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Does Pharmacy First provide a blueprint for the future?
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The NHS should let pharmacies recruit patients directly to deliver the services they want, argues Company Chemists’ Association (CCA) chief executive Malcolm Harrison
It’s no secret that the CCA has been vocal in backing Pharmacy First. It has, without a doubt, had the most successful launch and rollout of any national NHS-commissioned pharmacy service to date.
Of course, as with any such large-scale launch, the service has not been without its niggles and there’s still so much more to do to drive its success. But does the Pharmacy First service serve as the blueprint for all future NHS-commissioned services? I think it does.
There’s no doubt that the core role of community pharmacy is the procurement and supply of medicines, and no-one sitting around the table should forget this fact. However, once a solution has been found to secure this role in a financially sustainable way, the future for pharmacies and pharmacists in community is undoubtedly clinical.
If the powers that be are to commission further clinical services from community pharmacy, they would do well to bottle the learnings from Pharmacy First.
What makes Pharmacy First a good blueprint for all future services? For me it boils down to three crucial factors:
Pharmacies and pharmacy teams are able to directly recruit patients
- There is a demonstrable NHS need
- The service fills a clear role that patients want.
- Pharmacy-led recruitment
Let’s take each in turn. The learned readers of this publication will know that 1.6 million patients visit their local pharmacy each day.
One thing pharmacy teams are especially good at is understanding and recognising patient needs. Pharmacy First allows pharmacy teams to recruit patients to the service. It is not wholly reliant on referrals from other providers. The same is true of the blood pressure check service and flu vaccinations – each successful in their own right.
This is perhaps where the Discharge Medicines Service (DMS) falls down. DMS is undoubtedly a great idea, with a clear NHS need, but its success is wholly reliant on referrals from hospitals. Despite every 23 DMS consultations at a pharmacy preventing one readmission in hospital, the service suffers from a well-known postcode lottery.
This is why I suspect the Community Pharmacy Consultation Service (CPCS) – wholly reliant on GP and NHS 111 referrals – never truly took off. In 2022/23, there were 1.25 million patient referrals, a fraction of the 20 million GP appointments the NHS estimated could be transferred.
NHS need
There is a clear patient need for Pharmacy First within NHS primary care. With pressures in general practice at an all-time high, it offers a simple alternate access route into primary care.
Take a urinary tract infection (UTI) for example. Left untreated, there is a risk that women aged 16-64 with a UTI could suffer complications such as kidney problems, systemic infections, and more. These complications would invariably need to be treated elsewhere within the system, often in secondary care.
Among CCA members, nearly a third of all Pharmacy First consultations have been for women’s UTIs. We know more broadly that 92 per cent of all Pharmacy First consultations lead to treatment or advice within the pharmacy without the need for onward referral. In other words, without Pharmacy First, those women with UTIs, would have had to potentially wait days before seeing their GP.
Our data shows that by the end of August, 1.2 million patients had been successfully treated through Pharmacy First. We are seeing a consistent level of growth in volumes week-on-week, and we are confident that the sector can achieve the target run rate of six million patients a year. However, a lack of referrals into the service from elsewhere in the system may mean that we won’t get there as quickly as the NHS commissioners would like.
Patient demand
It has been said before – probably by me – that the pandemic proved that patients want to receive NHS care from their community pharmacies. When the rest of the system closed it doors, we didn’t. People saw this and turned to their local pharmacists when they needed help. We know that often people cannot, or will not, wait days to get advice, treatment or both.
We know that A&E departments are often filled with people who could safely be treated elsewhere in the system, but from a patient’s perspective a five-hour wait at the hospital is shorter than a two-to-three week wait to see a GP.
People also want to see and feel the benefit. The fact that patients are asking for the service is a strong indicator that it will be successful. Medicine Use Reviews may have been a step in our journey towards delivering clinical care, but very few patients have ever walked in and asked for one.
Pharmacy First fills a role that patients want. Our data shows an increase in use of Pharmacy First when GPs are traditionally not available. Also, during the recent global IT outage, CCA members saw a 15 per cent uplift in Pharmacy First consultations.
So, if we are to realise a clinical future and harness the opportunity of independent prescribing, new services henceforth must take forward the blueprint laid out by Pharmacy First.
Any new service must pass those three tests – trusting local pharmacies to identify the patients who need additional care, meeting a clear system need, and filling a role that patients want, trust and increasingly expect.