Pharmacy First service

Community Pharmacy England made a proposal to the Department of Health and Social Care and NHS England for a Pharmacy First service back in March 2022 and followed up on our bid with an extensive influencing campaign to build wider support for the proposal from stakeholders and influencers.

The Pharmacy First service, which commenced on 31st January 2024, is a crucial first step in recognising and properly funding the enormous amount of healthcare advice that community pharmacies provide to the public every day and in establishing and funding community pharmacy as the first port of call for healthcare advice.

What does the service involve?

The Advanced service involves pharmacists providing advice and NHS-funded treatment, where clinically appropriate, for seven common conditions (age restrictions apply):

Consultations for these seven clinical pathways can be provided to patients presenting to the pharmacy as well as those referred electronically by NHS 111, general practices and others.

The service also incorporates the elements of the Community Pharmacist Consultation Service, i.e. minor illness consultations with a pharmacist and the supply of urgent medicines (and appliances), both following an electronic referral from NHS 111, general practices (urgent supply referrals are not allowed from general practices) and other authorised healthcare providers (i.e. patients are not able to present to the pharmacy without an electronic referral).

In the clinical pathway consultations with a pharmacist, people with symptoms suggestive of the seven conditions will be provided with advice and will be supplied, where clinically necessary, with a prescription-only treatment under a Patient Group Direction (PGD) or in one pathway, an over-the-counter medicine (supplied under a clinical protocol), all at NHS expense.

In the future, we hope that independent prescribers will be able to use their skills to complete episodes of care within the service, without the need for a PGD. However, for the time being, all pharmacists providing the service must use the PGDs and clinical protocol.

The service requirements are included in the service specification and the associated clinical pathways.

Download the service specification and clinical pathways

Videos talking through each of the seven clinical pathways

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Patient Group Directions

The 23 patient group directions (PGD) and one protocol for the service authorise supply of medicines at NHS expense.

Download the final PGDs and protocol

Master PGD and Protocol authorisation sheet (Microsoft Word)
Pharmacists working under the PGDs and protocol and an authorising manager need to sign them before their use. This master authorisation sheet can be used to sign/authorise all 23 PGDs and the protocol in one document.

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Drug Tariff

The Drug Tariff determination sets out the detail of the funding for the service (see also the Funding and claiming payment section below) and the Secretary of State Directions provide the legal basis for the provision of the service:

Drug Tariff determination and Secretary of State Directions for the Pharmacy First service

Please note, the Drug Tariff Determination was updated in the November 2024 Drug Tariff to show the changes to the monthly targets for the clinical pathway strand of the service.

Pharmacy owner implementation checklist: Pharmacy First service
This checklist details the actions pharmacy owners need to undertake to prepare to provide the Pharmacy First service.

Pharmacist implementation checklist: Pharmacy First service
This checklist provides suggested actions that pharmacists need to undertake to prepare to provide the Pharmacy First service.

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Webinars

In late 2023 and early 2024, Community Pharmacy England hosted a series of webinars to help pharmacy owners and their teams to prepare for the new Pharmacy First service, and changes to the PCS and Hypertension Case-Finding Service.

There were two webinars on the Pharmacy First service:

Pharmacy First: Getting to know the service – this webinar provided the initial launch information for the Pharmacy First service, outlining the core

Download the slides from the webinar

Pharmacy First: Getting ready for launch – this webinar focused on how to prepare for the service’s launch, building on the content of the earlier webinar and providing additional practical information.

Download the slides from the webinar

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Consultation room

Pharmacies must have a consultation room that will be used for the provision of the service which meets the requirements of the terms of service.

There must be IT equipment accessible within the consultation room to allow contemporaneous records of the consultations provided to be made within the NHS-assured Pharmacy First IT system (see below for further information on IT systems).

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Providing the service via remote consultations

In most circumstances, the service requirements do allow remote consultations to be provided by a pharmacist who is at the pharmacy premises, but there are exceptions and specific requirements to be aware of, which are set out in the table below.

Further guidance on remote consultations

The pharmacist will also need to consider whether a remote consultation is clinically appropriate and safe to undertake.

Minor illness consultations (referrals) and urgent medicines supply consultations (referrals) can be undertaken via telephone/audio or video consultation by a pharmacist who is at the pharmacy.

