Keith Kendall
Hello everyone. My name is Keith Kendall. I’m a pharmacist and a Senior Pharmacy Integration lead for the North East and Yorkshire region for NHS England. Welcome to the Transforming Primary Care podcast. This is a Series 4 episode where we’re going to discuss the recent expansion of services delivered in Community Pharmacy, including the continuation of Pharmacy First and all happening at the time of a national public awareness campaign being underway. We’ve also got Pharmacy Contraception Service and the New Medicine Service, which have also been subject to recent announcements around expansions of those services. That was from the end of October 2025. And there’s also work underway to support the aims of the 10 year plan for health and lots of mentions in things like the medium-term planning framework.
Joining me today to discuss this topic are Fiona Burns, lead independent prescribing pharmacist and designated prescribing practitioner for Pharmacy Plus Health in West Yorkshire, we’ve got Philip Xiu, GP partner and designated prescribing practitioner at Alwoodley Medical Centre, West Yorkshire and Fiona and Philip Xiu work together. And we’ve got Taff Haque from Superintendent pharmacist from Taff’s Pharmacy in Humber in North Yorkshire. And you can see we’re spreading across the different ICBs. We have Elissa Ghamraoui, our pharmacist at Boots in Newcastle City centre in the North East in Cumbria and Anna Young non-medical prescribing independent prescribing development lead for primary care in South Yorkshire and also an advanced practice nurse. So welcome everybody.
I’m going to kick off first of all with a question -it’s because it’s been about a year since I last chaired a podcast and that was about nine months after the start of Pharmacy First. So now we’re even further along the road. What have been the most recent changes to NHS Community Pharmacy services and what are the benefits to patients in terms of access. I’m going to kick off with you, Elissa.
Elissa Ghamraoui
Thanks, Keith. So the recent expansion of the NHS Pharmacy services now includes emergency contraception, which I think is amazing for accessibility. Now pharmacists in England are able to provide women with convenient access to free emergency contraception.
It’s a great step in ensuring women can get the healthcare they need when they need it. Women can also visit their local pharmacist as a first port of call to access free contraception service advice, support and medication without the need for a GP or appointment.
Keith Kendall
Thank you, Elissa. And if you and anybody wants to chip in here, that’s fine. What is all the response you’re getting from patients?
Elissa Ghamraoui
The patients are actually very happy. A lot of them in the beginning didn’t know about the service and I think it is important to keep reminding patients that these services exist, but the usual feedback is that they’re surprised with the how convenient, how fast it is and how easy it is to access these services and how available because obviously there’s more pharmacies available and people can come in usually without even needing to have an appointment. So it’s mainly walk-in basis.
Keith Kendall
Thanks, Elissa. Taff, do you want to come in?
Taffazzal Haque
Yeah, thanks, Keith. Thanks, Elissa. I think with the addition of the emergency hormonal contraception to the current service that was provided already, it’s just been fantastic. It’s almost you can see we can do sort of the full breadth. It’s expanding the services to allow for more provisions, and I think the awareness is important, the more patients that become aware of it and you’ll see more utilisation of it.
And I think it deals with the discrepancy of local services that were prevalent, you know, in different areas. In one area you might have EHC service, in another area you might not have had it and now patients are able to sort of ‘oh pharmacies provide it’ so they can go to it. So again, that helps with the uptake of the service when there’s a national service that’s on provision.
Keith Kendall
Yeah, thanks. Thanks, Taff And do you want to talk a little bit about pharmacy first?
Taffazzal Haque
Yeah, yeah, absolutely. So obviously with Pharmacy First, we’re, what, two years in now? How quick that goes and initially from feeling almost it was a bit rushed when it came in. I feel there’s been improvements in three areas in my opinion on what I’m seeing on the ground. Essentially the patients firstly, you know the trust and the confidence that a patient will be dealt with, and they can get their conditions dealt with in the community pharmacy is definitely increased.
We’re seeing patients are now not only being referred by GPs, but coming themselves because they’ve either had previous experience or they know somebody that’s had an experience and perhaps advising friends and family to utilise the service .I think the other aspect for ourselves as pharmacists in in the pharmacies, you know, there’s definitely a growth in confidence and feeling more comfortable with it. It’s gone on from being sort of a bolt-on service to a part of the daily practice in a pharmacy, you know, everybody’s got their own way they deal with it, they might have different process involved, but it’s just become part and parcel of daily practice I think. And the other one which is quite important as well is our GP colleagues as well, sort of Philip Xiu’s here as well and he might give us some insight – there’s that trust and that working together that’s building.
