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21 February 2024

Pharmacy First, which bypasses GPs, may lead to even greater antibiotic use

Asking busy pharmacists to conduct thorough patient consultations is yet another “solution” that won’t solve anything at all.

By Phil Whitaker

There was a message next to the appointment: “Phone mum. No better with medication.” I opened Jody’s notes, expecting to see a colleague’s entry. But the only recent addition to her records was a file attachment marked “Pharmacy First”.

My curiosity was piqued. This would be my first experience of the Pharmacy First scheme, which went live in England on 31 January. Community pharmacists are now empowered to dispense prescription-only medications for seven minor illnesses without the need for patients to contact their GP surgery. Jody, I read, had attended with a sore throat and had been supplied with a five-day course of penicillin.

“She’s just as bad,” said her mum, Angela, when I rang. “The antibiotics haven’t done a thing.”

However 14-year-old Jody was feeling, it evidently wasn’t enough to keep her off school.

“I’m sure it’s just a cold,” I said. “That’ll be why the penicillin hasn’t helped.”

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Most sore throats are caused by viral infections, and even when there’s good-going tonsillitis, only 15-30 per cent will be due to streptococcus, the bacterium that antibiotics might make some difference to. A prediction system called FeverPain is used in Pharmacy First to try to differentiate. Each criterion – recent high fever; pus on severely inflamed tonsils; short duration of illness; and absence of cough or cold – scores a point. The higher the score, the more likely the illness is to be bacterial. But even with a full house, FeverPain is not much better at predicting strep than tossing a coin would be.

A chief concern about Pharmacy First is that it will lead to far greater antibiotic use, which will compound the escalating problem of drug resistance. In an attempt to counter this, NHS England has compiled detailed Patient Group Directions (PGDs) for each condition, which pharmacists must adhere to. The PGD for sore throat alone runs to 17 pages.

When I first heard of the Pharmacy First scheme, I wondered how it could possibly work. Our local pharmacists are constantly run off their feet. How would they have time to conduct thorough consultations with waves of random customers walking in off the street? According to Community Pharmacy England, NHS contract funding – which accounts for 80 per cent of pharmacy income – has been cut by 30 per cent in real terms over the past seven years. More than 1,000 pharmacies have closed over the same period. Pharmacy First must represent a lifeline. Ninety eight per cent of pharmacies in England have enrolled. But I suspect that, rather than asking “Can we actually do this?”, the dominant response has been: “Just show me where to sign.”

The funding per consultation is higher than that provided to general practice. The madness is that it won’t free up GP appointments. Most practices have developed mixed-skill teams, and patients with minor illnesses will be managed by nurse practitioners or paramedics. It’s not clear what they will do once their caseload disappears into the pharmacy sector.

Pharmacy First is typical of the wheezes regularly cooked up by our policymakers. Rather than addressing the actual problem – which is that since 2015 they’ve allowed GP numbers to fall to 60 per cent of where they ought to be – they have come up with a bright, shiny “solution” that won’t solve anything at all.

And, like all such schemes, its densely detailed PGDs, crafted by people with no experience of the NHS front line, won’t survive contact with reality. After finishing the call with Angela, I went through the pharmacist’s paperwork. Jody’s temperature was recorded as 0.0°C. She hadn’t been a block of ice: that is the software’s default if no temperature reading is entered. The box labelled “Clinical Findings” was completely blank. The pharmacist hadn’t even seen Jody. They had simply gone on Angela’s say-so when she’d come in after dropping her sore-throated daughter off at school for the day.

[See also: Why the NHS is Labour’s biggest political opportunity]

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This article appears in the 21 Feb 2024 issue of the New Statesman, Fractured Nation