Organisation objective
- NHS Mandate from Government
Working with people and communities:
- Qualitative data and insight, for example, national surveys; complaints
- Quantitative data and insight, for example national surveys
- Other (please list below)
Utilising data and evidence is an integral part of our approach to policy development. We have engaged pharmacy representative and professional bodies and groups such as Healthwatch as the Pharmacy First Service has been developed. Additionally, through the NHS England Clinical Pathway Development Group clinical experts have supported the development of the seven clinical pathways for the service. Whilst developing the service we have also drawn on the findings of the 2022 Ipsos ‘Public Perceptions of Community Pharmacy’ survey which provides insight on aspects such as: which services and types of pharmacies are most used, and public perceptions of pharmacies delivering minor illness services.
For both of the expanded services (Blood Pressure Check Service and the Pharmacy Contraception Service) and the Community Pharmacist Consultation Service which preceded Pharmacy First, these national services have been developed using the evaluation and findings from Pharmacy Integration Fund pilots. This has included engaging clinical experts and pharmacy professionals, engaging with patient groups from charity organisations such as the British Hypertension Society (blood pressure) and the Meningitis Trust (CPCS), and interviewing patients to inform service design and the impact of user experience.
Executive summary
The Delivery Plan for Recovering Access to Primary Care, published in May 2023, included three community pharmacy commitments:
- Launching the Pharmacy First service and enabling the supply of NHS medicines for seven conditions;
- Increasing the provision of the community pharmacy NHS Pharmacy Contraception Service and the Blood Pressure Checks Service; and
- Investing to significantly improve the digital infrastructure between general practice and community pharmacy.
These commitments are expected to save 10 million appointments in general practice a year once fully implemented and improve access to care for patients.
In the eight months since publication, significant progress has been made against these ambitions. Contraception and blood pressure services were expanded in December 2023, and the launch of the Pharmacy First service is on track for 31 January 2024.
This is a significant moment for community pharmacy recognising the importance of pharmacy teams to the NHS and their vital role in the delivery of patient facing services. It builds on the growing range of patient facing services which have been introduced into pharmacies over the past five years, alongside the contributions of the sector in supporting patients throughout COVID-19, including through the pivotal role of the sector in the COVID-19 vaccination programme.
Action required
The Board is asked to note the information provided in the report.
Background
Strategic context
1. Community pharmacy is a crucial part of primary care and the health system. Around 22 million adults in England visit a community pharmacy for advice about a minor health problem each year (Public Perceptions of Community Pharmacy | Ipsos). 80% of people in England live within a 20-minute walk of a pharmacy, and they play an essential role in addressing health inequalities with twice as many pharmacies in areas of higher Community pharmacies are well regarded with around nine in ten people surveyed positively rating the advice they received from their local pharmacy, with public support for the further expansion of services across the sector (Public Perceptions of Community Pharmacy | Ipsos).
2 Through the five year Community Pharmacy Contractual Framework (2019- 2024) community pharmacies have – alongside providing medicines advice and supply and increased provision of clinical services – become the first port of call for healthy living and minor illness support, and have become further integrated into the NHS, supporting the management of demand in general practice and urgent care settings.
3. The Pharmacy First service will expand community pharmacy’s role in the overall health system. It will launch from 31 January 2024 and will build on current services meaning community pharmacies can complete an episode of care for people with seven common conditions- sinusitis, sore throat, earache, infected insect bite, impetigo, shingles, and uncomplicated urinary tract infections in women. Together with expansion of the pharmacy contraception and blood pressure services introduced in December 2023, this is expected to save 10 million appointments in general practice a year once fully implemented and improve convenience for patients.
4. Pharmacists and their teams are qualified and talented professionals and furthering the scope of their work with the NHS is a benefit to patients. Launching the Pharmacy First service shows our intention to continue to work with the sector to further expand the contribution made by community pharmacy teams to patients, their communities and the health system. It is part of a series of strategic developments that encompass optimising skill mix in pharmacy and enabling independent prescribing.
5. It should be noted that although there is an impressive uptake of contractors, the minimum contractual expectation to secure the fixed payment for the delivery of Pharmacy First is staggered. This is to reflect the need for contractors to adapt as we roll out the new service.
Progress to date
A. Negotiations
6. Negotiations with Community Pharmacy England on the Pharmacy First service and expansion of the contraception and blood pressure services concluded constructively in November 2023. The service specifications have been published on the NHS England website – NHS England » Community Pharmacy advanced service specification: NHS Pharmacy First Service and NHS England » NHS Pharmacy Contraception Service. Additional details on the service are in A
7. The previous Community Pharmacist Consultation Service (for urgent repeat medicine supply and minor illness) and the seven new clinical pathways will combine, to form the Pharmacy First service. The clinical pathways element of Pharmacy First, alongside the expansions of the blood pressure and contraception services, is funded from additional investment announced in the delivery plan. Existing services and dispensing activity, including those elements previously commissioned as the Community Pharmacist Consultation Service, will continue to be funded by existing Community Pharmacy Contractual Framework funding.
B. Clinical Development
8. When delivering the Pharmacy First service, pharmacists will follow a robust clinical pathway which includes self-care and safety-netting advice and, if appropriate, supplying a restricted set of prescription only medicines via Patient Group Directions (PGDs) and Over the Counter (OTC) medicines via clinical protocol for seven health conditions without the need to visit general practice.