So there has been expansion in services, but those sort of building relationships with our GP colleagues, you know, the rest of primary care. I think it’s really helped build that and these types of services, you know, in pharmacy affairs definitely has allowed for that, you know. So I think there’s a bit of work to be done, but overall positive I think definitely over the last few months for us , we’ve seen an uptake, but we’ve still got capacity to do more, sorry.
I don’t know what everyone else’s thoughts are, if they would sort of feel the same, but hopefully so.
Keith Kendall
Phil
Philip Xiu
Yeah, thanks. Thanks very much, Taff. Actually, you know, I very much echo what you said and I think you mentioned the word trust and I think that’s the foundation of this working relationship is trust. It’s about building upon mutual respect and the relationship that’s being built up through both education and interaction between two different colleagues and between the staff members. And if you increase trust and you work together, just like any new service or any new staff going through induction, you need a period of trust before it can be built upon, it can be expanded and that’s when potentially new services can come in as well.
Keith Kendall
Yeah, thanks, Philip. And Fiona.
Fiona Burns
Yeah, I was just going to just expand upon the contraception service. So I think there’s an interesting option around the supply and refer where you can a patient that is borderline exclusion criteria where the BMI or the blood pressure is just borderline, you can actually supply them with the contraception, but explain to the patient that you know they will need a further consultation before another supply can be made. So I think that’s really interesting as well. And some GP surgeries have managed to sort of offload quite a lot of workload with the contraception service being available in the community pharmacy, which I think is fantastic and then that kind of movement of the development of staff, so technicians can actually offer these services as well. So we’re seeing that shift in the staff in the community pharmacies and offering the pharmacists time to do a more clinical role.
The other thing as well is the traceability of the morning after pill as well. So it’s really good that you can see from the GP practice that patients are accessing the emergency hormonal contraception. So for example, if they’re using it for long term contraception, that information is there to tell the GP surgery so that they can have that deeper consultation to address long term contraception and also having those conversations both in the pharmacy and in the GP practice ties in with public health.
Keith Kendall
Yeah, yeah. I see your point there also about joining up the data that’s there, the information and to the patient record giving a more complete picture. And that’s always been a problem for Community Pharmacy is being a bit isolated and then having a limited snapshot of information and we yeah, we should recognise the accessibility of data and it is a bit of a game changer for Community Pharmacy and bringing it into the fold of the primary care team. Anna, did you want to bring a view in from outside of pharmacy?
Anna Young
Outside, from a nursing perspective, but also from a kind of general practice perspective. I know both Taff and Phil talked about relationship and that importance and one of the roles I’ve been doing over the last year is working with my experience of supporting and developing prescribers, but also my experience within the Faculty of Advancing Practice and supporting and developing advanced practice and the importance of supervision. And I just think we have to be really careful that we don’t rely on unofficial relationships, but actually there needs to be a structure and that’s some of the work that I’ve been doing in place to support structurally that supervision and support for community pharmacists because it can be a really, really isolating role.
I know from the work I’ve done in prescribing in out of hours and things, it can be really isolating. It’d be really difficult if you don’t have a relationship in a system in place in which you can get that support either as debrief or as a kind’ve’ I saw this patient and I wasn’t 100% sure. I’ve done this for them today, but actually can you pick them up in your surgery?’ And so whilst there’s some excellence or there’s examples of excellence in relationship like you know, Philip and Fiona have said they’ve worked together for years. I know within South Yorkshire when we’ve been doing the Pathfinder project, which we may explain a bit more in a minute and that’s where pharmacists are using their independent prescribing rather than working with Pharmacy First, which is a kind of set of conditions that people see.
What we don’t always get is, when you’ve got pharmacists that perhaps aren’t connected to GP surgeries, that actually those pharmacists need to know that there’s a support structure in place as they develop their skills as they expand their prescribing practice. So I think it’s two things, isn’t it? It’s brilliant relationships -it’s fantastic and that’s what needs to be the basis of it. But we need to ensure that as we go forward that we continue to advocate for systems that continue to support pharmacists as they develop and widen their skills and their scope of prescribing practice.
