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Local Pharmacy First scheme in place for 20 years to be axed this month

A Pharmacy First scheme that has been running “in one form or another” in Nottingham for 20 years is being decommissioned at the end of this month, the LPC has said.

The local pharmaceutical committee (LPC) – Community Pharmacy Nottinghamshire – confirmed via its website that Nottinghamshire integrated care board (ICB) is “not commissioning the Pharmacy First service from April 1” but that it will be “decommissioned” on March 31.

The LPC said it is concerned that pharmacy teams already under a lot of pressure will end up bearing the brunt of patient frustration because they will now have to pay for various treatments previously available under the scheme.

Read more: Pharmacy First service ‘most likely’ route to new funding, PSNC boss predicts

In a series of FAQs for pharmacies, the LPC said that over-the-counter (OTC) medicines “that might have been provided free of charge under the Pharmacy First scheme will no longer be supplied free” due to the decommissioning of the service.

And an LPC letter sent to pharmacy teams earlier this year warned that patients may be left “feeling disappointed and frustrated” as a result of the change.

“As such, you and your colleagues should be ready to manage patient expectations by explaining the change to them,” it added.

 

“No direct replacement”

 

The FAQs also set out that there would be “no direct replacement” for the scheme and that NHS England (NHSE) has suggested that the community pharmacist consultation service (CPCS) is an “alternative service”.

But the LPC warned that the two services do not work in the same way.

“CPCS is a consultation service whereas Pharmacy First is primarily about supply of an [OTC] medicine”, the FAQs said.

They pointed out that people “cannot access” CPCS by walking into the pharmacy without a referral from a GP practice or 111.

 

"Wrong on so many levels”

 

Community Pharmacy Nottinghamshire chief officer Nick Hunter told C+D that the decision to scrap the service was “wrong on so many levels”.

It comes at a time when people can least afford it, he noted, with some people struggling so much the LPC has been asked if it can put medicines in food bank parcels.

“We are now just trying to minimise the harm and manage public expectation,” he told C+D.

Read more: PSNC kicks off ‘proper discussions’ on Pharmacy First with DH

The scheme – which started as a way to provide headlice treatment but expanded to cover 16 minor ailments including hayfever and haemorrhoids – was not really promoted locally but because it has been in place "in one form or another" for 20 years, people know about it, Mr Hunter explained.

“It was most used in the more deprived communities and it does really feed into the health inequalities agenda,” he said.

 

Poor timing

 

“It comes at the wrong time and doesn’t fit with anything that has been discussed at the national level around Pharmacy First,” Mr Hunter added.

According to the FAQs, the decision to end the scheme is “due to this service sitting outside of the national guidance around people taking responsibility for their own self-care”.

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

Other areas with similar services have “already stopped” providing them as a result of NHS recommendations to GPs that "items listed as of limited therapeutic value are no longer prescribed”, it added.

It comes as the pharmacy negotiator has predicted that a national Pharmacy First minor ailments service is the “most likely” route to new funding for community pharmacies in England, although it is unclear when this would actually be commissioned.  

 

ICB “scoping out” future services

 

To a certain extent, the local scheme has been at the mercy of poor timing as commissioning transfers from NHSE to integrated care boards (ICB), Mr Hunter explained.

The LPC has been working with ICB colleagues to come up with a business plan for a new service that it believes has a chance of being signed off, Mr Hunter told C+D.

However, sign off will not be until later this year at the earliest, he added.

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

An NHS Nottingham and Nottinghamshire ICB spokesperson said that NHSE “has informed GPs, pharmacy staff, stakeholders and the public about the end of the Pharmacy First service” and “worked with them to support this”.
 
“We are currently scoping out what future pharmacy services will look like in the area,” they added.

 

Service details

 

The decommissioned scheme aimed to deliver an “accessible minor ailments service” through community pharmacies in Nottinghamshire for patients registered with a GP within the commissioning area, the LPC said.

The service – offered by the “majority” of community pharmacies in Nottingham and Nottinghamshire – covered “16 minor self-limited ailments” for which patients would see a pharmacist rather than a GP or practice nurse, it added.

Read more: 2022: The year of the missed Pharmacy First opportunity, PSNC says

These included:

• Athletes foot
• Bacterial conjunctivitis
• Constipation
• Diarrhoea
• Earache
• Haemorrhoids
• Hay fever
• Head lice
• Insect bites and stings
• Sore throat
• Teething
• Temperature
• Threadworms
• Toothache
• Vaginal thrush
• Warts and verruca

This week, members of the House of Lords joined growing calls for the government to “enter into discussions” with the Pharmaceutical Services Negotiating Committee (PSNC) to urgently introduce a national Pharmacy First service.

The government has not formally announced its intention to introduce it, although it has touted a Pharmacy First minor ailments scheme since late 2021.

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