Introduction
Welcome to episode 2 of the transforming primary care podcast; an exploration of how teams across the North East and Yorkshire region are making improvements which make it easier and quicker for patients to get the help they need from primary care.
Podcast transcript
Keith Kendall
Hello everyone. My name is Keith Kendall. I’m a pharmacist and I’m the regional pharmacy integration lead for North East and Yorkshire for NHS England. We’re here today to talk about Pharmacy First service, which was introduced at the end of January this year. So, it’s been going for about just over nine months now. Pharmacy First builds on the NHS community pharmacist consultation service or CPCS as some of you will have heard of it and that service enabled referrals to be sent from NHS 111 and urgent and emergency care settings like urgent treatment centres or in A &E departments for minor illness, but also urgent repeat medicines supply requests as well, and for GP practices they can send minor illness referrals as well. Now that original service CPCS helped improve capacity at those healthcare settings I’ve just mentioned and it was more convenient for patients to be able to access Community pharmacies because in the heart of the communities, they’re either very local to people where people live or they’re more accessible, perhaps out of hours when individuals need to access a service after work and when maybe a GP practice might be closed.
Pharmacy First, as I’ve just said, builds on the service, CPCS, and it includes consultation with the pharmacist and that consultation can, if it’s the right thing for the patient end up with the supply of certain medicines for seven common conditions and I’ll come to those in a minute. Before we get to it. I just want to make it clear that before Pharmacy First, apart from some very small minor exceptions a member of the public would have had to be seen by GP or prescriber if they didn’t have access to this service, so we’re providing extra access in that way through Pharmacy First.
Now we know that pharmacists are experts in minor illness and this additional group of seven common conditions, it really expands what the pharmacy can do to help those patients there and then at the pharmacy.
Now those conditions, I’m not going to go into all of them include earache, sore throat infected insect bites, not so much at this time of year, and urinary tract infections as well in women. And there are some limitations in terms of who could be seen for the service and who can access it and who those common conditions apply to.
So in this episode of the podcast, we’re going to discuss the progress made in the first nine months of the service with some guests, and I’m going to introduce them in a minute. We’re having this discussion just before a new wave of the public awareness campaign for Pharmacy First gets underway. So really good timing. We’re going to be hearing from some pharmacists, a GP and a community pharmacy clinical lead about how things have gone so far in terms of practices and the public beginning to think Pharmacy First.
So today I’m joined by Doctor Omar Alisha, senior partner at Trinity Medical Centre, Wakefield. Hi, Omar. We’ve got Sarah Passmore, Superintendent Pharmacist, Pharmacy Plus Health, also in Wakefield, very close to Omar. We’ve got Dawn Cruikshank, Superintendent Pharmacist at Harrops Pharmacy in Loftus, North Yorkshire and Claire Thomas, our community pharmacy clinical lead for South Yorkshire.
And last but not least, Abby Fraser pharmacist at Clemitson’s Pharmacy, Crook County Durham.
Welcome, everybody. Great to have you in the room and great to be able to hear from you in a minute and hear about your experiences. I’m going to kick off with a really open question and this is really aimed at anybody at first of all. So, what were your initial thoughts or perceptions about pharmacies first and service before you began delivering or referring into it? So it’s open to everybody.
And think about, did they really match up to your reality once the service started for you?
Who would like to go first.
Omar Alisha
I’ll go first, Keith. So when it first came, we looked at it based on our previous experience with CPCS and to be honest, we thought this might not work well because we thought the number of patients going to be involved on the pathway and the communications so so we were not very optimistic about it when it first came.
But actually once it was introduced and implemented, we were presently surprised how well it worked.
Keith Kendall
Excellent. Yeah, that’s great. And what in particular was different for you?
Omar Alisha
So I think it was clear. So the seven conditions were clear. So to identify the patients who are suitable for this service was relatively easy.
Care navigators could do that. We didn’t need clinicians to identify these patients.
And then the public was more prepared for it. So we didn’t have a massive resistance from patients going to the service.
But also a part of the initial phases, the pharmacists were also prepared for it. At the beginning they were struggling a bit with capacity, but as the service settled, we saw some improvement there.
