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‘A lot of failures’: Less than 40% of Pharmacy First consultations secure fee

An Avicenna poll has revealed that pharmacies in the group are experiencing long Pharmacy First consultations, most of which do not reach the gateway criteria for payment.

A poll of Avicenna pharmacies has revealed that more than two-thirds (69%) of branches report spending 20 minutes or more on average in Pharmacy First consultations, Avicenna chair Salim Jetha told the Sigma conference on Wednesday (February 28).


The poll of 109 pharmacies in the Avicenna group found that 20% were spending an average of 30 minutes or more in each consultation with a patient.


Just 9% of respondents spent an average of 10 minutes on a consultation, while 71% spent between 15 and 25 minutes on average, according to the survey. 


Read more: Pharmacy First funding breakdown: Upfront, monthly and consultation fees


Mr Jetha said that he had commissioned the poll among Avicenna members because he had been experiencing “a lot of failures” - consultations that did not meet the gateway criteria.


The poll revealed high rates of gateway criteria failure, with respondents reporting that consultations met the criteria for payment in just 37% of cases on average.


A quarter (25%) of responding Avicenna pharmacies said just two in ten (20%) patients met Pharmacy First gateway criteria, while 14% reported that just one in ten (10%) met the threshold for payment and 23% reported a success rate of just three in ten (30%), according to the survey results.


Read more: Third of pharmacists say Pharmacy First ‘harder to implement’ than expected

And some 79% said the success rate was 50% or less, meaning the vast majority were receiving payment for at most half of the consultations they delivered.



“Major learning curve”



Mr Jetha told delegates that his experience of GP referrals so far was varied, with some practices “totally dormant” and others referring “everything - pregnancy tests, eczema, chickenpox, the whole lot – lock, stock and barrel”.


He recounted one consultation for an apparent infected insect bite that lasted ten minutes until the patient disclosed that they had only had the inflamed bite for 24 hours, which fell below the gateway criteria for a consultation payment.


Read more: CPE hits out at GPs for ‘disappointing’ Pharmacy First reaction


He referred them to a GP, who prescribed them  the same medication as he would have, had they met the Pharmacy First criteria, he said.


He added that the next time he sees an insect bite, his first question will be, “How long has it been there?” 


Mr Jetha conceded that as pharmacists perform more consultations, they will “learn and get better and better”, but he said it was “a major learning curve for most pharmacists”.



“Beyond our control”



On Monday (February 26), Community Pharmacy England (CPE) chief executive Janet Morrison told the conference in relation to Pharmacy First that community pharmacy “shouldn't be punished” for factors “beyond [its] control”, like poor marketing and GPs that “don't play ball”.


Avicenna Group sales director Brij Valla had questioned the “steep” minimum requirements for the service, which reach a minimum of 30 consultations per month by October to qualify for the £1,000 payment.


Mr Valla cited Wales’s average of “around 23” consultations per month after offering the service for “a number of years” as a cause for concern.


Read more: ‘We have to be realistic’: Government could impose new contract, CPE warns

Ms Morrison said that the demand for 30 consultations was “driven” by the government's attempt to reach its goal of saving 10 million GP appointments and that CPE is waiting for the latest data “to really get a full picture”.


The monthly payment is “really critical to capacity” and urging the government not to withdraw this fee will form part of the negotiator’s arguments in ongoing 2024/25 contract negotiations, she added. 


Read more: Pharmacy First cash may get sucked into core funding ‘black hole’, warns NPA boss


“One of the major concerns is around capacity,” Ms Morrison said, adding that she is “very worried”.


She said that CPE will tell the government that it has to “keep investing in this infrastructure” if the sector is going to continue to deliver the Pharmacy First service.


“Something has to give”



Meanwhile, Mr Jetha said that with the sector “concentrating on Pharmacy First”, other services offered by community pharmacy may fall by the wayside, identifying the free medicine delivery services offered by many pharmacies as “high risk”. 


“Something has to give,” he said.


Read more: Long-awaited NHSE pharmacy economic review to begin in March

He listed several problems that the sector needs to grapple with, notably its tendency to offer “free advice”.


And he compared his free consultation that did not lead to a payment to a solicitor charging £50 for a notarised signature and questioned why his “time and my knowledge” was not valued similarly. 


It comes after new poll data from the National Pharmacy Association (NPA) found earlier this month that almost a third of pharmacists offering the new Pharmacy First service are struggling more than they expected to.  

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