NHS England recently announced a £645m investment in community pharmacy services to help address the crisis in access to primary care.
The government’s plans include a new “pharmacy first” service, in which people in England who need prescription medication will be able to get it directly from a pharmacy, without a GP appointment, for various common conditions including earache, sore throat or urinary tract infections. The scheme is already proving successful in Scotland and Wales.
Pharmacists are the third-largest health profession in the country and making better use of our skills makes sense. As trusted experts, our teams are ideally placed to do more to help the public stay well and free up appointments with GPs for those who need more complex care. Plans also include pharmacy teams providing blood-pressure checks and oral contraception for women.
However, the success of the new scheme will depend on how it is implemented. The funding outlined in the government’s primary care recovery plan must flow to those working on the front line who will need resources and support to make it work.
“Pharmacy first” is unlikely to be available consistently across the country until early 2024, as the finer details, such as the supporting infrastructure and IT systems, need to be worked through.
This service will mean that pharmacists can manage a complete episode of care for a patient and support them to self-care. It means that people will no longer have to go to their GP to get a prescription for many common conditions, which is then taken back to the pharmacy to be dispensed. This is game-changing and pharmacy organisations have called for such a scheme for many years.
Extra capacity will be essential in pharmacies to cope with the extra consultations, and we are concerned about additional pressures on an already-stretched service. This must be adequately resourced and staffed to make it work effectively. The government’s long-awaited NHS workforce plan needs to be published as soon as possible to address this.
Once the service is available, the public will be able to walk in to a community pharmacy for any of the common conditions the service covers. They will discuss their symptoms in a confidential consultation room, where advice and treatment will be provided as needed.
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If the individual does not pay for prescriptions, then treatment for a minor condition will be provided free of charge. Providing treatment to help prevent common conditions from becoming worse and requiring more complex treatment later on is better for patients, and also more cost-effective for the system.
As there are more community pharmacies in deprived areas, providing greater access to care should have a positive impact in reducing health inequalities too.
A significant amount of on-the-day appointments at GP practices are taken up with treating common conditions and “pharmacy first” should help reduce the strain in general practice and other parts of the NHS such as emergency care.
Pharmacists already provide advice on common conditions, but currently we must send the individual back to their GP for a prescription, who then comes back to us to dispense it. A scheme that enables pharmacists to initiate and supply the medicines directly will provide a better patient experience as well as saving on GP appointments. The development of this service is also likely to encourage closer working between community pharmacists and local GP practices, and will require investment into digital pathways in pharmacy to link to other healthcare services.
When it comes to prescribing antibiotics, pharmacists have a full understanding of the principles of optimising therapy and minimising antibiotic resistance, and often lead on antimicrobial resistance programmes in their area. Pharmacists already carefully scrutinise whether or not an antibiotic is really required. A study funded by the Department of Health and Social Care has already demonstrated that pharmacists working in GP practices improve medicine-prescribing outcomes, particularly in antibiotic prescribing.
Later this month, the National Institute for Health and Care Research is expected to issue a call for research focused on understanding the impact, safety, cost-effectiveness and acceptability of an expanded service to treat common conditions in community pharmacy, as well as any implications for antibiotic use and antimicrobial resistance. The outcomes of this research will influence how the service is provided. Pharmacy teams stand ready to deliver and we look forward to the much-needed investment in the sector.
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