Keith Kendall
OK. That’s great. Thanks so much. And I think Dawn you wanted to come in and then we’ll come to you, Abi
Dawn Cruikshank
Yeah. Thank you, Keith.
I sort of reflect a little bit on what Omar said there, because at the beginning of the service, when everything was first published it did provide a bit of concern for myself too, because there was so much that seemed to be needing to be read. So much training needed to be done. But then when you got down to the nitty gritty of it, it was so clear, the pathways were so clear to follow. The patient group directions, you know , very, very clear as well. And also the training that we needed when you did the training, it was more of a reassurance that it was what you are already doing as the day job. You know, we were doing this on a daily basis anyway and what happened with the introduction of Pharmacy First, it actually gave us the tools to be able to complete consultations that otherwise we would have had to refer on to the practises so very, very valuable. So even though there was a lot of concerns about capacity at the beginning it’s speeded up the process.
I don’t know if that’s how you found it, Abi,
Abi Fraser
Yes, Dawn, just to really reiterate what you’ve said, but also the relationships that we’ve built up with our local practices using the CPCS framework and we were able to build on those and the Pharmacy First was an opportunity to treat more patients, as Dawn said, without needing to refer back to the GP to sort of complete the cycle, but also it gave the GPs more confidence that we were working to a very structured protocol within the PGDs so they could see as s well the types of conditions that we could treat in the exclusion criteria, and they were very clear on why people were being sent back to them when they had to be.
Keith Kendall
Great. Thanks, Abi. Sarah, I think you want to come in.
Sarah Passmore
Yeah, it’s just to kind of reflect on what Abi and Dawn both said. You know, we were a little bit nervous, but really, really excited to use those skills that, that we already knew that we had and then the experiences that we had in with the doctor’s surgery, who were really on board with it to start off with, you know, we didn’t have the challenges of trying to engage and get the doctors on board. So that really, really helped to get us up and running.
The pharmacist who we had in place at the time she again, the amount of training she found to start off with she thought it was going to be kind of overbearing and then she broke it down and actually really, really enjoyed that, the training that there was in place at the time, because I think it was, it was quite a short period of time for the go live. So I think a lot of us were a bit concerned about getting all that completed in time, but actually people really rose to the challenge and thoroughly enjoyed it, and they really enjoyed getting their hands on as well and learning those practical skills as well as the theoretical, which is really helpful.
Keith Kendall
Yeah, that that’s a really good point. I’m glad you raised it this there Sarah about the hands on training. I think as you saying there some pharmacies were a bit nervous themselves about doing some of this stuff, especially with some of the conditions. And I suppose the checks they would need to have at the pharmacy to make sure that they’re doing the right thing for the patient. And there were a number of – there was a short time, wasn’t there, to be able to prepare for this. It was from November, I think, until the end of January. And guess what was right in the way was Christmas, wasn’t it, one of the busiest trading periods, not just for in pharmacy but for prescriptions as well. So not really a not great deal of time for people, but I think those sessions, those face-to-face sessions were really useful from what I’ve heard back from pharmacists about to give them confidence in what they’re doing in how to do the checks that they need to do and just to know that they’re not doing it in isolation. And that’s quite often an issue for pharmacists, isn’t it? We work in isolation, especially in community pharmacy and you don’t really know how you’re doing or what you need to work on.
Sarah, do you want to come back? And then I’ll bring Claire in?
Sarah Passmore
And I I think the other bit around that was that there was some really good videos just to help support. So after they’ve done the face to face training it was a nice way of then doing a reflection and kind of going over some of those things, especially after they’d had some of the initial consultation pieces just to keep that refresher and then re-remind themselves just about, you know, learning and it’s that ongoing learning as well as the initial learning which has been really helpful too.
Keith Kendall
Yeah. Thanks Sarah. Claire.
