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What could England’s national Pharmacy First service look like?

With all eyes on an anticipated nationwide roll out, C+D looks at an existing Pharmacy First model to see what lessons can be learned

The expected introduction of a national English Pharmacy First scheme has been high on the news agenda for some months.

It all started when, last year, former health secretary Sajid Javid revealed that the government wanted to bring in the service to encourage patients with minor illnesses to visit their pharmacy. The hope was that this would take the pressure off GPs.

Read more: DH hints at Pharmacy First timeline as it heralds bigger role for sector

Meanwhile, C+D exclusively revealed the government’s potential timeframe for the introduction of a Pharmacy First service in England last week.

However, the Pharmacy First model is nothing new in and of itself. There are already national schemes in place in Wales and Scotland, and locally commissioned services in parts of England.

C+D takes a closer look at one locally commissioned Pharmacy First scheme in Liverpool.


What does the service entail?


NHS Liverpool Clinical Commissioning Group and Community Pharmacy Liverpool launched a Pharmacy First scheme for Liverpool in May this year.

This particular scheme is only available in Liverpool-based pharmacies and covers treatments for:

  • sore throats
  • urinary infections
  • eye infections (conjunctivitis)
  • oral thrush in babies
  • impetigo
  • mild skin conditions such as dermatitis, eczema, or insect bite reactions
  • nappy rash for babies
  • other skin problems such as minor cuts, burns, and scalds.

The service can be accessed by parents and carers as well as their children and runs alongside the Care at the Chemist scheme, which is another minor ailments service.

Under the scheme, pharmacists ask patients “a few quick questions” before deciding whether they are suitable for treatment, according to Community Pharmacy Liverpool’s chief officer Matt Harvey.

Suitable patients who haven’t recently been prescribed treatment for their condition can then be given treatment “there and then” at the pharmacy, he says.

Read more: Steve Barclay: Pharmacy First an ‘opportunity’ to solve GP appointment crisis


How many additional services have you provided through Pharmacy First?


“Pharmacy First started off treating urinary tract infections and sore throats on April 21 [this year],” Mr Harvey says.

Now, “a multitude of different conditions” are covered under the scheme, he adds.

“What it has been great for is enhancing the number of Community Pharmacist Consultation Service (CPCS) referrals we receive from local general practices,” he continues.

While 1,784 patients were referred to pharmacies via Liverpool GP practices in November, “the majority” of them will have been given further care under the Pharmacy First service.

“That’s 1,784 patients that would otherwise have been seen within GP practice,” Mr Harvey notes.


As you were launching the service, what did you consider success would look like?


Mr Harvey says: “We wanted care to be moved from areas of the system to community pharmacy. We wanted patients to choose pharmacy first, hence the name and communications strategy behind this.”
“We had no figures in mind, as we always knew it would take time for the service to develop and grow,” he explains.


What has surprised you most since you launched the service?


It can be difficult to decide which minor ailments should come under the scope of the scheme, Mr Harvey explains.

Read more: Pharmacy First: Steve Barclay reveals government is looking at next steps

“Some of the conditions have seen more consultations that I was expecting, and similarly some that I pushed for inclusion haven’t been as popular,” he says.


Have you had any other Local Pharmaceutical Committees (LPCs) asking for help in setting up their own Pharmacy First-style service?


“Yes. We have had conversations both locally and with LPCs across the country about the service,” he says.


Has the service achieved its objectives?


Liverpool’s Pharmacy First service appears to have been a roaring success.
“It is continually achieving its objectives as numbers increase month on month, meaning more patients are being seen by Liverpool community pharmacies for treatments they would otherwise have needed a prescription for,” Mr Harvey adds.


What’s next for the service?


There are high hopes for the service.
Mr Harvey says: “There are plans for a larger number of conditions to be treated.


Read more: Taking the pressure off: What do pharmacists want their future to look like?

“Patient Group Directions and pathways have been drafted, but this has stalled due to clinical commissioning groups ceasing to exist and integrated care board governance structures not yet being mature enough to sign this off.”


What are your tips for users to optimise the service?


Mr Harvey’s biggest take away is that Pharmacy First is most definitely “not a referral service”.
“Patients can walk in and ask for the service, and pharmacists and their staff can recruit patients that come to the pharmacy suffering with and wanting treatments for ailments covered by the service,” he concludes.


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