NPA Chief Executive Paul Rees discusses the necessary steps to ensure the scheme’s effectiveness and sustainability…
The Pharmacy First schemes in each of our four nations are excellent innovations and, in many ways, make pharmacy the front door to health care.
The NPA played a key role in the introduction of Pharmacy First in England and, having called for it for some time, then-Health Secretary Sajid Javid first announced the Government intended to introduce the scheme, at one of our member events.
Several years later, we were grateful to the Prime Minister Rishi Sunak for pushing ahead with the initiative and ensuring that it was introduced prior to the general election. And we played an instrumental role in helping members successfully gear up for its deployment.
But, despite this, it is fair to say that the roll out of the scheme has been rather patchy.
While there were around 400,000 Pharmacy First consultations by the end of May, which is an unprecedented start to a new pharmacy initiative, there are a number of problems.
Challenges in implementation
 The first is that for pharmacies to be able to carry out Pharmacy First consultations at scale, they need GPs to refer patients to pharmacies via Pharmacy First.
 However, while some GPs are referring many patients via Pharmacy First, many other GPs aren’t referring patients via the scheme at all.
Early in May, we revealed, via the national media, that around two-thirds of GPs are not making referrals through Pharmacy First, with a minority openly saying they will not cooperate with the scheme.
 This is profoundly disappointing, especially when the scheme was developed in order to take the burden of too many consultations away from general practice.
 Another issue is that where pharmacy teams see walk-ins they are only paid where these cases meet the gateway criteria, which anecdotally only happens with around 25 per cent of all walk-in patients in some pharmacies.
This means that pharmacy teams are often consulting with patients for several minutes before it becomes clear that they won’t hit the gateway and therefore won’t be able to help the patient or be recompensed for their work.
This is plain wrong – so we are lobbying for an activity fee to be paid for all patients seen through Pharmacy First.
We also want a fundamental review of the gateway criteria, which currently are too restrictive.
Another issue with Pharmacy First is that there are artificial leaps in the numbers of consultations that pharmacies are expected to carry out each month in order to receive the £1,000 monthly payment.
The steps up in August, to 20; and in October, to 30, are causing a great deal of concern across the sector – with many pharmacies fearing that they won’t be able to hit these higher numbers.
Some pharmacies are thriving with Pharmacy First and are already hitting 20 consultations a month – the figure required in August – with a few hitting an incredible 200 each four-week period.
However, many pharmacies are struggling to carry out even 10 consultations a month – with some reporting a gradual decline in monthly consultations due to fewer sore throat presentations.
Many pharmacy teams who are struggling to achieve the minimum numbers are feeling disheartened.
And there is a real risk that some of them will simply drop out of Pharmacy First when the figures go up in August or in October, as it will feel like too great a mountain to climb.
As a result, we are lobbying for all pharmacies taking part in Pharmacy First to be given the £1,000 monthly payment regardless of what number they hit.
At a national level, there is also a risk that community pharmacy, a sector already struggling with the biggest funding crisis in living memory, will lose out on much of the £645m that has been promised for Pharmacy First.
The current version of Pharmacy First runs out at the end of March next year with currently no cast-iron guarantee of it continuing.
Therefore, the money that has been unspent by that date could be clawed back – meaning that a whopping £465m could be taken away after next March.
That would be an outrage.
So, we urgently need the Government and NHS England to pledge not to claw back a single penny of the £645m – and this is a point we’ve already made to all three main party leaders.
But what else should happen?
Well, we need to learn the lessons from what is/isn’t working well and spread the learnings as quickly as possible.
This particular task is made more difficult by the fact there has been a complete paucity of data from NHS England and the Government on how the scheme is rolling out.
Despite this, a number of things are clear.
First, we need GP bodies to urgently encourage GPs to refer via Pharmacy First as a matter of course, in line with expected best practice. Where GPs are encouraged by their professional membership bodies to follow certain protocols this is soon seen as the excepted norm. This is a point we plan to make in meetings with both the BMA and Practice Managers Association.
Second, we need ICSs to be supportive of community pharmacy and encourage GPs to view pharmacies in a positive light, with an expectation that they will work collaboratively with them. It is where ICSs are positive about pharmacy that Pharmacy First often works well, such as in North-East London.
Third, we need LPCs to leverage their work with LMCs to encourage a local expectation for GPs and pharmacies to work together in partnership – a positive relationship between these two sets of organisations can create a positive framework for the roll out of Pharmacy First, such as in Avon and Somerset.
But is there anything that pharmacies can do for themselves, to help create a more positive landscape?
Well, some pharmacies have been very adept at developing good relationships with their nearby GP practices, either via the practice manager or with the GPs themselves – and we have seen time and again that this can make a material difference.
Also, many pharmacies are trying to make sure that they prepare for every patient interaction and make every patient interaction count – by creating a triage process whereby no walk-in is ever seen by a pharmacist until it is clear they have hit the gateway and the consultation will be officially classified as a Pharmacy First consultation. That way the pharmacist’s time is used in the most optimal way.
In addition, a number of pharmacies are assertively marketing Pharmacy First to their patients through posters, screens and customer interactions, to make sure their local communities are fully aware of the benefits of the scheme.
Conclusion
Pharmacy First works well in Scotland, Wales and Northern Ireland, where pharmacies see patients with 26, 27 and 13 ailments respectively.
It can also work in England and be a success, off the back hard work and skills of the community pharmacy workforce – as long all the key stakeholders in the round make the right interventions now.
Author
Paul Rees, CEO of the National Pharmacy Association (NPA)
