Pharmacy First

September 4, 2013 | Filed under

pharmacyRecent surveys have indicated that 57,000,000 GP appointments, and up to a third of A&E attendances, are used by people with common conditions or medicines related problems that could be managed in the community pharmacy. This is at a time when GPs are struggling to cope with the elderly and people with long term conditions, and A&Es are bursting at the seams. I can support the increased resourcing of A&E and general practice, but we also must change the flow of patients through the system, giving them alternative access points for high quality healthcare.

NHS Direct managed a huge amount of calls from people concerned about their health and wanting advice. Approximately 5% of these were referred to community pharmacy as a destination. NHS 111 does not routinely include community pharmacy, and so even this 5% are now being directed to their GPs, walk in centres and A&E services. If everything directs people to general practice or to A&E what do we expect? We are the cause of the problem and need to introduce a solution.

Minor ailment schemes in community pharmacy have been commissioned for years. They have been based on the principle of “Advise: Treat: Refer”, and have been successful in reducing the demand on general practice in a limited fashion. The coverage within England has been patchy at a time where NHS Scotland has this as a core service. And, the access to medicines in some schemes has been poor, meaning that patients who are exempt from prescription charges still go to the GP to get the medicines. Also the advertising of these schemes has been local and in some cases limited. Why is it that if I live in Croydon I can go to a community pharmacy to have my common condition diagnosed and treated within a ‘Pharmacy First’ scheme, but I can’t when I am on holiday in Blackpool?

I have witnessed success where GPs reinforce the scheme asking patients “what did the pharmacist say?” Receptionists are triaging patients to community pharmacy when they call to make an appointment. I have heard patients talking about the convenience of being able to see a community pharmacist without an appointment, when the GP practice is closed and there are more than 2,000 community pharmacies that open between 85 and 100 hours a week.

Now is a time for action on this and we must move swiftly:

  • NHS England must develop a national framework for a ‘Pharmacy First’ scheme within community pharmacy. Develop the service framework and the PGDs.
  • NHS England should generate the national publicity campaign and generate materials for local adaptation.
  • Area teams of NHS England should commission community pharmacy to deliver the service on an area-wide basis.
  • Commissioners must ensure that community pharmacy is a clear destination of all NHS 111 services.
  • LPCs and LPNs should support and encourage all community pharmacies to take part, resourcing their pharmacies to deliver a first class service.

The government should also review the legal structures allowing community pharmacy to prescribe medicines from a limited list within the Pharmacy First schemes. The current reimbursement scheme is clunky and requires additional administration. A new legal category ‘independent community pharmacy prescriber (limited)’ would enable community pharmacists with appropriate training to prescribe medicines from a community pharmacy formulary. There is both a robust reimbursement and monitoring scheme for this route through the NHSBSA and ePACT.

It is no longer acceptable to have a piecemeal minor ailment service across the country, and systems like NHS 111 that undermine the role of community pharmacy in managing people with common complaints. We cannot stand by and do nothing that changes the flow of people to general practice and A&E services while we close Walk-in-Centres due to lack of funding. It is just ridiculous that we lag so far behind Scotland in our thinking and our service delivery. So come on NHS England – save the NHS.


The comments are those of Mark Robinson in his role as director of the Medicines Management Partnership.

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