Keith Kendall
Yeah, thanks. Thanks very much, Anna. I think we’ll come to independent prescribing part in a little while and we’ll come to that. But just before we move on, Fiona, do you want to come in?
Fiona Burns
Yeah, I was just going to touch on the hypertension case finding in community pharmacy, which I think has been another excellent service, just tapping into the broader population and being able to identify patients with high blood pressure that perhaps haven’t had any checks done recently. I just think the, you know, blood pressure is that golden gate to a person’s health and if it’s not right, that can be the first sign in sort of finding out an underlying condition. So I think that’s just another really excellent service and really helps the accessibility that we have as well and just sort of ties in with other things.
The opportunity to offer the ABPM as well just means that you’ve nicely set up the patient ready for the clinician at the surgery to do the diagnosis part of the consultation. So yeah, another great service that we’ve been developing in community pharmacy.
Keith Kendall
Thanks very much.. Yeah, it’s important we don’t forget the hypertension case finding service as it’s properly called, often referred to as the BP check service, but is intended to be a case finding service for hypertension. It’s plays a really valuable role and we’ve all heard about the three shifts and obviously the move to greater prevention and pharmacy’s ideally placed to be able to pick up those patients who wouldn’t normally be seeing their healthcare professional and maybe less frequently seeing their GP or practice nurse.
But quite often patients come into the pharmacy very regularly, don’t they? Even if it’s just for a chat, to pick up the medicine or for a minor illness so that there’s a great opportunity to pick up with patients and offer a service and identify these people before it becomes a problem or before it’s even recognised. Just talking about the benefits to of some of the services that we’ve we’re talking about here from the viewpoint of the GP practice and maybe outside the GP practice, other professions, what do we see as being some of the benefits of these expansion of services, – what does that look like from a GP perspective or perhaps from a nurse perspective?
Philip Xiu
Thanks Keith. I can, I can weigh in on this. Now from my perspective as a GP, I think probably the keyword here is collaboration because all these services that’s been mentioned in terms of Pharmacy 1st and Pathfinder services, they don’t work well in a silo and they work best as previously said with Anna in a system.
And in one integrated system is when pharmacies and practices can work together holistically. And I would say the fact that in Pathfinder and within the pharmacy first is not about offloading work from GP primary care onto the community pharmacies is really is about getting the right patient to the right clinician the first time around rather than anything else and increasing access and I can definitely see it working in in the practice that I’m at because we’ve seen a noticeable reduction in the number of requests for appointments, for example, the seven common conditions that’s covered under Pharmacy First and I think that’s mainly because they can go a pharmacy, they can have a clinical consultation and they can get the appropriate treatment if it is needed and it’s faster for the patients and it does free up capacity for us as well.
And I understand that for some pharmacies they’re open for example later in the evenings when the GPs are shut and also on Saturdays as well where when we’re shut as well. So I think overall it’s a great benefit to the patients in terms of access and what that means is the fact that by freeing up some of the GP’s time, that means I can dedicate some of my time to the more complex longer term conditions, maybe more detailed medications review or maybe manage diagnostic uncertainty and to answer queries that way, and I think that’s really good because it frees up capacity and the resources so that the patient can see the right person at the right place at the right time. And I think that’s going to be vital going forward, especially with the resource constraints that we live under. Over to you, Keith.
Keith Kendall
Yeah, thanks. Things aren’t getting easier, are they? Anna, do you want to come in?
Anna Young
Yeah, thank you. And I completely agree with you Phil and I think when you look at it in the context of the 10 year plan, the shift from hospital to community, you know things like working together with our community pharmacy colleagues are key to ensuring this happens -but that’s the key phrase working together – and you know I think to reassure public who are out there that there are lots of safeguards in place. So for example, when I do my clinical consultations, when I do my clinical day, I often see people who’ve come in because they’ve seen the pharmacist and be treated once for say vaginal thrush. But they can’t be seen again because the constraints at the moment within community pharmacy is they can’t do the investigations, find out is it actually, you know, vaginal thrush or is there something else going on? Is there other infections? Is there other issues that need an examination and that needs kind of further exploration?
