NHS Pharmacy First is a primary care service that takes pressure of GP appointments by allowing surgery receptionists to refer ‘minor ailments’ to local community pharmacists. NHS England guidance lists around 70 minor symptoms & conditions for such referrals, and research suggests this could amount to one in every five or six appointments currently being provided by doctors.
The Rationale for Pharmacy First
In recent years with growing list sizes there has been increasing demand for GP appointments. This has resulted in a daily 8.00am scramble by frustrated patients struggling to secure an appointment to see a doctor. It became quite politically sensitive and with an election looming the NHS Pharmacy First was launched in February 2024 as part of its Primary Care Access Recovery Plan (PCARP) strategy.
Pivotal to this strategy was the recognition that community pharmacists were well placed and already experienced in managing a raft of minor ailments with over the counter medicines.
How does Pharmacy First work in Practice?
This commissioned service model permits pharmacies to receive secure electronic referrals from surgeries containing patient contact details and a brief description of the minor ailment presenting. The pharmacy then arranges a consultation, provides advice and supplies medicines as appropriate. A summary record of the intervention is automatically returned to the practice by the secure referral system.
The pharmacy service fee is paid out of the national pharmacy budget so it is important to note there is no defunding or cost to the practice with which the referred patient is registered. The intent is to encourage teamworking which is assisted by avoiding issues over funding between NHS contractors.
Performance in Practice?
In the NHS Midlands Region over 70,000 Pharmacy First interventions were being processed per month in the 3 months to January 2025, with 78,000 in December alone.
This averages a very significant 5,300 sessions of GP activity per month and growing!
Within this however is a wide range of practice-level engagement. Astute practices are already using it to deflect hundreds of appointments per month, equivalent to dozens of GP overtime sessions which are being avoided as well as their attendant costs. Whereas practices that have been distracted by workload have mostly ignored this primary care service, presuming it to be a pharmacy contractor initiative. (which is understandable given the ‘name on the tin’.) They have not recognised that this is a PCARP service concept which is mainly controlled by practice referrals, and so they have been missing out on the commercial benefits – for over a year!
Why not give it a Try?
The financial and operational benefits for practices are compelling and many practices are now endeavouring to get it established. NHS England produced a Toolkit for Practices when it was formerly known as the CPCS (Community Pharmacy Consultation Service). This toolkit continues to be helpful.
The referral process is simple, yet the main issue is reception team compliance, exacerbated by the 20%+ turnover of reception staff.
Ideally a decision support IT system which identifies referable symptoms would be helpful to reception teams in these circumstances, and this is precisely the purpose of ReferralFlow which identifies allowable symptoms and indicates when a Pharmacy First referral may be appropriate.