Clinical pathways consultations can be conducted via good quality video consultation by a pharmacist who is at the pharmacy. Remote clinical pathways consultations can only be provided via a good quality video consultation – they cannot be provided by a telephone/audio consultation.

The acute otitis media (AOM) clinical pathway requires the use of an otoscope, so that pathway cannot not be provided via a remote consultation.

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Equipment

Where ear examinations are performed within the pharmacy, the pharmacist must use an otoscope. Consequently, all pharmacies providing the service (bar DSPs) must have an otoscope.

Guidance on selecting a suitable otoscope can be found in Annex C of the service specification.

While the otoscope is the only equipment specified by the service specification, pharmacy owners may want to consider having a thermometer which can be used to measure patients’ temperatures during consultation. Tongue depressors and a small torch may also help with examination of the throat, within the sore throat pathway.

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Standard Operating Procedure and Business Continuity Plan

Pharmacy owners must have a Standard Operating Procedure (SOP) for the service, which all staff participating in provision of the service must be familiar with and follow.

The SOP must include the process for escalation of any clinical and non-clinical issues identified during the provision of the service. To support this, the pharmacy must have available, signposting details for other local services, contact details for local out of hours and urgent care providers and contact details for the local Integrated Care Board (ICB).

Various pharmacy support organisations provide template SOPs which their members can personalise for use in their pharmacy. We have also produced a key contact details template for the Pharmacy First service.

Key contact details for the service (Word)

Key contact details for the service

While pharmacy owners should already have local safeguarding contacts, it is worth noting that the NHS England safeguarding app has a directory of safeguarding contacts for every local authority in England, searchable by region. It can be accessed via Apple iOS, Google Play – download it by visiting your device’s app store and searching for ‘NHS Safeguarding’.

Below is a summary template which can be used to record details on local GP practices referring into the Pharmacy First service, as well as details on other local pharmacies providing the service.

GP referrals to Pharmacy First service – summary details for local PCN (Word)

GP referrals to Pharmacy First service – summary details for local PCN (PDF)

Pharmacy owners must also ensure the service is included in their business continuity plan.

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Competency and training requirements

The pharmacy owner must ensure that pharmacists providing the service are competent to do so, including the use of an otoscope (except for DSPs) and be familiar with the clinical pathways, clinical protocol and PGDs. This may involve completion of training.

The pharmacy owner must keep documentary evidence that pharmacy staff involved in the provision of the service are competent and remain up to date with regards to the specific skills and knowledge that are appropriate to their role, and to the aspects of the service they are delivering.

The Centre for Pharmacy Postgraduate Education (CPPE) has a webpage which details training resources which may help pharmacists preparing to provide the service.

CPPE have also developed, with NHS England, a Pharmacy First self-assessment framework, which pharmacists can use to assess their knowledge in relation to the service and to identify any gaps in their knowledge, which need to be filled.

CPPE Pharmacy First page (including the Pharmacy First self-assessment framework)

Other training options we have been made aware of:

Agilio iLearn Pharmacy First training

Tick bites/Lyme disease 
While tick bites/Lyme disease is not treatable under the Pharmacy First clinical pathway for infected insect bites, with patients needing to be signposted onwards, patients may present with a tick bite with an erythema migrans (EM) rash – also known as a bullseye rash. Therefore understanding more about the signs and symptoms should help pharmacy teams recognise the symptoms and allow them to signpost patients as appropriate.

Lyme Disease UK – Resources for pharmacy teams

Lyme Resource Centre – Resources for health professionals

The prior learning, knowledge and experience of each pharmacist will vary and consequently each individual will need to reflect on their own learning needs and identify any gaps in their knowledge which they need to fill.

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Selecting an IT system

As with the previous Community Pharmacist Consultation Service, an NHS-assured Pharmacy First IT system, which meets the minimum digital requirements of the service (as specified within the Community Pharmacy Clinical Services Standard and including an application programming interface (API) to facilitate transfer of data into the NHSBSA MYS portal) must be used by pharmacy owners.

When choosing an IT supplier, pharmacy owners may want to refer to the NHS CPCS IT Buyers Guide.

These IT systems allow pharmacy staff to make a clinical record for the service and the data in the record will then be used by the IT system to populate a claim for payment within the NHSBSA’s MYS portal.

