The Pharmacy First service takes referrals from 111 and Urgent and Emergency Care settings and general practice into community pharmacies. Pharmacies then provide a minor illness consultation, which may include the urgent supply of a medicine that would otherwise have to be prescribed by a GP.

As Andre Yeung, a senior pharmacist based within the North East and Cumbria area describes:

“The aim of the service is to address health inequalities, it’s to provide access for patients, it’s to prevent illnesses from getting worse and it’s also to create capacity for general practice as well.”

On 31 January 2024 the existing Community Pharmacist Consultation Service (CPCS) got a major upgrade and now pharmacists are able to supply prescription-only medicines to treat seven common conditions.

 Andre adds: “areas have really adapted to this new service; they’ve changed the way that they’re working between the practice and the pharmacies”

Whitburn Surgery is a relatively small practice with three GPs and around 5,500 patients.

Practice Manager Stacey Reid used Pharmacy First successfully at her last practice and recognises what a great tool it is for relieving pressure and creating capacity.

 Successful signposting and referrals

Says Stacey:

“The patient contacts the surgery in person or by online consultation to put in an appointment request. All our staff in reception and admin are trained as care navigators so they will identify if they’re suitable for the pharmacy scheme. They’ll offer this option to the patient explaining the process to them and then they’ll put the referral through – it never uses a GP or a nurse practitioner’s time.

“We have bespoke guides that we’ve created for our practice as we signpost out to a lot of services, which includes the national guidance for referring to the pharmacy. The pack includes age ranges and exclusions.”

Senior administrator Ashleigh Smith describes how this works for administrative colleagues in practice:

“A lot of people phone up for a cough and cold and they want to see a doctor – we ask them if they’ve been to the pharmacist?

“If they think they’re going to speak to our admin team rather than a doctor, they’re not happy to do that, but if they know it’s a trained pharmacist that can prescribe treatment it makes a big difference.”

Relieving burden

 GPs and patients at the practice have welcomed the new service with open arms

“Before the new service was brought in, seeing and treating these minor conditions would be taking an appointment away that was so desperately needed for more significant issues,” explains Stacey

“Although you’re asking the patients some questions, you’re not delving too much into the detail and most patients are quite happy to tell you briefly about what’s going on.”

The practice did some work to increase understanding of what should and shouldn’t routinely fall within GP remit. Once this training was in place staff felt confident that the practice was helping both staff and patients with the new approach.

Ashleigh says;

“You need to put the trust into your staff. In South Tyneside all of our practices are well trained in signposting and referrals and given the desperate need for GP appointments it seems crazy to not use the appropriate clinician for the appropriate thing.

“You’ve got to get your GPs on board and get them to understand that their time is better spent doing what only they can do, rather than seeing what a physio or a podiatrist can…. once they’re on board with that then the service works excellently.”

“Our GPs and the nurse practitioner took to it really well because it takes the workload from them to allow them to focus on other more specialised things.”

Patients are fans of the new service too due to the greater choice and convenience it offers them.

Ashleigh continues:

“Our patients really took to it – they’re getting seen quickly, efficiently and they can get a prescription if it’s certain things. When you talk about it to them they’re quite happy to give it a go especially working people because they can just go after work or pop in at dinner time.

Stacey adds: “It’s not clinical triage and we make that very clear to our patients. If the patient isn’t happy with that option, they can come back to us.”

Building relationships

 Through implementing the service, the practice has strengthened relationships with the local pharmacy and have put regular catchups about progress in place.

As is usual with the bedding in of a new way of working, it’s not always clear cut – some of the more complex cases still move between care providers, but patients still get the care that they need.

Stacey and Ashleigh talk through how pharmacy and GP practice work in tandem:

“Sometimes we do get things back from the pharmacy – that’s totally okay. They get in touch with us, and the patient can normally be back here within a couple of hours, which then allows us to still treat the patient the same day.

Ashleigh adds:

“They send through a document and call to say that a patient needs to be seen fairly soon or urgently and we’ll try and get them in with the GP. A lot of these requests stem from the times we’ve given patients advice at the time of referring them and said that if it doesn’t rectify within this certain time scale see your GP, but they have gone back to the pharmacy instead.”

 Information transfer from the point of care system

The information transfer enabled within Pharmacy First also has the potential to make things easier for staff and patients. Messages coming back from the pharmacies after patients have been seen either go directly into the email system as a task or as an email to the practice inbox.

Andre concludes:

“The information includes patient details, presenting condition, observations, anything they’ve tried already, medication and advice given.

“This is simply saved in the system by attaching the response to the patient record and marked as seen by the pharmacist. “

If you work in general practice and would like peer advice from other practices about how you can make this work in your practice or PCN, email the primary care transformation team for more information at england.ney.pctransformation@nhs.net