So it’s fantastic to work together and myself as an advanced nurse practitioner, I can then say to the patient, ‘you know you did right do that. Do you know the community pharmacist can also see you if you have XY and Z in the future?’ So, it’s that collaboration going on and I think the other piece of work that I’ve been doing in South Yorkshire when we talk about kind of developing as a as a whole team, as a wider team is the education work that I do. So once a month I run webinars on supporting and developing independent prescribers in primary care and whilst working with the kind of Pathfinder pharmacists and all the community pharmacists in our patch, I’ve invited them into it as well so that they can listen and hear from experts on different clinical topics so that they feel that they’re up to date with all that’s going on in the wider clinical system.
So they’re not isolated and that’s the key phrase, is not being isolated. It’s seeing ourselves as a whole network working together for the benefit of patients, working together for the prevention, working together for the kind of community, you know, the shift from hospitals, community and as we get increasingly into the digitalisation of the NHS, you know, it’s working together on that as well and hopefully, well, one day, fingers crossed, have digital systems that will talk really easily to each other. So we won’t have quite so arduous processes of kind of letting each other know. I mean that would be a dream, wouldn’t it?
But yeah, fantastic. And I just think it’s great and I just think we’re one big family of healthcare professionals that are there to really support the patient and to really educate because that’s a massive part of it is educating patients about illness, what needs treating and what doesn’t, what can be self-care. You know, it’s not all about medicines. It’s about actually recognising the normal processes of being ill and it gives the patient confidence knowing that we’re all saying a similar thing and they can access that health advice from lots of different places. Thank you.
Keith Kendall
Yeah, great to hear that enthusiasm Anna there. And you point at the end there about self-care, really important because not everything needs to go to a healthcare professional and patients, the public probably need a greater education about what’s appropriate and where to go for the right level of support and obviously Pharmacy First is a really important point of capturing that. And if we all have the same levels of enthusiasm as you Anna and Philip there, then we’d be moving forward even faster. So just thinking about moving forward and a bit about the future, but community services, they have developed quite a bit over the last few years as we’ve been talking about. But what do you think that the areas could be to expand upon? What are the opportunities?
Wanted to hear from a couple of the pharmacists. First of all, I’ll come back to you, Elissa
Elissa Ghamraoui
So in terms of like expanding services, I think we are moving towards what’s kind of like available in in Scotland I think Pharmacy Pathfinder stuff as well. So it is really about increasing again availability and accessibility and collaborating with the GP surgeries all together to sort of be able to treat more minor illnesses in the pharmacy, getting pharmacists to do more services and seeing more patients rather than like the traditional way of thinking of a pharmacist being behind the counter and doing prescriptions.
Keith Kendall
Yeah, that’s that’s great, Elissa. Taff do you want to come in?
Taff Haque
Yeah. So obviously with Pathfinder, you know that I think that’s been one of the biggest shifts for us as an organisation. You know, this pilot has really changed the way in which we work and we can see like if you have horizon scoping, you can see how things will be going forward. So it’s touching on things like Anna, Philip and Elissa has talked about and Fiona as well. The difference with us in our site was we’re not directly co-located with another surgery.
So we had to forge those links and build that trust and demonstrate what we can and can’t do. I just, I don’t even know where to begin because there’s just been so many benefits with this pilot and you know it is coming to an end at some point, but we’re going to continue it in one fashion or other based on the sort of the relationships that we’ve built with our surgeries. For example, hypertension case finding, you know that’s a national service, but with one of the local surgeries for example, what we’ve done is we’ve gone in and we’ve got one of the models where we can treat sort of hypertensive patients already, you know, and that was the initial model that started off.
We sort of expanded that to deal with newly diagnosed because it fell nicely in line with the hypertension case finding service where you detect something, you do an ABPM, but then we have to pass it back to the GP. So we’ve expanded that now -it’s gone to a point where the surgery that we’re working with really well, they’ve just said blanket anything that’s hypertension, anything with blood pressure, send it to the Pharmacy and via the mechanisms that we have got. And that makes it I think easier for the practice as well on all levels, whether it’s the care navigators, receptionists or admin staff. They just know, if it’s blood pressure, they can deal with that at the Pharmacy and it’s another aspect of this pilot, or this expansion of service, and that’s I think we miss out on and we don’t really look at is the fact the satisfaction and the development for our clinicians, our pharmacists, you know we’re moving away from that ticking a box for a pharmacist in the back somewhere where you’re adopting technology and you’re letting dispensers and maybe technicians deal with that and you’re moving out and you have a sense of satisfaction. It’s really helping with our retention of staffing as well.