Claire Thomas
Thanks, Keith. On some reflections from my perspective, you know in my role supporting engagement with the service and previous experience with the CPCS service, we did have some challenges with GP engagement with colleagues being concerned about patient escalation or bounce backs, a lot of people saw that as the service was failing. And I think the introduction of the Pharmacy First clinical pathways element has actually really helped support and challenge some of those concerns because not only can the pharmacist now manage more patients to completion within the pharmacy setting, by explaining to our general practise colleagues the reason why some of these patients may need escalation (and it will be very small numbers, I think the escalation rates that we’re currently seeing are really, really low.) It is just that because these are strict clinical pathways, there are strict exclusion and inclusion criteria within the patient group directions. Being able to explain that to practice colleagues does help and helps them understand why we need those local discussions early on in implementation to agree how patients will be escalated and also reassure colleagues that these are minor illnesses and even where a patient falls out of scope of one of the clinical pathways and does need escalation, they don’t necessarily need a same day urgent appointment. So I think it’s about managing patient expectations and also helping to support that understanding from general practice colleagues that actually in a small number of cases patient escalation is appropriate.
And we all know, actually, once you sit down with the patient and start to take a history, it can sometimes be a different, actually a different condition that they’ve presented with that they’ve actually contacted the practice about in the 1st place. So we just need to ensure that there’s some sort of process in place. But in the main, this extension of the CPCS service to have clinical pathway is a massive improvement, a massive step forward on what we had before.
Keith Kendall
Thanks, Claire. Abi do you want to come back on that?
Abi Fraser
Thanks Keith, just one thing to add in that I think we haven’t mentioned just yet – the massive benefit to Pharmacy First for us was that there was suddenly an avenue created for patients to be treated without GP contact in the first place. So patients can walk in from the street without actually having to go through the referral process which was necessary within the community pharmacy consultation service. the CPCS, that came before.
Keith Kendall
Yeah, that’s a really good point. I’m glad you brought that up. Hoping to tease that out at some point during today. That was one of the big differences, wasn’t it with CPCS, is that there, was that walk in access, but only if the individual meets the criteria for the seven clinical conditions.
When they’re not referred and we’ll come to this and sure this will come out later on when they’re not referred and they walk in and they don’t meet those criteria, it’s a bit more difficult because they can’t really access the service in the same way.
Claire, is that? Do you want to come back or should I move on?
Claire Thomas
Just a little bit of feedback from some of our local contractors at a recent local pharmaceutical committee meeting.
That some of them have been trying to collect data on the number of walk ins that meet the clinical pathways and on average, a pharmacy appears to need to see between 5 and 7 patients as a walk in before they can identify one patient that actually meets the clinical pathway criteria. So I just wanted to highlight that although patients can walk in and that’s a very welcome part of this service.
I do think for this service to be successful and one point you know hopefully we’ll tease out at some point is around the tipping point within pharmacy for having a high volume of referrals helping to drive change within the pharmacy itself. I’d just like to highlight to listeners that if a patient is contacting a GP practice for any minor illness, not just one of the seven clinical conditions in the clinical pathway element that in order to to make this work and support our patients and our pharmacies, is that does need to be formally referred rather than verbally signposted.
And that will just help this service work well and help ensure those patients do get a dedicated appointment with a pharmacist.
Keith Kendall
Yeah, that, that, that’s a really good point and really important to make it clear, Claire, because if we make life too complicated for everybody, then it ends up being a bit of a mess and really we want as many patients to be able to access this service, whatever element of it, whether it’s minor illness or the clinical conditions when it’s appropriate, we want them all to be able to, to access it first time and not to have to jump around through too many hoops. But I even if a referral from the GP practice to the pharmacy and the pharmacy picking it up means that creates some capacity there, and then that’s one appointment, which would have been taken, which can be picked up by the pharmacy and somebody else can be seen a little bit quicker. I’m going to move this on a little bit if I can.
So, Omar, I’m going to try and bring you in first on this if that’s all right. One thing we all recognise from the Community Pharmacy Consultation Service was that not all GP practices were actively referring into the service.
As Claire was just alluding to it as well, not all practices were engaged with it for whatever reasons and that becomes a bit of a problem. So that’s prior to becoming Pharmacy First. But how do you think, how has Pharmacy First been a step forward compared to CPCS in encouraging practices to refer?
