One year into the NHS Pharmacy First Service in England, millions of patients and thousands of GPs have already benefited – and there’s scope to develop Pharmacy First into something truly game-changing in terms of improving access to primary care.
Under the scheme, pharmacists can assess and treat patients for sinusitis, sore throat, earache, infected insect bite, impetigo, shingles, and uncomplicated urinary tract infections in women (under the age of 65) without the need for an appointment or prescription. They can also get advice about a wider range of minor illnesses.
The service is a Godsend for patients and parents who want convenient clinical care for common illnesses, without the need to make an appointment with their overstretched GPs.
Up to 4 million people have used the service so far – many of whom have been referred by their GP practice. This has freed up valuable time for GPs, to spend with patients and handle complex clinical cases.
However, the proportion of GP practices engaging with the service and referring to pharmacies remains stubbornly at around 75%. We want patients to benefit wherever they live, instead of there being a postcode lottery of care.
System leaders can help. There has been greatest progress in those areas where integrated care boards have worked hard to build understanding and achieve an integrated approach within their local system. They have understood this to be a significant opportunity for channel-shift and expanding same day urgent care, with the right care offered by the right professionals in the right place.
In due course we should then think about expanding the range of illnesses in scope. In Scotland, where the list of clinical conditions is longer, 30% of the population used Pharmacy First Scotland in the most recent 12 months reported (October 2022 to September 2023).
In particular, I believe patients should be able to walk in without a GP referral for advice and NHS treatment on a much longer list of conditions, for example oral thrush and scabies. In my own patch – Cornwall – local commissioners now include migraine in a pioneering walk-in scheme.
To help deliver the big shift to community-based care envisaged for the NHS 10 Year Health Plan, pharmacies will need to have the confidence to invest more in services like Pharmacy First, which have so much potential to free up capacity elsewhere in the system and ease waiting times.
But as is stands, confidence is in short supply, due to a decade of severe underfunding within the Community Pharmacy Contractual Framework.
So the future success of Pharmacy First is closely bound to the outcome of forthcoming contract negotiations. Without a fair deal on funding, promising NHS services like this will wither on the vine.
This first year of Pharmacy First is a story of a sector delivering significant change under intense pressure. I don’t blame any of my colleagues for feeling in turns exhausted and frustrated, but also professionally fulfilled, with the satisfaction of knowing they are providing a valuable service for their communities.
I hope this is just the beginning of a seismic change in patient choice and behaviour, that will eventually make the most of primary care capacity across every system and dramatically improve access to care across England.