We’ve got pharmacists coming from far, far afield when they can have a comfortable job locally doing, you know, the old type of sort of pharmacist role jobs, but they’re coming further afield because they’re seeing, ‘oh, there’s stimulation there, there’s something different there.’ They’re utilising their sort of knowledge, you know, and things like that. So I think this expansion not only helps with patients and relationships, but also as a profession for us to develop and retain staff within community pharmacy, if that makes sense, Keith, I don’t know if everyone else sees that or the Pathfinder sites.
Keith Kendall
Yeah, yeah.I think we’ll come to Phil in a second. I think you mentioned the pharmacies independent prescriber Pathfinder programme which is coming to the end at the end of December and we’ll talk a little bit more about the future in in a minute, but we’ve had just over 40 Pathfinder sites across the North East and Yorkshire I’ve been delighted with the amount of passion and the drive that’s been in there both from those sites but also from the integrated care system community pharmacy leads as well really support supporting and really starting from almost zero base to develop these clinical models as you were describing there Taff. I know the similar ones in West Yorkshire and in the other ICBs as well. So yeah, really exciting things. Phil, I think you wanted to come in on this bit.
Philip Xiu
Just want to really support what Taff said really. You know, I love to hear that sort of natural organic expansion of the hypertension work that you’ve been doing. And I think that’s the logical step really because obviously there’s no reason why it can’t be scaled up in that fashion.
It’s logically sequentially and safely and I think from the sounds of it, you know you’ve really taken to be working not just with the GPs in terms of their requirements, but also the demands of the local population because at the heart of all of this and everything that we do, we should be putting the patients first and obviously one community pharmacy in one different geographic location may serve a completely different population need to elsewhere and I think I think that’s key to all of this is the fact that you know as things are introduced or expanded upon the actual natural force of things that we go along should be really be dictated by the demands of the local population and their care needs as well as actually the needs of the GPs in that location and of course the skill set and the support network that’s been given as well.
So I really love that example there that you had Taff.
Keith Kendall
Anna –
Anna Young
Thank you both. I agree. I agree with totally what everyone’s saying, and I love that kind of example of how things can be different depending on the different system. You know, where I work, it’s an area of high deprivation and there’s a lot of health illiteracy, there’s a lot of use of interpreters and I know that has been an issue with the Pathfinder project, hasn’t there, about perhaps not having interpreters used within it. And I think that’s an interesting feedback to the national team about actually to understand the kind of the nuance of the system in different places that one size doesn’t fit all.
But I really love that kind of idea of pharmacists and practice nurses working together with the kind of medication and then the education side that practice nurses do so well and actually there there’s a kind of you know collaboration that that can be formed there which is fantastic and I think when we talk about the future of Community Pharmacy and what they can do, especially as we know that the future is that all pharmacists will be independent prescribers. I think it’s really important again to go back to that supervision and development and ensuring that community pharmacists have a system where they can continue to grow and expand their prescribing practice, not just independently as a stand-alone service, but actually alongside the wider primary care system.
So when we’re talking about neighbourhood working, we’re all working together. We’ve got the same education pathway, we’ve got the same development pathway that you know community pharmacists who have incredible difficulty being released to come to training events because they might be the only prescriber in that practice and I think we have to be really real about what the pressures are for community pharmacists.
But I think if we can work together as health professionals as a system, I think it’s you know there’s a real potential for like you say patients first that actually if somebody’s working Monday to Friday, 9 to 5, they can suddenly access all of their healthcare, you know, a lot of their healthcare at the community pharmacist because that works really well for them, you know, potentially asthma reviews, all of that kind of thing, could be done within a community pharmacy setting.
But actually if there’s another issue that goes on, there’s a there’s a wider system issue with health literacy than that pharmacy, community pharmacy can work with the local surgery to look at what’s the nuance for that practice population. Yeah, I think it’s a really exciting future. Fiona –
Fiona Burns
Yeah, I was just going to mention around the Pathfinder service that I’ve been running since March 2024. There’s something really special about prescribing in the community pharmacy sector. It’s that more informal environment that suits certain people or helps with patients that we have the white coat syndrome, it just offers that accessibility.