Omar Alisha
Yeah, I I could see that in my PCN. Some practices in our PCN didn’t get the idea. And to be honest, till now they are not heavy users of the service. And it’s like any new idea, any change, you will have people accept it at different rates? I think once GPs realised this is something that would benefit them and the patients it’s adding an extra capacity for better access. They go by the idea, but fundamentally I think why it’s worked for us is because the people, the key people who make it work, work together very well so that you’ve got the pharmacy the lead pharmacists and our access team in my practice where they manage the appointments in the practice they worked really well together and we made it part of our access pathway so. when we are processing patients requests for help, our access team can pick those patients who are suitable for the service and refer them on and the reason why it has been successful is because we managed to communicate clearly to our GPs and colleagues that the vast majority of these patients who go into the pharmacist are getting dealt with and not coming back. And yes, we accepted there would be about 20% or so of these patients coming back because they needed more inputs from the GPs. That’s fine. We have to look at the bigger percentage that have been managed to be dealt with and help us to free slots, appointments and deal with more patients on any given day. And I think that the other thing, especially at the beginning, it was a bit of a challenge is the capacity. The local pharmacists were struggling with capacity and that put some people off the service. But as I said when when the service did progress its capacity became better.
Keith Kendall
It’s really refreshing to hear that, that attitude and response to those patients that might need to be referred back because you’re absolutely right, some people do focus on the smaller percentage rather than the benefit to them that’s coming in.
Has anybody else got any views on that?
Abi?
Abi Fraser
I think that it’s a good time to bring in how we work in our locality, which is quite unique to us. We’ve developed a system with our local practices over the last few years that has developed into almost a triage system, so the practice has realised that care navigating people and sending people to pharmacy without an official referral pathway left a lot of uncertainty.
The reception team weren’t particularly happy with that to start with, and they didn’t know whether the patient did end up at a pharmacy or what the outcome was. So we could easily persuade them that the using the referral platform, for example in our area, we use PharmOutcomes to refer patients to pharmacy and she would, there was an audit trail. So multiple patients are sent daily, some of those patients, the practice staff know we won’t be able to treat. So they may not fit a clinical pathway, there may not be anything over the counter that is suitable to treat their minor illness, but the practice know we will refer back with enough information about the patient’s condition and how urgently they need access to a GP or another healthcare professional. That sometimes the on-call GP can deal with those patients much more efficiently than if they’d started at that point. They’ve already seen a healthcare professional, we’ve already made some judgements, we’ve made some notes and that may mean they don’t need to deal with that person for 24/48 hours, or it may end up just with the generation of a prescription without even a need for a discussion with the patient. So we’ve developed this, it’s not something that that happened overnight, but it to me it’s it’s where the service could lead if if everyone sort of gets on board with it.
Keith Kendall
Yeah. Thanks, Abi. And I think your set up with your pharmacy and the practice is a little bit different to many others out there, isn’t it? But as you say, it could be a way to move forward a model that people will look to take on. OK, thank you. Is anybody else going to have the comments, Dawn?
Dawn Cruikshank
Yeah. Thanks, Keith. I’m just thinking of the difference between the two practices I deal with – one of them makes referrals through the platform and another one signposts patients to me. So it just says go down the road, see Dawn and she’ll be able to help you.
Now, if they’re within the criteria for the seven common conditions, the practice does get information back and regarding the consultation that I’ve had with patients.
If it is outside that they don’t. So my concern is from both patient’s point of view and the practice’s point of view, if they just signposted, there’s no, like you said, Abi, there’s no audit trail to say that that patient has been seen and what the outcome was. Plus, we know that to expect somebody to come if it’s an official referral through the platform, we are able to contact them, arrange appointment times that suit them and suit us as well, because obviously they could turn up and we could be extremely busy. It could be our busiest point in time and they may have to wait a little bit.
So by getting an official referral, that means that we can sort of arrange our days a little bit better as well as getting a bit more information from the referrer regarding what the patient’s coming to attend for. But the biggest thing as well, if they’ve made the effort to contact the practice for some help and support and they get sign posted through to come to see me, but they don’t turn up. I’ve got no way of knowing that that that individual was supposed to come to see me.
So a little bit get lost to the system.
Keith Kendall
Sarah.
Sarah Passmore
And it’s just a backup Omar’s point before about those referrals back.
