Just how close are we to a “Pharmacy First” model in England?

Sales and Marketing Director Louise Laban takes a closer look at where we are on the journey to Pharmacy First in England.

The frustrations facing those working in community pharmacy in England are well documented. The pandemic transformed patients’ perception of pharmacy from a dispenser of medicine to the first line of defence for health advice. Expectations of community pharmacy are on the increase yet these expectations are set against a backdrop of 10 years flat funding, workforce challenges and no national programme to support them in the clinical role that they have now taken on.

An overhaul is urgently required to support community pharmacy to become an integral part of the healthcare system and to ensure it is fit for the future. But at the minute those with the power to change things seem to be all talk and no action. How much longer does community pharmacy have to wait? Only last week we were told that 650 pharmacies had disappeared in England in the last six years and the warning from pharmacy bodies is that this trend will only get worse unless the Government steps in to help put an end to the “something for nothing culture”.

Pharmacists are being asked to deliver more clinical services but they are being expected to do it without a national programme and the financial support to resource the services effectively. The industry is crying out for a “Pharmacy First” model that will support pharmacy to focus on prevention as well as reacting. We know when it is done properly it works – just take a look over the border at Scotland. Since its Pharmacy First scheme launched there two years ago, pharmacists have completed “well over” three million consultations according to Community Pharmacy Scotland.

And they are not stopping there – their focus is already on what is coming next. Scotland’s Chief Pharmaceutical Officer Alison Strath is now talking about moving from an NHS Pharmacy First service to NHS Pharmacy First Plus with investment in prescribing training programmes for current pharmacists to allow them to use further clinical skills. This visionary approach would allow pharmacies to treat conditions beyond the scope of the current scheme including UTIs and allergies.

In England we are still trailing behind. While we seem to be inching closer to implementing a standard Pharmacy First model, it currently feels like it is just out of our grasp. Only last week new Healthy Secretary, Steven Barclay, said he was working on a Pharmacy First model to ease pressure on hospitals in an interview with the Daily Telegraph. His predecessor Sajid Javid said the same thing earlier this year.

Within the last week there was also the announcement that applications were open for almost 3000 funded independent prescriber training places in England. These places are only available to those pharmacists working in certain settings like primary care networks or NHS Trusts. In addition, the funding from Health Education England doesn’t address the lack of trained supervisors (DPPs) or any renumeration for that role.

It's also been announced that community pharmacists in England will be offered funded clinical skills training including history taking and identification for a range of serious conditions as part of a £2m programme expected to start in December this year. Health Education England said the programme is intended to enable the transformation of the pharmacy workforce to deliver clinical services and is part of a 3-year programme of education and training for post registration community pharmacists. The programme requires community pharmacists to pass an online module in history taking before being able to take specialised modules in dermatology, cardiology, ear, nose and throat and paediatric care.

Yet despite this there is still no framework for a Pharmacy First programme in England. Pharmacy First along with an effective supply of medicine should be one of the core services for community pharmacy. It is a service that needs to planned out properly and fully resourced. Resourced so that pharmacy can deliver the programme and address workforce challenges – be it through recruitment, investment in technology to free up existing pharmacy staff or both.

Community pharmacy should be about improving patient outcomes and supporting the wider NHS. But at the minute it feels like the poor relation. A service that is overworked and underfunded. A service that is continually being asked to deliver more for less. It’s a service that can’t continue to survive on unfulfilled promise. What is needed now is action – pharmacy has waited long enough.