So like the extended minor elements that I offer, you know to be able to offer it on the late evenings and the Saturdays, you know the sort of six patients I see in the morning that you know they would be presenting at A&E or an out of hours It’s just been fantastic and also it’s been quite interesting seeing the progression of the hypertension case findings, so being able to initiate blood pressure and taking it a step further within the pharmacy, that’s been really great.
There’s the fact that we’re really good communicators in community pharmacy and we’re good at explaining things and having that sort of key eye on compliance and things like that, that I think the lipids model works really well.
So with the lipid model, patients don’t feel poorly. So there’s a bit of a conversation to be had of why they’ve got this cardiovascular risk. They don’t feel poorly and you know they need to come to terms with why they need to be on this tablet. And often I can start them on it. They go home and they read something in, say, the Daily Mail or a family member has a chat with them about it and then the fact they can actually ring me and get through to me direct, that they can pop in in between appointments so I can address all that new agenda that comes out as a result of that first consultation of starting the monostatin. So it’s just been a really sort of interesting, excellent model – has really good collaboration with surgery as well.
But I think that one’s probably been the most interesting of all and we’re looking into offering inclisoran injections as well as part of the lipid model. The other thing as well is the fact that we’re sort of tackling those health inequalities right in the heart of our neighbourhoods. So we’re reaching out to patients that are finding it difficult to get into the GP surgery in the usual way.
So perhaps they’ve got mental health issues and they haven’t got the patience to, you know, sit on the phone or they’re elderly and they’re hard of hearing on the phone or they’re IT illiterate or there might be like shift workers that you know, pop in when they wake up in the morning at half four and then they’ve missed an appointment for the day so we can see them for an extended minor illness.
So yeah, there’s just something really special about that prescribing in the community pharmacy, just providing that like personalised, tailored feel that you know we can bring through community pharmacies and you know we know our patients well as well like it’s the same team, same pharmacist. So again when they’re poorly, you would spot that because you know you know your patients.
Keith Kendall
Yeah. And a lot of that the trust we talked about earlier on comes from building that relationship with the local pharmacist and not just the local pharmacist, but the team as well. We talked earlier on, didn’t you, about the pharmacy technicians and the increasing role for those because they are stepping up and taking on a bigger role in a pharmacy which is freeing up the pharmacies to do things like these advanced services and the acting as independent prescribers and obviously being a prescriber gives you the opportunity to do that little bit more than is going on in most pharmacies and that’s what the Pathfinder programme has really proved the benefit from and certainly some of the feedback that the different integrated care systems have had from the patients accessing the service has been really, really positive. I’m sure that will come through in the evaluation of the Pathfinder programme.
The Independent Prescribing Pathfinder Programme or IP Pathfinder Programme was introduced in 2023 and is put in place to inform the future commissioning framework for independent prescribing in community pharmacy services.
The programme is intended to explore how community pharmacists and the teams can deliver an integrated clinical service which aligns to prescribing activity with general practise and it meets the population needs of local communities. So the ICSs, the integrated care systems, of which we have 4 in the North East and Yorkshire, were invited to submit an expression of interest that was supported by the board, and funding was approved for all four of our ICSs to proceed.
The Pathfinder programme has now been running, it’s now November 2025, and it’s coming to an end in December 2025.And some sites will continue with a clinical model, which has received some funding from outside the Pathfinder programme, and that’s cardiovascular disease funding. Those sites will continue with those clinical models until the end of March.
We now wait for the future decisions about how the Pathfinder programme and the evaluation which will be published shortly will inform the future commissioning framework and that means the community pharmacy contractual framework which will continue to be commissioned into the following years.
So we’re currently working through 25/26 and would expect the future commissioning framework for 26/27 to be in place early, early in the new financial year, if not by April.
Taff Do you want to come in and bring some points in?
Taff Haque
Yeah, definitely. Thanks Fiona for sharing those bits because our site as a Pathfinder site as well, I can definitely say our experience has been the same. You’ve got some really great examples there of how well it works. The additional, I don’t know if you yourselves are doing this model, but we’re doing one which is the unavailable meds model and it’s definitely not a clinically demanding model, but I cannot believe the unbelievable amount of benefits brought to ourselves and our GP colleagues.