We find that has been really, really beneficial in that patient journey and the patient not feeling like they’re being bounced around sort of different healthcare professionals as well because like often they’ll have been referred into the pharmacy in the first place after speaking to the to the GP. And because we’ve had prompt referrals back into the medical centre, it means that the patient’s condition is being treated quite timely, which is really, really important for these particular conditions that that, that we’re treating. So we’ve found that really, really beneficial and helpful.
Keith Kendall
Omar, do you want to come in?
Omar Alisha
Yeah. I’ll just come to that point. What we do as well. We really deal with Pharmacy First as part of our pathways. Very integrated part of our pathway in the practice we refer to the pharmacy but also we aim sending a message an SMS message to the patients to say we’ve got your request, you have been referred to our colleagues who will look after you and they will see you, and we see that’s really powerful because the patient is not just being popped off to somebody else, they have been referred properly and communicated to the patient and the pharmacy are really good as well they let us know about the outcome. So, I think the communication is a key part here.
Keith Kendall
Yeah, that’s really good. I’ve seen your set up in Wakefield, Omar, and absolutely as you described it there, Pharmacy First is just one of the options. And if it fits Pharmacy First, that’s where it goes and it’s completely integrated. It’s really, really well set up and that means all the staff are right behind it and they just see it as one of the options for them to send patients through to get the care that they need.
Dawn, did you want to say something?
Dawn Cruikshank
Yeah, I didn’t know if it would be worthwhile bringing in a patient scenario at this point because I did receive a referral one evening sort of 5 clock on a Friday for a patient with an urinary tract infection.
They came to see me. I went through the full consultation.
And as we mentioned before, there are criteria for us to be able to supply and not be able to supply. This lady had diabetes, so I was not able to supply her antibiotics for an urinary tract infection. But what I was able to do was fill in all of the information, send it back to the practice. I contacted the practice and said if there’s any chance that a GP could please review the recommendations that I’ve made here and within 10 minutes I’ve got a prescription back so that was a Friday, five till six absolute nightmare time, but the patient was so appreciative she actually burst down in tears because she said I’d normally end up in hospital because I don’t get the antibiotics in time it hits her so fast and hard.
And I was able to sort it, sort of within really a half hour time schedule. So it’s the patience, isn’t it, that are getting the benefit from this service?
Keith Kendall
Exactly. That’s why we’re all here. And that’s done in partnership, isn’t it? That’s a great example of. working together for the patient’s benefit and really good example. Claire, do you want to come in and then we’re going to talk a bit more about patient benefits.
Claire Thomas
Yeah, I was just going to say Keith, that’s an excellent example Dawn of your local relationships because in my experience of trying to support this service, it is really key that those local relationships are strong and it’s fantastic that you’ve got that really close relationship with your GPs who are happy and willing to, you know, review your consultation details and respect the fact that you’re a clinician in your own right and despite the restrictions of the patient group directives. You know you’ve been able to use your clinical judgement and make a recommendation to the GP, which they’ve then been happy to help the patient out working together. So I think that’s a fantastic example of collaborative working and you know, and understanding the strengths of our pharmacists and the clinical skills we have, because I strongly believe this is a stepping stone towards independent prescribing. And I just, I would like to see, you know more of these great examples happening across the country. So thank you.
Keith Kendall
That’s great. Thank you. Thanks, Claire. So let’s delve into a bit more into the benefits of the service and it’ll be great if we can, we can share some other examples of the benefits, particularly for patients. And we’d like to talk about what they see as the benefits for patients and maybe share some examples.
We’ve had a really good one from you there, Dawn.
Dawn Cruikshank
I’ll just follow up with the number of times we get patients that are so so grateful and people with children particularly that keep coming back to us once they’ve had one consultation, they know that they can return to us and get the quick support and I think that’s key, isn’t it? They’re getting access to a healthcare professional. pretty much on that day and most of the time able to finish the full consultation with an outcome that they’re happy with, and even if we have to refer them back, we’re able to get that referral back into the practice and get it highlighted as something that requires further help from the GP so the patients – just it’s overwhelmingly positive the feedback we get from them.
Keith Kendall
And I think we said it at the very start about the accessibility of Community Pharmacy is really important and normally in the community. close to where people live and we know how accessible they can be and that accessibility also stretches to sometimes beyond the hours a GP practice is open. What do they do then?
