Primary care
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Pharmacy First is something to celebrate

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England’s long-awaited Pharmacy First service commenced on 31st January, and for patients and clinicians alike, this represents a rare bit of good news at a tough time for primary care, and community pharmacies in particular. 

The scheme brings new funding to the sector at a time when many are struggling to keep the lights on. It offers pharmacists a valuable chance to make the most of their skills, and lays the foundations for pharmacy to play an even greater role in the delivery of primary care.

Community pharmacists have embraced the scheme, with more than 90% now signed up to offer consultations and NHS-funded treatments for seven common conditions: 

  • Sinusitis
  • Sore throat
  • Acute otitis media
  • Infected insect bites
  • Impetigo
  • Shingles
  • Uncomplicated urinary tract infections.

There are of course requirements to meet. Running the service requires an NHS-assured IT system that conforms to the Community Pharmacy Clinical Services Standard, as well as consultation rooms, otoscopes for ear examinations, and of course a Standard Operating Procedure to ensure staff know how to escalate any clinical and non-clinical issues that arise.

But as the high sign-up rate suggests, many pharmacists are already set up for much of this thanks to the Community Pharmacist Consultation Service (CPCS) which has now been subsumed into Pharmacy First. The CPCS already allowed pharmacists to consult on minor illness and supply urgent medicines, albeit following a referral from NHS 111, a GP or another authorised service. Pharmacy First feels like the natural next step towards making pharmacies the first port of call for patients seeking help for minor ailments. 

And patients seem keen, once they know what Pharmacy First can offer. A poll conducted by Superdrug found that two-thirds (67%) of patients would consider the service if it was “clear what services pharmacists can offer”. Furthermore, in good news for NHS England, the poll found that a majority of patients would be willing to see a pharmacist instead of a GP for most of the issues covered by Pharmacy First. 

In fact, CCA analysis suggests Pharmacy First could free up more than 30 million GP appointments each year in England - a figure that will be music to the ears of hard-pressed practices. 

So if patients, pharmacists and GPs welcome the move, and analysis suggests it will help relieve pressure on other primary care services, what’s the problem? Well, nothing really, except that while the services on offer in pharmacies are expanding, we're still losing actual pharmacies at an alarming rate. 

According to the CCA, between 2015 and 2022, England saw 808 pharmacies close, with only 138 new openings – that's a net drop of 670. And the latest data from 2022/23 shows another 50 closures which means that since 2015, we're down by about 720 pharmacies. 

And it's not just pharmacies. GP practices are closing too – a net loss of 343 between 2015 and 2022, and another 20 in 2022/23. This adds up to more than 1,000 primary care access points lost from the system.And these losses are hitting deprived areas the hardest. The most deprived areas lost four times as many pharmacies as the least deprived. Of all the primary care closures, 37% were in these deprived regions, creating "primary care cold spots" – areas where healthcare access is severely limited or inadequate.

Financial pressures are largely to blame here, and while the problems are not insurmountable, in order to realise the full benefit of Pharmacy First, and safeguard the future of community pharmacy as a whole, action is needed in a range of areas. 

Firstly though, it’s important to acknowledge that Pharmacy First does represent new money flowing into the sector. The £645 million financial commitment detailed in last year’s Delivery Plan For Recovering Access To Primary Care is of course a huge step forward and used wisely, will help to secure the future of community pharmacy. But that money alone won’t solve the underlying funding issues that have impacted the sector for so long. 

Thanks to inflation, community pharmacies in England have experienced a significant reduction in real-term funding, totaling £790 million since 2019. The rising costs of medications and fluctuating drug prices have exacerbated this funding shortfall. The National Pharmacy Association (NPA) highlighted a concerning trend: a majority of pharmacy owners reported net losses in dispensing NHS medications during 2022. 

As a result, numerous pharmacies have implemented cost-saving strategies, such as reducing business hours and scaling back certain NHS services. And about 40% of community pharmacies have resorted to increasing their bank loans to maintain day-to-day operations.

Inadequate funding has long beset community pharmacies. The existing funding gap amounts to an estimated £67,000 annually for each pharmacy in England. 

Another potential issue is training, specifically upskilling all pharmacists to become independent prescribers (IP). Anyone registering after 2026 will automatically be an IP, but this still leaves an estimated 23,000 pharmacists in England who are not qualified as IPs. And according to the CCA, under current plans, it will take until 2040 to train the entire workforce. To make the most of Pharmacy First, this must be accelerated.  

But for now, let’s celebrate this next phase for community pharmacy, which at last feels like it might be turning a corner towards a more positive and sustainable future. At Suvera, we think capacity building digital services should also be part of the picture, especially as community pharmacy becomes an even more central part of primary care. 

Ultimately, Pharmacy First will improve patient access, which can only be a good thing, but it feels like just the beginning. We’re excited to see how the sector develops, and we’ll be there to support it every step of the way.

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