The transfer of data via the API will happen throughout the month, as data is entered into the IT systems. The service provisions will then be available to view in MYS from the 1st of the following month. For example, service provisions in December will be available to view in MYS on 1st January. Pharmacy owners will then need to log into the MYS portal to check that the data matches the details in their IT system, and they will then need to submit their claim for payment.

The full dataset for the Pharmacy First service can be found in Annex B of the service specification.

The NHS-approved clinical IT system will also send messages containing a summary of the consultation to the patient’s general practice.

The following four IT suppliers worked with NHS England to develop their systems to include functionality to support the service, but over time, we expect other suppliers will add the service to their systems:

System and supplier

HxConsult (Positive Solutions)

Pharmacy Manager (Cegedim)

PharmOutcomes (Pinnacle Health)

Sonar health (Sonar informatics)

Read more about the IT requirements for all CPCF clinical services

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Signing up to provide the service

Pharmacy owners must notify NHS England that they intend to provide the service by completion of an electronic registration through the NHS Business Services Authority’s (NHSBSA) Manage Your Service (MYS) portal

The pharmacy owner must ensure that the service is available throughout the pharmacy’s full opening hours (i.e. core and supplementary).

Verbal consent to receive the service must be sought from the patient and recorded in the pharmacy’s clinical record for the service

The patient must also be advised of the following information sharing that will take place:

• The sharing of information about the service with NHS England as part of the service monitoring and evaluation.
• The sharing of information about the service with the NHSBSA and NHS England for the purpose of contract management and as part of post-payment verification (PPV).

Annex B of the service specification includes a summary of how the data will be used by the organisations.

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Resources for patients to use during/after consultations

Pharmacy First clinical pathways – online information sources for patients
When pharmacists are providing a consultation for one of the seven Pharmacy First clinical pathways, there are several leaflets/websites for patients to be pointed to which are listed in the PGDs and treatment protocol.

This resource lists all the patient-facing leaflets/website links listed in the PGDs and treatment protocol, excluding the marketing authorisation holder’s patient information leaflets (hard copies will be available within the medicine’s packaging, with copies also being available from medicines.org.uk/emc).

Hyperlinks to the leaflets/websites are listed, alongside QR codes for each leaflet/website so patients can scan this to access the leaflet/website link on their mobile phones.

The following resources are available to support pharmacy teams to promote the online Pharmacy First patient survey to patients following a consultation for the Minor illness (referrals) or Clinical pathways (referrals and walk-in) strands of the service:

• Poster
  The poster highlights the survey and includes a short link or QR code for the patient to scan. It could be displayed or kept in the consultation room to show to patients at the end of a Pharmacy First consultation.
• Small flyers
  These can be handed out to patients if they do not want to complete the survey at the end of the consultation, so they have the details of how to complete the survey later.

The short link to the survey is: bit.ly/PharmacyFirstSurvey

PDF copy of the survey questions

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Accessing the patient’s record

With the patient’s consent, their GP record (e.g. via GP Connect Access Record), national care record, or an alternative clinical record for the patient, must be checked by the pharmacist unless there is good reason not to do so.

NHS England is working with Pharmacy First IT system suppliers to add GP Connect Access Record functionality to their systems. In the meantime, pharmacists providing the Pharmacy First service can continue to access elements of the patient’s GP record via the National Care Records Service.

Use of GP Connect products requires the pharmacy owner to agree to the terms of the National Data Sharing Arrangement. By accessing GP Connect products via their NHS-assured Pharmacy First IT system, the pharmacy owner will be assumed to have read, understood, and accepted the terms of the National Data Sharing Arrangement.

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Communicating with GP practices following a consultation

The pharmacy must send a notification of the provision of the service to the patient’s general practice on the day of provision or on the following working day.

Where possible, this should be sent as a structured message in real-time via the Pharmacy First IT system. In the absence of an automated digital solution or if there is a temporary problem with the system, this should be sent via NHSmail or hard copy.

Where an action is required by the general practice team (such as booking the patient in for a follow up or appointment) an action message or alternative form of an Urgent Action communication (rather than the standard post event message) must be sent to the practice.