And you know, it means that some patients, it’s more appropriate for to go to the pharmacy first and if they match it with the with the seven clinical conditions and then the criteria for that great, they can be seen. If not, they’re still in wings of an escalation and when that could be to GP out of hours if it’s out of hours or if it’s not that urgent to their GP practice for the next day.
So there’s any other examples? I hear the UTI example quite often and I know that NE and North Cumbria had a UTI patient group direction in place prior to Pharmacy First and very similar really emotional response is and powerful responses examples from patients. Abi do you want to come back?
Abigail Fraser
Yeah, there’s a definitely a couple of examples in our area, Keith, of what’s gone well recently. And we had a very local outbreak of strep here at a local primary school.
Which resulted in a huge number of phone calls to the practice that morning at 8:00am and this is an example for me whereby the minor illness element of Pharmacy First and referrals from practice to pharmacy can result in reassurance for patients and doesn’t always have to result in in treatments. Strep A isn’t covered within our sore throat PGD, but all of the patients that rang the practice that morning were referred to pharmacy after discussion with myself and the reception team and 95% of parents got reassurance that their children were seen in the pharmacy the same day and were sent away with reassurance. The ones that needed treatment were sent back to the GP on call, who was prepared for those to come and treated them the same day.
And the comment was that saved hours of practice time that day.
The other good example we’ve got in our in our area of the last couple of months.
We had patients that admit to the overuse of the urgent care centre for convenience purposes, so patients waiting until 6:00 PM to ring 111 and get an appointment rather than try to navigate the GP practice system.
But on this occasion a patient had been reluctant to go to the GP. On occasion she’d rang with persistent headaches. But she’d really put up with it, thinking there was no way she was going to get in front of in front of a GP.
And on this occasion she had rang the practice and was referred to the pharmacy. We saw her the same day and took her blood pressure. She ended up in in A&E. She was admitted hospital for two weeks with malignant hypertension and the GP described that intervention as lifesaving. So had she rang the practice and been told to ring back at 8:00 AM the next morning because there were no appointments. I don’t feel like she would ever have followed that up.
The one thing I think we’ve got to strive for to benefit patients even more and to improve their journey is a standardised level of service across community pharmacy. That’s the biggest frustration I see just now is that patients can go to one pharmacy and get one level of service and to another and maybe it doesn’t quite match up.
Keith Kendall
Yeah. And there is a standard service specification for Pharmacy First as there are for all commissioned services. And I think to a degree, we’ve got to appreciate this is a relatively new service. Especially with the seven clinical conditions. But you’re absolutely right. We’ve got something like 96% coverage of community pharmacies that are offering registered and offering the service and that service should be of a consistently high level.
When patients access it, they should get the same level of care and you know it’s you’ve shared some really good examples there of some really powerful examples of what a difference this service can make to patients.
Particularly and in terms of accessibility and you know, complementing what’s already there with GP practices and higher levels of service such as emergency department, we don’t want patients going to an emergency department because they have couldn’t get a GP appointment.
Especially when we’ve got the Pharmacy First service and as you said before, some of you is that if it’s not suitable for the for the Pharmacy First service, you’ve got to means of escalating a little bit quicker. So overall they’re going to get seen quicker than waiting 4 hours or more in A&E and then even maybe then they’ll get I’m sure they’ll get great care, but we don’t really want them to go there in the 1st place, do we, unless they really need to. So I’m going to move us on and ask us a bit about benefits to practices Omar.
What would you would say the main benefits to practices? Omar you touched on some a little bit earlier in terms of that route to be able to refer patients out?
Omar Alisha
Thanks. Yeah. I think for us, we just see it as integrated part of our access system. So, so we know this capacity is available on daily basis and we utilise it to maximise our resources and offer the best possible access to patients. And we’ve seen that in term of patient’s feedback that they found access to appointments in our practice relatively acceptable and also our referral rate to other services is really low, in terms of the walk-in centre or ED because we have created enough capacity to deal with the demand come our way. We usually end dealing with the demands come up for why and then in terms of the GP that they also find that useful because they end seeing the patients they need to see and these cases will be taken off their clinics and instead they will be seeing patients who need more GP input in their care.
