Pharmacy First: Opportunity Knocks for Primary Care (2025)

Dr Leyla Hannbeck Explains Key Aspects of the Pharmacy First Scheme, Emphasising Its Potential Benefits for Community Pharmacy and General Practice

The Pharmacy First scheme, also known as the Common Conditions service, was launched in England on 31 January 2024.^1,2 Under the scheme, community pharmacists now have the power to manage seven common conditions (see Table 1), without the need for patients to visit their GP, using defined clinical pathways.^1–4 Community pharmacists were already able to advise people on these conditions, but they can now complete episodes of care for these patients without input from general practice.^1,2,4

Table 1: Conditions That Community Pharmacists Can Now Manage Under the Pharmacy First Scheme¹

The scheme also supports community pharmacists to assess the need for urgent repeat medication, and to offer advice regarding symptoms of minor illnesses.^1,2 Although these services have been available in some form since October 2019 as part of the Community Pharmacist Consultation Service, they have now been integrated into Pharmacy First.^1,2

For an overview of the Pharmacy First service, see Figure 1.²

Figure 1: Pharmacy First Service—Overview²

Aims of the Pharmacy First Scheme

Pharmacy First was originally proposed in May 2023 in NHS England’s Delivery plan for recovering access to primary care.⁵ In this plan, NHS England estimated that the scheme, alongside expansions of oral contraception and blood pressure pharmacy services, could save up to 10 million appointments in general practice per year.⁵ At its launch, over 10,000 community pharmacies were already signed up to the scheme, equating to more than 95% of pharmacies in England.¹

This article discusses the scheme in more detail, outlining its potential benefits and the importance of engagement by GPs and other stakeholders for its success.

Clinical Pathways

When consulting with and treating patients, community pharmacists are now able to offer self-care and safety-netting advice and, in some cases, provide certain NHS-funded, over-the-counter or prescription-only medicines.² In doing so, community pharmacists must adhere to a set of comprehensive patient group directions (PGDs) and follow specific clinical pathways outlined by NHS England.^2,3,6 Therefore, under this scheme, community pharmacy has been given the ability to provide some highly efficacious medicines with which to treat an array of common conditions.^1–4

See Figure 2 for an example of one of these clinical pathways, and Table 2 for an overview of the medicines offered through Pharmacy First.^3,6,7

Figure 2: Pharmacy First Clinical Pathway for Infected Insect Bites³

Table 2: Medicines Offered Through Pharmacy First, with Associated PGDs^6,7

The Importance of GP Engagement

In my opinion, much of Pharmacy First’s success will depend upon GP referrals, and GPs must be proactive in designating and using the patient referral pathway. So far, there seems to have been a mixed reaction from general practice: although some pharmacies received several referrals on the first day of the service, others received none.

I would therefore urge pharmacies to inform local practices that they are offering the service, discuss its benefits for patients and prescribers, and provide the pharmacy’s NHS email details—perhaps even by knocking on surgeries’ doors with promotional materials. Practices may also benefit from an explanation of how this will work from a pharmacy perspective. For Pharmacy First to succeed, it is important that GPs have the confidence that pharmacies can not only deliver the scheme, but also do so in a professional and clinically appropriate way.

In my experience, pharmacy teams are very happy to discuss the Pharmacy First service with GP colleagues, and I would highly recommend that meetings are set up between GP practices and pharmacies to discuss the details of the service and how the two professions can work together to ensure a seamless service and great outcomes for patient care.

How Will Pharmacy First Impact Wider Healthcare Provision?

Antimicrobial Use

Since the introduction of Pharmacy First, some observers have been sceptical regarding the service's potential to promote the wider use of antibiotics.^8,9 However, antimicrobial stewardship was considered throughout the development of the scheme: antimicrobial resistance specialists were involved in developing the PGDs that pharmacies will follow, and NHS England and the DHSC have announced that they will be closely monitoring the service’s supply of medicines after launch.^1,8,9

In my opinion, community pharmacists are one of the groups of healthcare professionals least likely to supply antibiotics indiscriminately. Both preclinical and undergraduate pharmacy training regimens recognise the importance of antimicrobial stewardship in general prescribing, and the holding and management of stock is second nature to pharmacy teams.

Easing the Pressure on General Practice

Critics have also suggested that this expansion of the role of community pharmacy will not have a significant impact on workload in general practice,¹⁰ as the estimated 10 million appointments in general practice it will save each year account for fewer than 4% of all GP consultations.^1,11 This may be the case, but it does not make the scheme futile; beyond helping people to gain timely access to NHS care, the service has the potential to provide evidence of community pharmacists’ capabilities, and may pave the way for future expansions of the role of community pharmacists in the management of other ailments.

Is Pharmacy First a Sign of Recovery in Community Pharmacy?

Government Investment

The Pharmacy First scheme evolved from the Scottish Pharmacy First model, which demonstrated successes and benefits following its launch in July 2020.^5,12,13 In England, the Association of Independent Multiple Pharmacies (AIMp), alongside other pharmacy bodies, campaigned for the service to be introduced for many months. It is also generally accepted that a personal intervention by Prime Minister Rishi Sunak, himself the son of a pharmacist, assisted the development of the scheme.¹⁴

In April 2023, Sunak discussed his vision for the Pharmacy First scheme with Ian Strachan, pharmacy owner and board member of the AIMp.¹⁵ His intention seemed to be to allow capable community pharmacists to take on extended roles to relieve pressure on other parts of the health system.¹⁵ The rollout of Pharmacy First—as well as the agreement made with Community Pharmacy England that finalised £645 million of funding over the scheme’s first 2 years^16,17—may therefore be an indication of increasing investment and trust in community pharmacy, despite the political turmoil associated with the current Government.

Wider Issues Facing Community Pharmacy

However, the launch of Pharmacy First has come at a difficult time for community pharmacy,¹⁸ and this opportunity does not cancel out other issues that must be addressed. Much of the sector agrees that community pharmacy is in financial crisis, in part because the 5-year funding deal—signed off in 2018—failed to account for rising input costs for pharmacy owners.¹⁸ Many stakeholders are calling for a fairer and more equitable funding contract.¹⁸ Indeed, in April 2023, the AIMp estimated that the community pharmacy sector had a shortfall of over £1.2 billion in its core funding.¹⁹ This figure was shared with HM Treasury in May 2023, alongside the relevant calculations, with a request that the Treasury review the sector’s financial package.^18,19

In my opinion, inflation, cost-of-living issues, and rising wholesale prices have all added to the financial and viability issues faced by community pharmacy, and the expectation that it should somehow innovate its way out of these challenges is both unfair and unrealistic. Current medicine shortages only add to the pressure on community pharmacy,^20,21 and there is an urgent need to address mounting costs to contractors and the NHS alike.

Summary

Pharmacy First certainly seems to be a step in the right direction for primary care, but further action is needed for community pharmacy to thrive in the coming years. The sector needs the headroom to be able to manage debt then move forward with a remuneration model that gives both stability and the potential to invest, plan, and prepare for the future.