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Explainer: Could the Pharmacy First service affect my clinical liability?

Experts offer answers to key questions about England’s forthcoming Pharmacy First service and what it means for professional indemnity insurance

Professional indemnity cover is a mandatory cost carried by all pharmacists in Great Britain as a condition for registration with the General Pharmaceutical Council (GPhC).

The regulator requires this cover for clinical liability to be “appropriate to the nature and extent of the risks” of a pharmacist’s practice, which include the services they provide, according to the GPhC’s website.

Read more: Pharmacy First set for national launch ‘by end of 2023’ following consultation

The arrival of a national Pharmacy First minor ailments scheme in England, expected to launch by the end of the year, is part of a services sea change announced by the government in its primary care recovery plan earlier this month (May 9).

Pharmacy First’s introduction, backed by part of a £645 million government investment in clinical services, will see pharmacists able to issue prescription medication for seven common conditions:

  • Uncomplicated urinary tract infections in women
  • Earache
  • Sinusitis
  • Sore throat
  • Insect bites
  • Impetigo
  • Shingles


These powers will be added to a growing list of  services offered by pharmacists, including the provision of oral contraceptives and hypertension check-ups.

However, key details about Pharmacy First – including a launch date and how much of the £645 million funding pot will be allocated to it – are now subject to “detailed negotiations” between the Department of Health and Social Care (DH) and the Pharmaceutical Services Negotiating Committee (PSNC).

Pharmacists who are considering offering Pharmacy First will have to wait for the outcome of these talks before deciding whether it is in their interest to offer the advanced service.

But it’s not just about the money. Although details on how the service will be funded is likely to be a key question on pharmacists’ minds, they may also be considering its ramifications on indemnity insurance and their clinical liability.

C+D asked NHS England (NHSE) and legal and insurance experts to answer some of the burning questions around clinical liability and Pharmacy First.


Could Pharmacy First affect my clinical liability?



NHSE has been tight-lipped about many of the details of Pharmacy First and its potential effect on clinical liability is no different, with a spokesperson confirming to C+D that these issues will be resolved during the consultations on the primary care recovery plan.

Read more: Explained: The professional indemnity requirements for pharmacy workers

Lisa Banks, managing director of National Pharmacy Association Insurance (NPA Insurance), which provides professional indemnity cover to pharmacists, told C+D that the company will “continue to liaise closely with NHSE to ensure that the right cover is available to our members as they take on expanded roles”.

NPA Insurance has previously worked with NHSE to “ensure that COVID-19 vaccine services were appropriately covered”, she added.


Will Pharmacy First increase the cost of my indemnity cover?


The details of Pharmacy First’s impact on indemnity insurance remain unclear while the particulars of the service are being negotiated.

However, it seems likely that insurance costs will not be affected because pharmacists offering the Pharmacy First service will supply prescription-only medicines under patient group directions (PGDs).

Read more: Is pharmacists’ indemnity insurance reflecting their expanded roles?

NPA Insurance confirmed to C+D that it has “not previously charged an additional premium for PGDs”. However, a spokesperson added that until the specifics of the Pharmacy First service are agreed, “no insurance provider can fully assess the risks” associated with it.

“As further key information emerges about the Pharmacy First service, such as the service specification, we will then be able to assess the risk,” Ms Banks explained. “As with any insurance provision, the price has to reflect the level of risk involved.”


Is there a risk to offering Pharmacy First?


Noel Wardle, a partner at Temple Bright and specialist in pharmacy law, told C+D that the risk of negligence that may result in patient harm “may increase the greater the pharmacist’s clinical role, particularly in circumstances where the pharmacist is performing an activity which is outside of their usual role”.

“Whenever a pharmacist performs their professional functions, they must do so competently – [in other words] not negligently. The same is true of the proposed Pharmacy First scheme,” he explained. “A pharmacist providing the service must provide the scheme in accordance with a practice accepted as proper by a reasonable body of pharmacists who are skilled in providing that service.”

Read more: No state-backed indemnity for pharmacy is ‘unfair’ and ‘extraordinary’

Mr Wardle advised that pharmacists “approach the provision of any new service with care”, making sure they are confident to provide it safely and exercising “reasonable care and skill” when doing so.

Therefore, pharmacists should only agree to provide the Pharmacy First service “where they feel that they have the necessary skills and resources to provide it safely”, he said.

“Pharmacists may be required to demonstrate, retrospectively, that they did have the necessary skills and resources to provide the service safely, for example, by evidencing their competencies and training,” he explained.

When faced with a possible claim, pharmacists must be able to give a “clinical justification for providing – or refusing – a particular treatment”, Mr Wardle said. To this end, he said that it was important to gather “all relevant information to enable them to treat the patient safely”, and to record this information and “any decision-making and treatment”.


What else should I consider?


Pharmacists’ Defence Association (PDA) director, Paul Day, pointed out that pharmacists already provide “a range of clinical activities” across the healthcare sector.

But, he cautioned, “pharmacists should continue to ensure they keep their professional activities within the boundaries of their competence”.

Read more: DH: ‘No plans’ to grant state indemnity to community pharmacy teams

Mr Day called on employers and commissioners to “ensure they provide the time and resources for pharmacists to be adequately trained to safely and competently undertake additional activities”.

He added that there should be enough qualified members of a pharmaceutical team to keep pace with the “overall volume of activity pharmacists are asked to deliver”.

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