So once this is clear to everyone and I think data is very important here, we share data with our clinicians in terms of the number of patients who are getting dealt with by the service and it’s a really powerful tool. So people start appreciate how important Pharmacy First is in terms of dealing with the with the demand that come our way.
Keith Kendall
So Omar, if you were to give a bit of advice to another practice, who maybe doesn’t see it the way that you do for Pharmacy First, what would what would you say to them?
Omar Alisha
I think that the most important thing you think about this as an integrated part of your services. This is not something else you have to do. It’s just not something else the system has asked you to do. This is something there to benefit you, to take work off you in a period of time, especially now we’re heading into the winter period where demand is going up and up. This is really a useful service to help us.
So once you get that and make it an integral part of your system or whatever system you use internally, most practices now are using modern journal practice approach in terms of managing access, you need to make Pharmacy First part of your access system and offer it to the appropriate patients and the key thing here is patient selection. You have to choose the right patients who meet the criteria so you can get high level of completion. If you send the wrong patients of course you’re going to get the wrong outcome.
And communication and work together with your local pharmacist is really key. I mean in our practice in Wakefield, the reason why it’s worked is because my team worked with Sarah’s team and they managed to build a really good relationship.
Communication on almost on daily basis to deal with teething issues, communications issues and it does work.
Keith Kendall
I think great points and I’m really glad that you made that last one about communication, building the right relationships, because it does need, if a practice is going to start referring, you need to engage with a community pharmacist. When the pharmacies started offering the service, the ask was engage with your practices, maybe sometimes the timing wasn’t quite right for everybody at the start, but you know we can reset, start again. And we’ve got the campaign coming up, which is going to raise awareness with the public lots more, be great if everybody can see that as an opportunity to really get behind the service again, work collaboratively, work together for the good of the patients.
I’m going to move us on a little bit again. I’m just going to just touch on a little bit about pharmacies. Obviously this is a service which the pharmacy is going to get paid for. There’s a fee for it and that’s right that the pharmacy get paid for it. But other than fees for the pharmacy, what else would you say are the benefits for pharmacies from your perspectives, particularly the pharmacists on the panel?
Go on Sarah, you go first.
Sarah Passmore
From my point of view it’s given our pharmacists the opportunity to use the skills and knowledge that they’ve always wanted to, in an environment that helps them bring that out, and then also it’s, we’ve used this opportunity to develop the skills of our staff and we changed our medicine sales protocol and the self-care and advice to include this pathway.
So we’ve got, we got the whole pharmacy team involved in it and it’s encouraged them to develop their skills further.
Keith Kendall
That’s great. Thank you, Sarah. Yeah, it’s satisfaction. Abi, you. You obviously wanted to come in.
Abigail Fraser
Yeah, just to just to reiterate what Sarah said for us, it was an opportunity to realign our workflow in the pharmacy and reconsider the use of our pharmacy team and their skills to ensure that the usual activities weren’t adversely affected.
The Pharmacy First structure gave our pharmacists and locums a lot more confidence than the CPCS system. So, some were put off by the uncertainty of that because this is the Pharmacy First, clinical pathways are very structured, our pharmacists were quick to engage with it.
Keith Kendall
And Claire, you want to come in?
Claire Thomas
Yeah, just building on the comments made so far in my experience in my role as Community Pharmacy Clinical Lead in South Yorkshire, in one area in South Yorkshire where we’ve got two pharmacies working very, very closely with their GP practice, there’s been a tipping point. So they’ve seen with the CPCS service actually initially they got such good local relationships and started to get in such high numbers of referrals through, it’s completely transformed the way that their pharmacy teams work. They like you’ve just mentioned there about skill mix, so they’ve utilised their team, in a different way, it’s enabling those pharmacists to focus on patients, obviously still overseeing the dispensing process, but they are heavily patient led. So they are service-led models of work where the pharmacist is front of house seeing patients one consultation after another. One of them has even been able to expand the premises and have additional consultation rooms. So it is really is key to have those good, strong local relationships and start to increase, I know there’s been a few mentions of concerns around capacity. Now in my experience, what we’ve seen here is it is a perceived problem, but actually the more referrals they get, it just leads to a change in practice and that and that they can meet that capacity, they can meet that demand. But while ever there’s only a small number of referrals coming through, so they’re not routine, they’re not, they’re not getting very many each day, they just end up squeezing them in between everything else they’re doing. It doesn’t drive change within the pharmacy.
