Category M taking £45 million out of the system, we all need this Pharmacy First money; there’s no prospect of a national contract being negotiated any time soon because there’s going to be a new government in post.

I’m in a village, not a city centre. I’ve got a finite population of around 3,500 people, who are not all going to have shingles every day, are they? If I can’t get the surgery to do referrals then there’s no way it’s going to pay for what I’m losing, and I’m not going to be the only one in that situation. We can’t raise prices like Tesco can.

I’ll probably lose £900 a month through the Category M cuts – it’s one thing to say I’ll get a grand back with Pharmacy First, but there are other expenses. For instance, I’m picking up an examination couch this week and I’m spending over £1,000 on a consultation tool that allows me to record consultations effectively because my PMR system doesn’t do that.

Along with about £450 on getting the website sorted, I’ve burnt two grand straight away and I’ve not even started. All that said, it’s going to transform pharmacy. We’re using our clinical skills, which is terrific. We’re not the shopkeeper that sticks labels on boxes any more. It should give career fulfilment, especially for the youngest guys graduating from 2026.”

Why has the roll-out been so rushed?
Waqas Ahmad, owner, Prescriptions Pharmacy, Prescot

“This is a good service for patients and the profession, as it gives us a chance to prove ourselves as clinicians. However, there are a lot of immediate issues, such as Community Pharmacy England making last minute announcements on IT.

I was chatting to someone who said something that resonated with me: the Pharmacy First service has probably been negotiated for a little under two years, and they’ve given us two months to prepare for it. Why is it now suddenly so rushed for us? The IT system suppliers aren’t ready so I haven’t seen any demos and can’t make comparisons. As far as I’ve been told, none of the suppliers are offering video consultation functionality, even though that’s a big part of the service.

On that point – while I’m not saying we do the same job as a GP, they are allowed to fill a day with telephone consultations that include taking a full history, making diagnoses and calling in the patients they need to see in person. Why aren’t we allowed to do that with Pharmacy First?

The initial contact from the patient is often going to be via telephone – so we’ll do a mini triage and decide whether they need to come in and see us or do a video consult – but effectively, you have to then hang up the phone and arrange a video consult or do it face to face (they’ll have to come in and pick up their medication anyway). It seems silly to have to stop a consultation halfway through and restart it.

And funding is always a concern. Many pharmacies are short staffed because they can’t afford to pay staff appropriately. A full-time member of staff on minimum wage costs the pharmacy around £1,800 a month.

With Pharmacy First, we get a £1,000 payment and then around £15 per consultation, so based on that, we would need to be doing around 54-55 consultations a month just to pay for that minimum wage person. The cost increases for trained counter staff and pharmacy technicians. So the service in its current form, which is supposedly the magic bullet to give us the funding we need to do so much more, doesn’t give us any extra funding to recruit staff members, meaning all the work has to be done with what we have in place now.

We have a good relationship with the local GP surgery, who have consistently made CPCS referrals, so we are expecting to get quite a few referrals and hit the targets as set out by NHSE in the time frames it has set.

But the main thing for me has always been that core funding is in real terms down by 40 per cent –that’s the crux of all of pharmacy’s problems at the moment and must be addressed. This service is needed, it’s the direction of travel and I’m on board with it – but our base service needs to be in a strong place so that we can move on and deliver this.

Most pharmacies have had to cut staff and services, if not close. How many have been shuttered over the last year? You can’t make a loss continually; LloydsPharmacy, the second biggest chain over the last 20 years or more, left the market last year. What sort of signal does that send? And the Boots closures have been concentrated in the more traditional pharmacies rather than the big health and beauty stores. It shows that pharmacy is not sustainable, and we’re all in that situation now.”

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