The model basically consists of if somebody presents with a prescription and it’s unavailable, we will just change it to the suitable alternative based on what is available or not. I think if we go back the best part of two years when we didn’t have this model and we weren’t utilising it, the amount of time, energy, effort not only of the pharmacy team but the surgery team, the patient that is being saved is incredible. I think most of our GP colleagues that are in our patch and we’re doing the service quite well for at the moment, they’re dreading the day that all those sort of requests will be going back. You know when we did sort of a cost evaluation of time, it’s unbelievable.
You know from the point of when we’re presented with a prescription to when it could potentially come back a couple of days you know for a patient and it’s such a small, little model, but it’s made such a difference on the ground. You know another thing that Anna sort of mentioned earlier on, I just wanted to pick up on that was you know the support and supervision that’s required when we’re prescribing in community pharmacy because we definitely are siloed. You know, most pharmacies have one pharmacist and you’re on your own, you’re making a decision, do you know what to do, what not to do? Pathfinder, thanks to NHS England, or you know, the powers that be, you know, has enabled us on our side to have 2,3, sometimes 4 pharmacists on site.
The difference – I worked in general practice – so the difference between you know, being able to ring someone and then just walk into the next room and knock on the door. I’m not sure about that. What do you think? It’s been game changing, it’s such a massive shift and I think I’m really for hopefully whether it’s the next contractual negotiations or where it falls or who’s who it’s up to is pharmacies do need more than one clinician like that in practice regularly if we are to do these type of services.
So when we talk about expansion, we need to make sure it’s got the right sort of backing and not just funding. You know, the model needs to change and that’s been so different for us. You know, here on my side, you know, I’ve got pharmacists below me, besides me everywhere and that makes a difference, you know, when we talk about vision having structure supervision, having a senior in where you can discuss or XYZ to just thought I’d touch on that before I forgot. I know but thank you Anna for discussing that before but I thought that that’s definitely important going forward Keith if that if that will make sense.
Keith Kendall
Do you want to come back on that, Anna?
Anna Young
Yeah, no, I totally agree. And I think one of the things that or the phrase that came to when Fiona was talking was about kind of every profession has superpowers and there’s different things that each of us do really, really well through our professional training. But just as you’ve kind of eloquently said again, Taff, we can’t do that in isolation.
Our profession superpowers are fantastic, but actually we need to be with our other superheroes in the other professions and have a structural model that enables that ongoing support and supervision because otherwise people won’t expand their prescribing. They won’t have the confidence to use it. They won’t be able to kind of make sure that, you know, they are happy to continue to take on new ways of working because they feel isolated and they feel vulnerable and that happens to us all. It doesn’t matter who we are, what profession we are, when we’re not working in a team, it can be really isolating.
So I think, yeah, definitely the kind of word going forward to the powers that be and the way the structures are funded in the future is, is making sure that people have got that that wrap around support and supervision, that we can work together as a team, definitely.
Keith Kendall
I think it’s a really good point Anna and thanks Taff as well for the point. I think you really described a really good enabler for the future for how community pharmacy can progress and working in collaboration with the with the other healthcare professionals in the local area.
Neighbourhoods has been mentioned but probably unofficially and that’s obviously something that is upcoming and is being developed at the moment and should provide some great opportunities for community pharmacy to play a part in what what’s being developed. Just it’d be interesting to hear from others apart from the things we’ve described already.
What do you think of the enablers to enable community pharmacies to play its role really along with other healthcare professionals in the future developments as described in the medium term planning document. What do we need? You mentioned a couple of things such as access to translation service. I know that’s not necessarily consistently available across each of the ICBs and finance is always the things that seems to get in the way of these things. Not that it’s not important. Fiona, do you want to come in?
Yeah, I just wanted to stress the importance of collaboration, which I know Phil mentioned as well. And Taff was saying about the isolation that community pharmacies have being like the the only community pharmacist on site and not used to sort of networking with other healthcare professionals and having someone.to run things by.
So the collaboration has been key – pivotal to the success of Pathfinder. And it’s that kind of walking in each other’s shoes, sharing each other’s perspectives that you kind of gain this mutual respect and understanding, you know, and often you can come with an idea, so many challenges and hurdles when you are doing something new and innovative that,you know ,that it can be a no at first, but then you’re showing your perspective and that can plant a seed and then you can sort of communicate back and forth and then that no can become a yes.
