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Is Pharmacy First the solution to NHSE’s backlog problem?

Adrian Zacher explores NHSE’s patient backlog problem, the role of community pharmacy and sets out some of his suggestions…

As we all know, the NHS has a huge patient backlog to contend with post-pandemic, and the accidents and emergency department (A&E) is overwhelmed. So, this is where I get contentious….

In my opinion, the medical community have undue influence over any attempts at NHS England’s (NHSE) reform.

Read more: Is helping patients sleep better a trivial pursuit?

NHSE’s pitiful bid to improve the situation for patient access to care, by rolling out a neutered clone of NHS Scotland’s Pharmacy First Plus, squanders the opportunity community pharmacy provides and compounds the problem.

The way Pharmacy First in England currently is, means the patient must effectively ‘self-diagnose’ themselves before seeking help in community pharmacy. The conditions community pharmacy can help with must be self-limiting or the community pharmacist does all the consultation work for zero reward.

I’m a fan of community pharmacy and consider it to be the ‘coalface’ of healthcare. The first (that word again) opportunity to have an informed healthcare professional and patient consultation occurs in community pharmacy.

Read more: Crisis, what crisis? MPs must help tackle sleep disorder problems now

So, then let’s consider antibiotic stewardship and ask ourselves which genius decided it made any sense to ONLY compensate community pharmacy consultations, that resulted in prescribing antibiotics? Looks to me like community pharmacy is being set up for a fall.

‘Complete Turmoil’ in community pharmacy, as reported by the BBC February 5 2024, because as we know that the NHS drug tariff means pharmacies may make financial losses buying medications.

This isn’t just unfair; it irresponsibly threatens patient care and undermines everything the NHS is doing to combat the patient appointment backlog.

If people cannot fill their prescriptions locally, they may not complete their course of medication and risk being readmitted.

Read more: Pharmacy First: Community pharmacy should wait and see what happens next

I suggest the public do NOT understand that the pharmacy team are only compensated when:

  • An over-the-counter (OTC) product is sold
  • Something is prescribed


While I applaud the fact Community Pharmacy is FINALLY being recognised as where people first seek help, and some (not remotely enough) money is being directed to the sector, the way Pharmacy First has been implemented appears:

  • Unnecessarily hurried
  • To place further unfunded burden on the sector (how much reading?!)
  • To leave the public confused about community pharmacy’s expanded role (which seven conditions?)


Read more: Is the community pharmacist consultation service really delivering?

Here’s another example of how crazy the present situation is to illustrate the problem:

Pharmacy First has no provision for self-presenting sleep issue individuals. So, they are ‘sold’ or depending on your viewpoint mis-sold an OTC sedating antihistamine. These products are not first-line therapy for insomnia and are explicitly contraindicated, that the National Institute of Care Excellence (NICE) guidelines explicitly state:


If I had hair, I would be tearing it out…

It’s high time consultations in community pharmacy were compensated for ALL self-presenting patients.

It’s time to end the public confusion over the role of community pharmacy and find a way to make what are effectively ‘NHS funded walk-in centres’ across the UK to deliver the change we all need.

Read more: Leadsom: ‘We want to support you in every way we can’

Pharmacy teams are not stupid. If they don’t know how to help, they will say so. The antiquated, parent-child approach shown towards community pharmacy smacks of protectionist medics making the rules for their own vested interests.

Forgetting what we’re all here for: the patient.


Adrian Zacher is CEO of The BSPSS and a member of the APPG for sleep taskforce

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