So that’s really what I wanted to share that in my experience, when we start to see a volume, the pharmacy teams can manage.
They just need to have strong, good local relationships and start to look at different ways that can utilise the skills of their team.
Keith Kendall
Yeah, that ability to plan workload is, is really important, isn’t it?
Claire Thomas
Yep, it’s key.
Keith Kendall
And if you know that you’re going to get five referrals from your most local practice per day, but there probably won’t send you any more than that. Then you can plan to deal with them and handle them. All right. Thanks, everybody. We’ve covered quite a lot of ground and that’s really great. But I just want to finish with one last question and that’s more about the future. So from a community pharmacy and GP perspective. what could be done locally and nationally to really make the most of this service we have the campaign, the Pharmacy First campaign, coming up again very shortly and I know there was a lot of attention with the first one that came up. But what can be done from a community pharmacy and GP perspective to really make the most of this service because we made a great start?
Omar,
Omar Alisha
Thanks Keith. I think the IT issues still needs to be developed further. I mean we’re using different system to communicate when patients send back, they send back by emails it’s not really good. So I think ideally we would all need to work from one system or systems that can talk to each other and the referrals backwards and forwards needs really to be very, very smooth. The other thing as well, I think this would happen with time in term of the training with the pharmacist and using more clinical judgement because it’s still some variation depending on the pharmacist.
But that would come with other training opening hours. Obviously it’s a national issues with pharmacists would love to use Pharmacy First for extended access services as well. But we are restricted with the opening hours.
Keith Kendall
Dawn
Dawn Cruikshank
Well, what I’d like to see Keith would be an increase in the number of conditions that we’re able to treat through Pharmacy First. Give us the tools to enable us to treat more patients.
I’ve just completed my prescribing training and a lot of pharmacists are already either trained or in the process of being trained, and in 2026, all of the pharmacy students coming out will be getting qualifications in prescribing as well.
So I know there’s a lot of work being done nationally about putting the infrastructure in place to enable us to use that training and those skills. So I think the future, if we could look to expand what we’re already doing it would be greatly positive for everybody involved.
I would say patients mainly, obviously pharmacists, given that stability if you’ve got that critical mass where you can see patients and the practices where they’ve got the confidence that they’re able to sort of refer to us.
Keith Kendall
Thanks Dawn. And yeah, we’ve been on a journey for the last few years and say we, we’re talking about community pharmacy, to have an increase in clinical role.
And pharmacy First is a really important step in that and you mentioned and Claire you mentioned about independent prescribing and September 2026 when all pharmacists register, will be independent prescribers. So Pharmacy First helps bridge that gap, but it’s more than that, it’s also A means of supporting patients now rather than waiting for a couple of years, and I’m sure there’ll be a period of time where both are in place and overlap and work alongside each other for the for the benefit of patients.
Anybody else like to come in about what they see about the future? What can be done, maybe nationally? You mentioned IT, not GPIT Omar, but IT in general and how it integrates across the two systems, Claire?
Claire Thomas
Some sort of alignment of our contracts. So the GP contract and the Community Pharmacy Contract or framework?
Certainly from my role as a Community Pharmacy Clinical Lead, I think there have been challenges around the way the service has been commissioned and perhaps perhaps promoted to general practice and at times it can be challenging and Omar has highlighted all the benefits to practices that sometimes I think because of all the pressures, it’s difficult to sit to realise those benefits and maybe if there was something within the two contractual frameworks that supported those collaborative relationships, those local relationships and working together on services like this and hypertension case finding. For example. I think that would really help move us forward. You know, as primary care providers working together for the needs of our local patients.
Keith Kendall
Yeah, that’s a really important point. And yeah, I think we can, we can all see there’s some benefits in there in being more aligned across the contract for those benefits of patients. Well, that’s great. I just want to thank you all for joining us here. I particularly want to enjoy the say thank you to Dawn, Sarah, Abi and Omar and Claire for joining us and contributing to the podcast today, I think it’s been really useful and thank you very much and thank you for listening.