Two of the four community pharmacy IT systems have started to automatically send details of a community pharmacy consultation to the GP clinical IT system via a structured message, ready for a staff member at the practice to check and update the patient’s record. The other two system suppliers are currently testing this functionality, ahead of getting approval to roll it out to their customers.

This functionality – GP Connect: Update Record – means Pharmacy First post-event messages sent by pharmacy IT systems will appear in the general practice IT system’s workflow. The structured message will be provisionally held against the patient record and will be visible by people reviewing the record. A member of the practice team will need to review and accept the message. The structured message will then be ingested into the patient record without the need for transcribing or coding.

Messages will be available to anyone accessing the general practice record including patients themselves (e.g. by logging into their account on the NHS website or NHS App).

The structured message which is incorporated into the patient record will include structured data on the consultation and free text notes added by the pharmacist.

Pharmacists wanting to update their knowledge of best practice record keeping can access the CPPE Documenting in patient clinical records e-learning programme.

Ahead of this development, the Pharmacy First IT systems will send a post-event message to the patient’s GP practice following a Pharmacy First consultation via NHSmail, with a summary of the consultation attached as a PDF. This is the approach which was previously used for the Community Pharmacist Consultation Service. Once the new GP Connect Update Record functionality is implemented, this will remove the need for practice staff to transcribe information from emails into the patient’s record.

GP clinical IT system suppliers will enable this functionality by default and further supplier specific information for general practices is available via the following links:

• EMIS Web
• TPP SystmOne

Read more about GP Connect: Update Record

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Clinical records

Details and the outcome of each consultation must be recorded in the pharmacy’s Pharmacy First IT system.

Pharmacy owners must adhere to defined standards of record keeping, ensuring the consultation record is made on the same day that it occurs unless exceptional circumstances apply.

Pharmacists wanting to update their knowledge of best practice record keeping can access the CPPE Documenting in patient clinical records e-learning programme.

Making contemporaneous records at the time of the consultation is the expectation of pharmacists providing the service. This not only meets expected professional standards, but it also supports timely provision of data to the patient’s general practice (see details of how the Pharmacy First IT system sends data to the patient’s GP practice above), which will also become available to view by other pharmacists providing a consultation to the patient, should they need to seek further support in due course.

Where the Pharmacy First IT system is unavailable due to exceptional circumstances beyond the control of the pharmacy contractor, then the consultation record must be added to the system as soon as possible after it becomes available again.

If the problem persists for a period greater than 3 working days, the contractor must notify the service commissioner (ICB) of the issue.

IT suppliers have published paper-based consultation record templates for pharmacists to use in business continuity scenarios, where the IT system is temporarily unavailable, e.g. due to a system outage or loss of internet connectivity.

Visibility of consultation records to patients

When GP Connect Update Record functionality is implemented, subject to the general practice making the record visible in online services, the Pharmacy First consultation record will be visible to the patient if they view their general practice record in online services such as the NHS app, NHS website account or GP patient apps.

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Supplying medicines

If a medicine is to be supplied following an urgent medicines supply consultation or a clinical pathways consultation, the service specification requires it to be made with reasonable promptness taking into account the clinical need of the individual.

For example, supply of antivirals for the treatment of shingles for eligible patients should be made within the defined timeframes of rash onset as outlined in the clinical pathway.

The service specification notes that Distance Selling Pharmacies (DSPs) should make necessary arrangements for a prompt delivery of the item, at no cost to the patient.

If the patient needs to be referred to another pharmacy to provide the clinical pathways consultation (e.g. due to no stock of the required medicine being available at the pharmacy or the patient of a DSP needing to receive the medicine more rapidly than the pharmacy can have it delivered), no payment will be due to the referring pharmacy.

The service specification also states that to help protect NHS resources, wherever practicable, pharmacy contractors should supply the best value product to meet the clinical need of the patient.

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NHS Prescription charges

The normal NHS prescription charge rules apply to medicines or appliances supplied under the service, whether via the urgent medicines supply part of the service or the seven clinical pathways.

The Pharmacy First IT system will print off a FP10DT EPS dispensing token and the patient should complete the relevant parts of the reverse of the form to claim exemption from the prescription charge or to indicate they have paid the NHS prescription charge.

