Introduction
One of the most pressing problems faced by healthcare services is the increasing prevalence of antimicrobial resistance (AMR). Compounded by a diminishing number of new antimicrobial agents entering clinical practice, such resistance is widely recognised as a major threat to public health, meriting inclusion on the National Risk Register.
Tackling antimicrobial resistance is a UK strategic priority, with the aim of reducing the number of serious infections that are resistant to treatment.
Over several years, the Pharmacy Quality Scheme (PQS) has focused on supporting good antimicrobial stewardship (AMS) within community pharmacies. This work continues to be a high priority following the introduction of the clinical pathways within the Pharmacy First service, where antimicrobials may be supplied to patients who meet specific criteria.
This clinical audit within the 2025-26 PQS will support pharmacy contractors and their teams to reflect on their management of patients referred to the pharmacy or presenting in the pharmacy seeking advice on the treatment of sore throat, where the patient has a FeverPAIN score of 0 to 3. This group of patients includes those who do not pass the gateway point having presented with a sore throat, alongside those who pass the gateway point in the Pharmacy First clinical pathway for sore throat, but who do not meet the criteria for antibiotic supply under the sore throat patient group direction.
Aims
- to review community pharmacy management of patients seeking advice on the treatment of sore throat, including actions taken to promote AMS, where the patient has a FeverPAIN score of 0 to 3
- to identify learnings from the audit data that can inform future enhancement of clinical practice
Audit timeframe
Pharmacy contractors can choose a time to start the clinical audit from 1 September 2025 to 3 February 2026. It must be completed and the data entered onto the NHSBSA data collection tool no later than 31 March 2026.
The audit must be carried over a period of 4 consecutive weeks, capturing data on consultations with patients included within the audit sample (see below) during that period.
Data should be collected on a minimum of 10 patients included within the audit sample over 4 weeks. If data cannot be collected on 10 patients during that 4-week period, the audit period must be extended to an 8-week period. If after that 8-week period no patients within the audit sample are identified, or fewer than 10 patients are identified, you will meet the PQS audit requirements as long as you can demonstrate that you have made a thorough effort to identify such patients. You must also declare on the Manage Your Service (MYS) data collection tool that no patients within the audit sample were identified.
The audit must start no later than 3 February 2026. This ensures that, if necessary, there is enough time to complete a 8-week audit and collect the data before the end of the PQS.
Audit sample
All patients referred to the pharmacy or presenting to the pharmacy seeking advice for the first time on the treatment of an episode of sore throat who have a FeverPain score of 0 to 3 points within the Pharmacy First sore throat clinical pathway are included.
Any patients previously seen for the same episode of sore throat who re-present to the pharmacy should not be included in the audit data collection for a second time.
Audit standards
Standard 1
A copy of the TARGET Treating your infection – respiratory tract infection (RTI) for community pharmacy leaflet is used in the consultation with the patient and is given to the patient (or sent to them, in the case of remote consultations).
Audit standard 100%
Standard 2
The consultation includes providing advice on the natural history and average length of sore throat symptoms.
Audit standard 100%
The TARGET leaflet contains advice on the natural history and average length of sore throat symptoms, which you can talk the patient through.
Standard 3
The consultation includes providing advice on when to re-consult if symptoms do not resolve.
Audit standard 100%
The TARGET leaflet contains advice on when to re-consult if symptoms do not resolve, which you can talk the patient through.
Standard 4
The consultation includes the provision of general information on AMS, antibiotic use and resistance.
Audit standard 100%
The TARGET leaflet contains general information on AMS, antibiotic use and resistance, which you can talk the patient through.
Standard 5
Face-to-face consultations on the pharmacy premises with patients with a FeverPAIN score of 2 or 3 (which therefore pass a gateway point in the Pharmacy First clinical pathway) include an examination of the patient’s throat and neck, as recommended by NICE CKS. This standard does not apply to remote consultations.
Audit standard 100%
How to complete the audit
1. Choose a start date for the audit.
2. Brief your staff on their role in the audit, particularly any staff who will advise patients on the management of sore throat who may score FeverPAIN 0 to 1 and may not be referred to the pharmacist for a Pharmacy First consultation.
3. For each patient included in the audit sample (which includes some patients who will pass the gateway point in the Pharmacy First sore throat clinical pathway and other patients that do not pass the gateway point and are provided with self-care advice under the Support for Self Care Essential service), staff should record the audit data on the data collection form (link below) after the consultation with the patient.
4. At the end of the audit period, share your anonymised audit data from the data collection form with NHS England by adding it to the MYS data collection tool.
MYS allows you to start your data collection and then return to it later if necessary (for example, if you want to start adding data to MYS before the end of the audit period). Where data collection has been started but not submitted, it will not be eligible for payment for the PQS.
When you successfully complete the data submission on MYS, you will receive a data collection submission confirmation email as evidence that the submission was successful. Retain a copy of this email. You may need to provide this to NHS England to demonstrate that you successfully completed the data submission.
If you don’t receive the data submission confirmation email within an hour of submitting your declaration:
- check your junk email folder (the email will be from noreply@online1.snapsurveys.com)
- immediately send an email to the NHSBSA provider assurance team (pharmacysupport@nhsbsa.nhs.uk) to make them aware of the issue if you don’t find the email
If no patients within the audit sample are identified during an 8-week audit period, you will meet the PQS audit requirements as long as you can evidence that you have made a thorough effort to identify such patients. You must also declare on the MYS data collection tool that no patients within the audit sample were identified.
All data from the audit must be successfully submitted to the MYS data collection tool before 11.59pm on 31 March 2026.
5. Using the data analysis sheet (link below), collate and then review your data from the data collection form to determine whether your pharmacy met the audit standards and to identify any learnings that can be incorporated into future practice.
6. Discuss any identified learnings with relevant members of your pharmacy team and agree how to put them into practice.
7. Retain the completed data analysis forms and the data analysis sheet at the pharmacy premises until at least 31 March 2029. It may be required for post-payment verification.
Key resources
Download the tools you’ll need to carry out and report on the audit. They include a data collection form for recording consultations and a data analysis sheet for reviewing your results.
Publication reference: PRN02044