So I think it’s just, you know, doing that networking with the GP surgeries, but also it’s so interesting seeing the other community pharmacies, the relationships that we’ve built with other pharmacies that don’t belong to the same company as ourselves and that network that we’ve built that we are seeing now, you know, we’re all learning and we’ve all got other healthcare professionals to bounce ideas off or you know, for second opinions or for support. So I think that has been fantastic. We need to continue that networking, encourage that for other community pharmacists as well.
Keith Kendall
Taff –
Taff Haque
For me, the one thing that comes to mind straight away is the digital transformation. So the digital infrastructure needs to be in place. I think if we went back a couple of years pre sort of the pilot, you know and then coming here today to the journey that we’ve taken, it’s required a lot of effort and that is key. You know, having that access to the patient record is so important and having the infrastructure for me straight away, I always think, OK, when this is all done and understood, how would we resurrect it or how does it continue? It’s maintaining that digital sort of. That’s one aspect, there’s multiple things I’m sure my colleagues here will mention, but that’s the first thing that springs to mind. And is making sure that there’s a safe and effective access to records to be able to keep everything in sight and it’s safe, isn’t it?
Anna Young
Yeah, agree with you Taff because the fact that as a community pharmacist you’re doing hypertension reviews and yet you can’t order the bloods on the same system. You can’t refer for an ECG or kind of see the results. I just think it’s bonkers in this day and age and I think for it to continue to progress, continue to have genuine neighbourhood working, there needs to be, you know, community nursing, community pharmacy, general practice, the kind of voluntary agencies there all needs to be some kind of shared platform where -maybe not voluntary services for all the clinical stuff, but do you know what I mean? – some shared platform for clinical chats and just to be able to, you know, send messages and to kind of keep that one team together for the patient.
Taff Haque
Exactly. Anna. I think if we can’t speak to each other, if we can’t communicate with each other and how are you providing the best level of care, we’re talking about neighbourhood teams, does that make sense? So I 100% agree with you. In an ideal world, there’ll be one record and one platform to rule them all. If my reference to Lord of the Rings isn’t missed, but I don’t know ,Keith, can you make that happen?
Keith Kendall
Yeah, yeah. Well, we’ll move on from that, Gandalf. No it’s a really good point. And to go back to something that was mentioned earlier on as well, it’s having the access to the information is really important, but also the opportunity to talk to each other and discuss different cases I think, you mentioned earlier on Anna ,and I’m glad you recognise that it’s really difficult to release community pharmacists currently with the way with the law stands and hopefully we’ll have a bit more flexibility going forward.
And also going forward a little bit, we talked there about what might happen with the Community Pharmacy contractual framework. Yes, we’ve had the Pathfinder programme -it’s been really, really valuable in terms of its learnings and what we’ve taken from it and I think part of that has been overcoming some of the limitations of what’s been able to be done, such as the EPS system, there’ll be lots of learnings digitally – access to information going forward as well.
But I suppose when we take those learnings, it’s now about taking it to the next stage. It’s about what happens in terms of commissioning, whether that’s through national commissioning through the Community Pharmacy contractual framework. Some of that might well be some of the services you’ve mentioned there. So expansion on what we currently do expansions of Pharmacy First, it might be a medicine supply service as an alternative as you described there Taff – that feels like a fairly simple way going forward. So that’s all needs to be considered.
So we need that time for negotiations and discussions to happen between the department, NHSE and Community Pharmacy England as the representative body. So that’s not going to come straight away.
But we’ve learned an awful lot from Pathfinder, as I’ve said, which will inform the future. And we’ve also got thousands of independent prescribers which are going to be coming out as qualified pharmacists and being able to prescribe from September next year, 2026. So we want to be able to make sure that they have the opportunity to work at the top of their licence as well and provide the maximum benefit and opportunity to support patients.
So it’s been a really fantastic discussion everybody. I just want to say thank you for your contributions. It’s been really great to hear not just from the pharmacists but also from colleagues outside pharmacy and hear their passion and enthusiasm for working with their pharmacist colleagues and not just pharmacists, but also the pharmacy technicians as I said before, playing a bigger role within the pharmacy. So it’s been really great to hear that enthusiasm and passion come across and yeah, just really want to thank you all for your time. And I’m sure this will be a really helpful listen for those who are looking to work with pharmacy going forward and also for those pharmacies who are looking to start to get a bit more excited about the future and about the bigger role that they can play. Thank you.