The printed FP10DT EPS dispensing token must include the following information:

• Full name, address and date of birth of the patient
• Patient’s NHS number (where they have one)
• Name, strength, and form of medicines requested (using DM+D name or shortened DM+D name)
• The quantity supplied
• Date of supply
• Name and address of patient’s GP (for those who are registered with one)
• Referral ID number (if the patient was referred)

Where medicines or appliances are supplied as part of an Urgent Medicines Supply consultation, the completed dispensing tokens should be sent to the NHSBSA as part of the month-end submission, clearly separated within the batch and marked ‘PF UMS’.

Similarly, where medicines are supplied as part of a Clinical Pathway consultation,  the completed dispensing tokens should be sent to the NHSBSA as part of the month-end submission, clearly separated within the batch and marked ‘PF CP’.

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Temporary pharmacy closures

In the event of a temporary closure, pharmacy owners must ensure the elements of their business continuity plan related to the service are activated and the service is temporarily withdrawn.

They must inform the NHS 111 provider and local IUC CAS of the temporary withdrawal by calling the NHS Directory of Services Provider and Commissioner Helpline (0300 0200 363) as soon as possible to stop referrals being made to the pharmacy.

GP practices and UEC settings within the pharmacy’s primary care network should also be contacted to prevent them making further direct referrals.

The service commissioner (ICB) must also be informed by the pharmacy owner.

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Withdrawal from the Pharmacy First service

If having registered to provide the Pharmacy First service, a pharmacy owner wishes to stop providing the service, they must notify NHS England that they are no longer going to provide the service via the MYS platform, giving at least 30 days’ notice prior to the cessation of the service. The pharmacy owner may be asked for their reason for withdrawal from the service.

Distance selling pharmacies (DSPs) can provide the Pharmacy First service but there are some limitations on how the service is provided from a DSP with regards to the clinical pathway strand of the service:

• DSPs cannot provide clinical pathway consultations face-to-face (with the patient being present at the pharmacy premises). This is because the first part of any discussions with a patient relating to the clinical pathways consultations, prior to the Gateway point in the clinical pathway being passed, is part of the Support for the Self Care Essential service. DSPs cannot provide Essential services at their pharmacy premises.
• DSPs are limited to providing six of the seven clinical pathways consultations. The acute otitis media pathway is excluded as it requires otoscope examination of the patient’s ear and DSPs cannot provide this type of consultation with the patient being present at the pharmacy premises.
• If the patient needs to be referred to another pharmacy due to the patient requiring the medicine more rapidly than the DSP can have it delivered or if the patient needs to be referred to another pharmacy for the acute otitis media pathway (as DSPs cannot provide this pathway), DSPs cannot claim a consultation fee for this.

Other important points to note are:

• DSPs still need to have a consultation room which meets the requirements in the Terms of Service in order to provide the service. Having a consultation room is a prerequisite for the provision of the Pharmacy First service.
• Remote clinical pathway consultations must be carried out by a pharmacist, at the pharmacy premises, via a good video consultation rather than be phone. This is because the clinical pathways will often require the pharmacist to examine the patient (e.g. a rash) or examine a sample of urine, in the case of the UTI pathway. The service specification requires a live video link of sufficient quality to be used to carry out an examination, as part of the consultation. This also applies to bricks and mortar pharmacies who are providing remote clinical pathway consultations.
• The service specification notes that DSPs should make necessary arrangements for a prompt delivery of a medicine or appliance provided as part of the service, at no cost to the patient.
• DSPs can carry out the urgent supply and minor illness strands of the service face-to-face (with the patient being present at the pharmacy premises); it is just the clinical pathway strand that DSPs cannot provide face-to-face.

The various options for providing consultations are set out in the table below.

If the Pharmacy First service is to deliver the maximum possible benefit to patients, the NHS and community pharmacies, it is important that there is a strong relationship between community pharmacies and local general practices.

Such strong local relationships will give confidence to general practice teams to make referrals to the Pharmacy First and other community pharmacy services wherever appropriate for patients.

We all know achieving long-term changes in practice can take time and consequently the work to embed referrals from general practice to Pharmacy First will in most cases need to be sustained over several months or perhaps longer.

We have received positive feedback from many LPCs and pharmacy teams about how local community pharmacy/general practice relationships are driving a good volume of referrals and benefits to patients. However, some pharmacy teams are experiencing low levels of referrals or none at all.

