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By Dr Claire Fuller, National Medical Director for Primary Care, and David Webb, Chief Pharmaceutical Officer, NHS England.

Every so often we experience a significant change in how NHS services are offered. Pharmacy First, which launched on 31 January 2024, is one of these changes.

Through Pharmacy First, patients, and general practice and community pharmacy teams will benefit from the use of the wider clinical skills in the primary care team.

The service involves community pharmacists using their clinical skills to 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 a GP appointment.

To ensure safe and effective delivery of the service, pharmacists, including locums, are using the seven clinical pathways, a clinical protocol, and patient group directions. The guidance provides robust pathways for pharmacists to follow, and ensures services and medicines are delivered in a safe and consistent manner, which the public and NHS can trust.

The seven clinical pathways have been designed using the latest evidence and expertise, in accordance with NICE guidelines. They have also been informed by advice from GPs and other doctors, pharmacists and specialists in areas like prescribing, children’s health, allergies, and antimicrobial resistance. The pathways have been approved at the highest level by the senior medical leadership at NHS England.

Using these clear pathways, antibiotics and antivirals will be offered to patients only if needed. Antibiotic dispensing data will be closely monitored, and the National Institute for Health Care Research has been commissioned to evaluate the service.

Of course, a change of such magnitude doesn’t happen overnight and will rely on clinical teams and fellow professionals in primary care as well as reception staff in general practices who will be referring patients to pharmacies. Following a formal referral to the pharmacy, the patient should be advised to contact the pharmacy, and that the pharmacist will be expecting the patient to make contact that day or when the pharmacy is next open. Patients can of course also simply self-present to their pharmacy.

If it works as well as we anticipate, and patients use the new service, Pharmacy First could help to relieve some pressures on general practices, address health inequalities and pave the way for future innovations. We’re currently growing the number of pharmacists qualified in independent prescribing, which would enable a wider group of patients to be seen and treated, such as those with long-term conditions.

It’s also an opportunity to build on the ‘Making Every Contact Count’ approach – where pharmacy teams can help to prevent ill-health by identifying and addressing health concerns as they emerge.

Over 95% of pharmacies have signed up to deliver Pharmacy First, meaning the service will be widely available across more than 10,200 pharmacies in England.

The digital infrastructure and interoperability between general practice and community pharmacy will be key to the success of the service and, as such, these are being significantly improved.

Previously, pharmacies could only see what medicines were being supplied via a summary of the patient care record. Now all four approved IT system suppliers have upgraded their systems, so community pharmacies automatically have the Pharmacy First screens to support the clinical pathways and can easily send data for monitoring.

It is essential for patient safety to ensure pharmacy consultations are recorded within GP records accurately and coded for auditing without increasing practice workload. To this end, we have worked with suppliers to redesign how pharmacy consultation outcomes are shared back to practices. The proposed updates to the record will surface directly in workflows, enabling practice staff to more easily review Pharmacy First consultation outcomes (including notes and any medicines provided) and add the information to the patient record with one click of a button. These changes will automatically roll out through GP clinical systems suppliers in the next few weeks. Until this functionality is rolled out, practices will continue to receive information through NHSMail, in line with existing processes.

Of course, the most important thing is for all of us to continue working closely with our local community pharmacy colleagues who have been assessing and treating minor illnesses for many years. They need our support as they develop into these new clinical services and there will be instances where pharmacists need to refer patients back to general practice, so it is important that we discuss and agree local processes to make this work in the best way for practices, pharmacies and patients.

A high profile, public-facing marketing ‘Think Pharmacy First’ campaign has been launched to support primary care teams. It explains what’s on offer and encourages patients to access relevant help at their local community pharmacy.

We all want to deliver excellence, and this service will help to support many people to access NHS care and address health inequalities. Thank you to NAPC members for your great contribution to healthcare in your local communities and your support for Pharmacy First.

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