At The Brooke Surgery in Greater Manchester, we have made Pharmacy First integral to how we work. It is not a side project.
In an average month we send more than two hundred cases to local pharmacies through this scheme. About nine in ten patient inquiries now go through Pharmacy First.
The remaining cases fit better with independent prescribers working locally. This small change has freed up clinical time and improved the day for patients and staff.
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Pharmacy First gives pharmacists clear pathways for seven common conditions and the ability to supply treatment under patient group directions (PGDs), where appropriate.
It aims to provide faster access to safe care in order to free up GP appointments. That promise can only become reality when you build the relationships and the processes that sit around it.
What unlocked impact for us was, firstly, proactive outreach. We met pharmacy teams in person, we agreed what good looks like, we shared our risk appetite and our escalation preferences, and we set up named contacts both ways.
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Because our pharmacists know who to call, escalation is safe and swift, and when GPs know what information comes back, trust grows.
Secondly, we created a simple referral flow. Our digital triage system includes clear prompts that route eligible patients to Pharmacy First. Administration colleagues use a simple guide that explains what to book and where.
If a patient’s presentation does not fit the PGD, the pharmacist sends structured notes back and we pick it up with no friction.
Thirdly, we ensured we have a safety net. We agreed an expectation for same day feedback on red flags and request brief standardised notes into the patient’s record.
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That small convention protects patients and protects staff workload. It also reassures pharmacists that they are not working in isolation.
The outcome of this is that every month we release eight to 10 full GP clinical days, and two to four practice nurse days. That extra capacity means more time for complex reviews and continuity of care.
It reduces the need for external support, saving £4-5,000 in avoided locum or contractor spend for a practice our size.
Pharmacies benefit as well, they are able to deliver more clinical services with confidence, supported by a responsive practice partner with clear safety nets.
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These are practical steps any practice and pharmacy can adopt within a week:
· Agree a single point of contact on both sides and commit to a 24-hour response for non-urgent queries. It sounds small, but it changes everything.
· Publish a one-page referral and feedback checklist. Keep it visible for reception, clinicians and pharmacists.
· Schedule a short huddle every month - ten minutes is enough. Look at numbers, a few cases that went well, a few that did not, and one thing to try next month.
· Tell patients about the service: when you explain that the pharmacist is trained and the GP is still in the loop, confidence rises and complaints fall.
· Measure what matters: we track number of referrals, turnaround time, bounce backs, and any unplanned recontacts within 72 hours. Most importantly, we track the time we have freed up and where we have reinvested it.
Pharmacy First is not about shifting work. It is about sharing care in a way that is safer and faster for the patient.
It is not a silver bullet, but it is a reliable tool once the relationships are in place. Start with trust, make the workflow easy, and keep talking. The capacity will follow.
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Pharmacy First has created a dependable first step for defined common conditions. Independent prescribing in community pharmacy is the natural next step. Used together, dynamically they create a broader front door to primary care.
The NHS England Pathfinder programme was set up to test different models of independent prescribing in community pharmacy and to inform future commissioning.
Activity across pilot sites shows a clear direction - pharmacist prescribers will have a growing role in same day care and in long term condition management where it is safe and appropriate.
What next?
There are system asks if we want to scale this nationally:
· Read and write access to the GP record for community pharmacist prescribers is essential.
· Clear national templates for feedback would cut duplication and reduce risk.
· Payment models that recognise assessment, initial prescribing and necessary follow up will support safe practice.
· Shared dashboards would help commissioners see what is working and where to focus training.
The end point is not a blurred line between pharmacy and general practice.
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It is a stronger line of partnership where each profession works at the top of its licence and the patient moves through the system without friction.
Pharmacy First gives us a consistent doorway. Independent prescribing extends the room beyond it.
With the right governance and the right relationships, this is a practical way to add safe capacity today.
Dr Valeed Ghafoor is GP partner at The Brooke Surgery, Hyde, and founder and CEO of Vallour.