Previous experience from the rollout of GP referrals to the Community Pharmacist Consultation Service is that sustained effort may be required to ensure that referrals are made and continue to be made over the following months.

To support pharmacy owners, their teams and LPCs to keep engaging with local general practice colleagues, we have a range of resources available:

Pharmacy First checklist – Promoting the service to your GP practice
This checklist provides suggested actions that pharmacy owners and their teams can choose to undertake to help promote the Pharmacy First service to their local GP practice team.

Pharmacy owner template email/letter to GP practices
An email/letter introducing the Pharmacy First service.

Briefing for Local Medical Committees and general practices on the Pharmacy First service
A three-page briefing introducing the service including questions and answers for GP practice teams.

PowerPoint presentation aimed at GP practice teams
A template presentation on the service that can be used by pharmacy owners or members of their team to present to GP practice teams, for example, at a practice meeting.

PowerPoint presentation aimed at patients
A template presentation on the service that can be used to present at events such as Patient Participation Group meetings at GP practices.

Pharmacy First template PowerPoint presentation aimed at Local Medical Committees and general practice colleagues – for use by LPCs
A template presentation on the service that can be used by LPCs to present to Local Medical Committees and general practice colleagues.

News story on the service
A template news story that could be used by GP practices on their website or in their patient newsletter.

Brief news story on the service
A shorter template news story that could be used by GP practices in their patient newsletter.

LPCs and pharmacy teams are encouraged to share the below animation and infographic with local GP practices, LMCs, PCNs and ICBs to improve understanding and engagement with the GP electronic referral pathway into the Pharmacy First service in their areas. You can show the animation at meetings directly from the Community Pharmacy England website, but if you need access to a downloadable version, please email: comms.team@cpe.org.uk

Watch the animation:

 

 

Pharmacy First: What GPs need to know infographic

Download this folder that contains the following resources:

• Clip 1: Introducing the service
• Clip 2: How the service works
• Clip 3: The value of the service
• Screenshots
• Social media tiles
• Suggested tweets/posts

We also have a page on our website aimed at GPs and their teams: Visit the Pharmacy First: Information for GPs webpage.

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NHS funding to support local work with Primary Care Networks

Some of the funding allocated to the Pharmacy First service within the Primary Care Recovery Plan is being used to support local implementation of the service (and also the Pharmacy Contraception Service and the Hypertension Case-finding Service).

The funding, which was announced at the end of May 2024, will be used to support work with general practices within a Primary Care Network (PCN). Integrated Care Boards and Local Pharmaceutical Committees (LPC) are currently working together to start to implement this approach at a local level. Please contact your LPC to find out how this is progressing in your area.

Read more about the PCN support

Community Pharmacy England resources

We have developed a range of materials including posters, social media assets and an animation which pharmacy owners can use to promote the service to patients.

Our shared folder (link below) allows you to download the latest versions of the following resources:

• Posters for display within pharmacies and for more general use (e.g. in general practice waiting rooms);
• Social media tiles and suggested social media posts about Pharmacy First;
• Videos and digital screen graphics;
• Small flyers about Pharmacy First; and
• Template local press release for Pharmacy First launch.

Download here: Pharmacy First promotional resources

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Animation for patients

The animation for patients provides clear and concise information about the Pharmacy First service, highlighting the seven conditions and the eligible age ranges within the clinical pathways consultations and explaining how patients can access those.

Pharmacy owners and their teams can use the animation to communicate the benefits and scope of the Pharmacy First service to their patients. For example, the animation can be linked to in pharmacy social media content and you can download a copy to play on digital screens in pharmacies. Similarly, general practices could be encouraged to use the animation on digital screens in their practice waiting areas.

Watch the animation: 

Two shorter clips are also available on YouTube:

How the Pharmacy First service works

The value of the Pharmacy First service

Open this folder to download the following resources: 

• Full animation
• Full animation with subtitles
• Clip 1: About the service and how it works
• Clip 2: The value of the service
• Social media cards
• Suggested tweets/posts

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We have incorporated all of the above resources into a Pharmacy First checklist so pharmacy owners can work through the checklist to see if there are any additional activities that they or their teams could participate in to promote the service to the public:

Pharmacy First checklist: Promoting the service to patients

NHS England resources

NHS England has relaunched their Pharmacy First public-facing campaign.

