Sometimes the most revealing questions in health policy come not from looking overseas, but closer to home.
At a recent Westminster Health Forum conference, Community Pharmacy England’s Janet Morrison and the National Pharmacy Association’s hard-working Olivier Picard drew attention to the striking differences between the Pharmacy First service in Scotland and in England. It is a comparison worth exploring and reflecting on from my vantage point as a former minister.
The numbers for Scotland’s Pharmacy First, which covers almost 30 conditions, are impressive. Some 35% of the population - almost two million people - accessed Pharmacy First Scotland in the latest reported 12-month period. The number using the service each quarter has risen by 70% in four years.
Read more: Are we making Pharmacy First too difficult to navigate?
Compare that with England, where Pharmacy First offers seven clinical pathways alongside minor illness referrals and urgent medicines supply, and where research this year found that awareness of the service “remains the biggest barrier” to wider use.
Scotland has taken a broader approach, building on years of community pharmacy provision and offering an expanded service through Pharmacy First Plus, where qualified independent prescribers can manage additional conditions.
Of course, the two systems are not directly comparable. Scotland has had longer to establish its service, and the way activity is recorded differs. But the scale of public engagement surely tells us something important.
Repeating mistakes
England’s Department of Health and Social Care admitted in a parliamentary answer earlier this year that it has not formally assessed the Scottish scheme. Being candid, that is repeating a mistake I made in government where we failed to learn (and where necessary, just copy) what was happening north of the border.
None of this is to diminish what England has achieved. I was proud to lay the foundations for a greater clinical role for community pharmacy, and Pharmacy First was a significant step forward.
Read more: GP leaders warn against expanded Pharmacy First service
But the direction of travel matters. If we genuinely believe in shifting care out of hospitals, relieving pressure on general practice and putting prevention at the heart of the NHS, then community pharmacy must be central to that ambition.
For me, the lesson from the Scots remains the sheer breadth of their service. Their model is built around the pharmacist assessing and managing a broad range of common conditions, with defined pathways for treatments and referrals.
England’s nationally commissioned service is more narrowly centred on its (albeit growing) agreed clinical pathways, alongside existing minor illness referrals and urgent medicines supply.
Read more: Political Pills: The Pharmacy First service needs a digital second act
That is an important distinction. England’s model can leave patients navigating different eligibility rules, whereas Scotland’s is presented more naturally as a general first point of contact.
As minister for Public Health, Primary Care and Prevention, that was the policy exam question I set officials, and I think that portfolio mix was important in allowing me to answer it. The fracturing of primary care and prevention across different ministers was a mistake so credit for putting them back together under Diana Johnson’s brief.
Be ambitious
Public awareness and behaviour are perhaps the most politically interesting part of the comparison for me. Scotland has had a universal Pharmacy First service since 2020, building on a longer history of community pharmacy-based minor ailment provision. England only launched its current service in January 2024; admittedly building on the vanishingly low-key Community Pharmacist Consultation Service.
The question is whether Scotland has succeeded in changing public expectations about where to seek help, rather than simply creating another NHS service. Many indicators suggest it has. Perhaps the most important lesson from Scotland isn’t how many conditions its pharmacists can treat - it’s that patients increasingly know they can turn to them in the first place.
England should be ambitious and ask when we can achieve the same.
Steve Brine is a consultant, podcaster, trustee, former MP for Winchester & chair of the Health Select Committee