9. Through the NHS England Clinical Pathway Development Group, clinical experts have supported the development of the seven Pharmacy First clinical pathways. Pharmacies already play a key role in advocating for appropriate use of antimicrobials. Clinical pathway consultations under the new service will be designed to incorporate the principles of antimicrobial stewardship and collaborative decision-making. These have been developed in line with the National Institute for Health and Clinical Excellence (NICE) guidelines to ensure they are evidence-based and do not promote inappropriate use of antimicrobials whilst ensuring patients are not unnecessarily referred to another health care professional. National templates for PGDs have also been developed to allow the supply of NHS
10. The seven clinical pathways and twenty-three PGDs have been published on the NHS England website.
C. IT system connectivity
11. We are investing to significantly improve the digital infrastructure connecting general practice and community pharmacy to streamline referrals, increase access to more parts of the GP patient record, and improve how GP records are updated following pharmacy consultations.
12. We are working closely with general practice and pharmacy IT system suppliers to update their clinical systems to support the launch of Pharmacy First. Throughout February 2024, pharmacies will become the first care setting in the NHS to be able to send structured updates into general practice, which will arrive seamlessly into workflows for review before being automatically filed into the patient record. This will save significant time in general practice teams by removing the need for staff to transcribe information from emails.
13. Suppliers are also being supported to develop the capability to send GP referrals straight into community pharmacy workflows, moving further away from NHSmail, and giving community pharmacy more access to parts of the GP record to support consultations. This will further integrate community pharmacy with wider NHS services.
14. NHS BSA will upgrade systems to collect additional information to reimburse and renumerate pharmacy contractors, and to monitor Pharmacy First prescribing rates at a local and national level to report to the AMR Programme Board.
15. NHS Pathways will upgrade the clinical triage system to send electronic referrals from NHS 111 and Urgent and Emergency Care settings to community pharmacy where a patient meets the criteria for the Pharmacy First service.
Mobilisation
16. The expansion of the community pharmacy oral contraception and blood pressure services in December 2023 has been successful with 3,406 and 9,449 contractors signed-up (15 January 2024) respectively. Pharmacy First is due to launch 31 January 2024. Participation is voluntary but sign up has been extremely high with 9,918 pharmacies signed up as of 17 January, which is over 92% of all pharmacies in England. We are confident that the IT system suppliers will have the digital infrastructure ready for the Pharmacy First service launch and are grateful for the significant development and testing work to achieve this.
17. A public campaign to support patient awareness and use of Pharmacy First will begin in February and run until the end of March 2024. This will target adults aged 18-40, who are more likely to experience the minor health conditions that the common conditions service covers or have children likely to experience these conditions, and who can sometimes face more barriers to accessing GP appointments (for example during working hours). The campaign will use multiple channels and supported through NHS and government communication.
18. We will closely monitor the Pharmacy First service post-launch, particularly in relation to antimicrobial supply to guard against the risk of increasing antimicrobial resistance, and the National Institute for Health and Care Research (NIHR) are in the process of commissioning an evaluation of this service.
Conclusion
19. The rollout our Pharmacy First is part of the NHS and government’s primary care access recovery plan, announced by the Chief Executive and Prime Minister in May, which committed to making it quicker and easier for millions of people to access healthcare on their high street. The NHS has delivered on our promise.
20. Community pharmacy already plays a key role in delivering high quality and convenient care for people in the heart of local communities. The introduction of Pharmacy First from 31 January will help people access the right NHS treatment and advice for minor illnesses whilst freeing up general practice time for those with more complex needs.
21. Pharmacy First is an exciting step forward for the sector and the NHS more widely. This is reflected in the strong support from stakeholders and the profession. The successful design and roll out of this service is another example of the health service delivering innovative and new services for our patients.
Annex A
Additional Detail on the Pharmacy First service
1. Pharmacy First is an advanced service and replaces the Community Pharmacist Consultation Service (CPCS). The full service consists of 3 elements:
- Pharmacy First (clinical pathways) – new element
- Pharmacy First (urgent repeat medicine supply) – previously commissioned as the CPCS
- Pharmacy First (NHS referrals for minor illness) – previously commissioned as the CPCS
2. The clinical pathways element of Pharmacy First will enable pharmacists to offer advice to patients and supply NHS medicines (including some prescription-only medicines under PGDs, where clinically appropriate, to treat seven common health conditions (see para 6).
3. The existing referral routes into CPCS will apply to the new clinical pathways element. Patients can self-refer to a pharmacy for the clinical pathways (subject to the patient being assessed by the pharmacist as passing a clinically established gateway point in the relevant clinical pathway).
4. Pharmacy contractors can remotely deliver Pharmacy First where it is safe to do so, and with suitable safeguards to ensure face-to-face clinical assessment are provided in person or by good-quality video consultation where needed. Distance selling pharmacies (DSPs) will provide the service for six of the seven conditions, excluding the earache pathway. DSPs will not provide Pharmacy First (clinical pathways) on their pharmacy premises due to the links with the support for self-care essential service and the restrictions regarding the provision of essential services set out in the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013.