Pharmacy First is about to take another significant step forward.
From October, the service in England will expand to cover five additional conditions: acne, migraine, scabies, ear infections and rhinitis.
The move is part of a broader effort to make better use of community pharmacy and give patients faster access to treatment closer to home. For pharmacies with an appropriately qualified independent prescriber, it creates the opportunity to assess and treat an even wider range of conditions without patients automatically needing to see their GP.
It feels like a logical progression for a profession whose clinical role has been steadily expanding.
Not everyone agrees.
The Doctors’ Association UK has raised concerns about the plans, warning that pharmacists could be asked to provide care “beyond their training” and questioning whether they have the diagnostic expertise needed to deal with conditions that may initially appear straightforward but can sometimes be more complex.
I have to say, I find that argument difficult to understand.
Nobody is suggesting pharmacists should replace GPs. Nor should any healthcare professional work outside their competence.
But suggesting that the expansion of Pharmacy First somehow asks pharmacists to stray beyond their capabilities feels increasingly detached from the direction both the profession and the NHS have been travelling.
Pharmacists are already highly trained healthcare professionals. Independent prescribing is becoming an increasingly important part of their clinical role and, from this year, newly qualified pharmacists will join the register as independent prescribers.
The new pathways are not simply being handed to pharmacists without safeguards either. They will be delivered by appropriately qualified professionals within defined clinical pathways and governance arrangements.
And there is another fundamental safeguard that should not be overlooked.
Pharmacists know when to refer.
If something does not look right, a presentation is more complex than initially thought or the pharmacist is not comfortable proceeding, the patient can be directed to the appropriate healthcare professional.
That is not a weakness in the model. It is how good primary care should work.
The bigger question is why, at a time when access to general practice remains under enormous pressure, we would want to put artificial limits around another highly skilled healthcare profession that can safely take on more.
Pharmacy First has already delivered millions of consultations since its launch. Expanding the service should allow more patients with appropriate conditions to receive advice and treatment conveniently in their communities, while freeing capacity elsewhere in primary care for people who genuinely need it.
That should be something GPs and pharmacists can get behind together.
Take flu vaccination. If a patient can receive their jab conveniently at a local pharmacy, why use GP capacity to deliver the same intervention?
Every appropriate interaction delivered through pharmacy creates room elsewhere in the system.
The same principle should apply more broadly. England does not need to invent this model from scratch either. Look north of the border.
In Scotland, Pharmacy First is already firmly established as a first point of contact for minor illness. Patients are actively encouraged to visit their community pharmacy, with teams providing advice and treatment across a broad range of common conditions and referring onwards when further investigation or specialist care is needed.
That is not pharmacists replacing GPs. It is pharmacists and GPs performing complementary roles within a better-connected primary care system.
Perhaps the more interesting question is why England has been so much slower to embrace the same principle.
Part of the answer, I believe, lies in how pharmacy represents itself.
Community Pharmacy Scotland has spent years establishing the profession as an integral part of the health service and has been closely involved in shaping how pharmacy develops.
England has a much more fragmented representative landscape.
Community Pharmacy England, the National Pharmacy Association, the Company Chemists’ Association and the Independent Pharmacies Association all represent different parts of the sector. Their positions are often broadly aligned, but multiple voices inevitably make it harder to present one clear message.
Compare that with the influence of the medical profession and the difference is obvious.
Whatever anyone thinks of the approach taken by doctors’ representative organisations over the years, they have proved highly effective at making their case.
Pharmacy needs to become better at doing the same. Because ultimately this debate is about much more than five additional conditions.
The NHS wants to move more care out of hospitals and into communities. It wants greater emphasis on prevention and better use of the clinical workforce.
Pharmacy should be central to that ambition. We now have a profession with expanding clinical skills, growing prescribing capability and an accessible network embedded within communities across the country.
The question should not be how tightly we can restrict what pharmacists do. It should be how we use those skills safely and effectively to their full potential.
GPs will always be essential. So will pharmacists. The future of primary care should not be a battle over who owns the patient.
It should be about making sure patients reach the right healthcare professional at the right time. Pharmacy is ready to play a much bigger part in that.
We should be finding ways to enable it, not reasons to hold it back.
