Pharmacy First service: Two Numark members share their experiences

Lack of cooperation from GP surgeries stalling the uptake of Pharmacy First service in some areas 

The nationwide implementation of the Pharmacy First service is viewed as a significant development that benefits pharmacies, primary care, and the broader National Health Service (NHS). Pharmacy teams are striving to ensure its success despite challenges within the industry landscape. However, not all pharmacists are able to reap the benefits from it.

Recently, two members of Numark shared their experiences of how the scheme is impacting their pharmacies.

Graham Phillips, who owns Letchworth Pharmacy in Hertfordshire, revealed that patients are responding favourably to the service. “It's all good, people are just delighted to have easier access to care,” he said.

In its first month, Letchworth Pharmacy provided around 100 consultations, and Phillips envisions that as the service matures, they will be able to conduct an average of 200 interventions per week.

“That will make it financially viable for us and mean that we're acting at scale from an NHS perspective. That's 200 GP appointments we've freed up in a week - that's a huge capability and capacity bump for the NHS,” he added.

Graham credits part of his success with Pharmacy First to the strong relationship he has established with local GPs in his area.

He said: “We've built a relationship with local GPs and because they're desperately short of clinical capacity and because they've got confidence in what we do, because we’ve reached out proactively and made contact, the mechanism is that GP receptionists are triaging some people and sending them to us.”

Though it’s getting referrals from GPs, Letchworth Pharmacy’s Pharmacy First consultations are primarily from “walk-in” patients.

Graham expressed his delight that community pharmacy is finally gaining recognition as an integral part of a multidisciplinary team within the community.

“In a hospital setting, everyone talks about the multidisciplinary team. In a community, when they talk about that, they just mean the GP practice, but we are absolutely part of that team.  I think finally, we’ve arrived as fully-fledged, fully recognised, fully enabled members of that team. I’m very optimistic,” he said.

But it’s a different story for Mohamed Moledina of Archer Pharmacy in Stevenage, who said that the lack of cooperation from GP surgeries in his area is stalling the uptake of Pharmacy First service and making it impossible to plan for the future.

“It’s been slower than I thought, mainly because we’ve had no referrals from the local surgeries,” he said.

He added that all the patients they have seen so far have been those visiting their pharmacy for over-the-counter medication, and they have been able to help them. For example, a woman visited for cystitis sachets, and they were able to prescribe antibiotics for her urinary tract infection.

Mohamed stated that he serves as the Primary Care Network (PCN) lead in his area and has visited GP practices to deliver presentations about the Pharmacy First service, but the doctors “have no idea about it, and they aren’t utilising the service.”

“It’s unfair that in some areas, GPs are on board and the pharmacists are getting a steady stream of referrals, and in some areas the GPs don’t get it and aren’t using the service, where we could be seeing patients and relieving pressure on them,” he stated.

Mohamed emphasised that pharmacies need steady referrals to effectively manage their time and potentially increase staffing levels. However, he said they can’t do that due to the uncertainty of the number of patients they can expect to see.

Some pharmacists, who do not wish to be named, have also informed Pharmacy Business that they are not receiving Pharmacy First referrals from their local GPs.

No support from the NHS for 10 years

Both Graham and Mohamed noted that the sector hasn’t received sufficient financial support from the NHS for a decade, and now, under-resourced community pharmacies are being tasked with delivering additional care.

Graham said: “We haven't had support from the NHS for 10 years. They've done nothing but deliberately undermine us. They've taken more and more money out of pharmacy to decimate it. It's like that very old wall at the end of your garden. Little bits of cement keep falling out, but the wall is still standing. It all seems fine until one day a wind comes, and the thing falls over. That's where pharmacy is and then they're saying, in the face of this crumbling situation, can you please do all this extra?

“This is typical of the NHS - the completely arbitrary arrogant way that they treat us. You couldn't make it up. It's appalling. We're fundamentally under resourced anyway and you're asking this under resourced network that you spent the last 10 years deliberately undermining to step up and deliver extra care.”

He even compared the treatment of community pharmacy by the NHS to the treatment of postmasters by the post office.

He expressed deep frustration over the decrease in the percentage of the NHS budget allocated to pharmacy, which has dropped from the historical figure of 2.4 per cent to 1.7 per cent.

“There’s basically a billion pounds missing. It's a billion-pound hole in the pharmacy budget,” she said.

Echoing his dismay at how pharmacies have been treated, Mohamed highlighted the brief notice of the service announcement, which gave them just one month to adapt, and the absence of a standardized training course, leaving individual pharmacists to determine their own needs.

He said: “They dropped the news in December, which is a busy period anyway, and a time in which people take holidays so they essentially gave us January to get up to speed. It’s not at all reasonable. There’s not been any standardised course, so it was up to individual pharmacists to decide what they need.

“Who else gets told to do a job with no explanation of what they’ll need to do and what it will entail? We need a standardised NHS course, and every pharmacist should be eligible. We’ve had to do most of it ourselves and materials we’ve had access including resources and guidance that we get as a benefit through our Numark membership.”

The Future of Pharmacy First  

Nevertheless, Graham has been in the fortunate position of being able to invest in his pharmacy. He has invested approximately £300,000 in his pharmacy, half of which was allocated to technology. This investment includes a dispensing robot, two prescription collection points, and three consultation rooms- two of which are set up to the standards of GPs.

“But for the last 10 years, with the exception of a few people like me, no one's had a penny to invest in pharmacy,” he said, adding that he could do so because he had sold some pharmacies, and had some cash.

“I know I’m the exception to the rule, and robots aren’t the right solution for everyone, but we wanted to prove a point, and I think we have now,” he added.

Graham, however, is optimistic about the scheme as he asserted, “The opportunity is huge, particularly given the financial circumstances of independent pharmacy. This could be transformational.”

Both Graham and Mohamed emphasised that the sector requires proper funding and support to  fulfil its role as a pillar of community healthcare. Pharmacy First holds the potential to ease pressure on other healthcare sectors, but this can only be achieved if pharmacists are properly equipped to provide such care, they added.

Launched on 31 January, NHS Pharmacy First service allows pharmacies to assist patients with common conditions including shingles, sinusitis, sore throat, and uncomplicated urinary tract infections in women.

A recent report by the Company Chemists’ Association (CCA) demonstrated strong patient demand for the new service, with CCA members alone delivering over 90,000 Pharmacy First consultations within the first two months.