Minor revisions have been made to the original campaign materials used earlier this year, including additional information on the age criteria for the clinical pathways.

The campaign materials are available on the Department of Health and Social Care’s Campaign Resource Centre website and include:

• A campaign toolkit;
• Social assets; and
• Posters.

View the ‘Think Pharmacy First’ resources

Read Janet Morrison’s (Chief Executive of Community Pharmacy England) comment on the relaunch of the campaign

Community Pharmacy England and Healthwatch England launched an online Pharmacy First patient survey in November 2024 that pharmacy owners can direct patients to after receiving the service.

The aim of this collaboration is to collect patient feedback on the service to help inform service improvements and to help to quantify the value of the service to the public.

Pharmacy teams providing Pharmacy First are asked to help promote the survey using the resources we have developed. To encourage as many responses as possible, the survey has been designed to be quick and easy to complete; during testing, most patients took around two minutes to complete it.

Who can use the survey?
We would like all pharmacies providing the Pharmacy First service to help gather valuable public feedback, by asking patients to complete the survey following a consultation for the Minor illness (referrals) or Clinical pathways (referrals and walk-in) strands of the service.

The survey is not for use where patients have used the Urgent supply of medicines / appliances strand of the service.

Why should we ask patients to complete the survey?
Use of the survey is optional, but we encourage pharmacy owners and their teams to consider offering it to patients for several reasons, including:

• Helping to gather important data on patients’ experience of using the service;
• Feeding into the national evaluation of the Pharmacy First service, and the results will be shared with the Department of Health and Social Care and NHS England;
• Supporting Community Pharmacy England and Healthwatch England’s national work, and local data can be shared with local Healthwatch organisations and Local Pharmaceutical Committees (LPCs) to inform their discussions on the service at a local level; and
• Reinforcing Community Pharmacy England’s communications and public affairs work to demonstrate the value of the Pharmacy First service.

We will also share a national summary of survey results via our website.

When should I ask patients to complete the survey?
Ask patients if they would be willing to complete the survey at the end of their Pharmacy First consultation (consultations for the Minor illness or Clinical pathways stands of the service).

If the Pharmacy First consultation was for a patient who cannot complete the survey (for example, a young child), the patient’s representative can complete the survey, but the answers should be based on the Pharmacy First consultation that the patient or their representative received from the pharmacy.

The survey will remain open until at least the end of 2025.

Promoting the feedback survey
We have produced the following resources to support pharmacy teams promoting the survey to patients:

• Poster
  The poster highlights the survey and includes a short link or QR code for the patient to scan. It could be displayed or kept in the consultation room to show to patients at the end of a Pharmacy First consultation.
• Small flyers
  These can be handed out to patients if they do not want to complete the survey at the end of the consultation, so they have the details of how to complete the survey later.

The short link to the survey is: bit.ly/PharmacyFirstSurvey

PDF copy of the survey questions

Funding for the clinical pathways consultations within the new service comes from the new investment, which is outside of the Community Pharmacy Contractual Framework (CPCF) funding (‘the global sum’).

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Consultation fee

Pharmacies will be paid £15 per completed consultation.

There are many different scenarios which can occur within the service, so to help pharmacy owners and their teams know when you can make a claim for a payment, we have published a resource to assist with this. It lists the different scenarios, whether you need to make an entry in your Pharmacy First IT system for that scenario and whether you can claim payment:

The Pharmacy First service – When can you claim?

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Monthly fixed payment

In addition to the £15 consultation fee, a monthly fixed payment of £1,000 will be paid to pharmacy owners who meet a minimum activity threshold of clinical pathways consultations (the threshold will increase over time as set out below).

Achieving the thresholds for the monthly Pharmacy First payment has been an ongoing matter of great concern for pharmacy owners and Community Pharmacy England.

There have been three agreed changes to the original thresholds, which were secured following Community Pharmacy England representations to the Department of Health and Social Care (DHSC) and NHS England. The table below shows the current thresholds that need to be achieved.

Read Janet Morrison’s (CEO, Community Pharmacy England) comment on the changes to the monthly targets

Month	Minimum number of clinical pathways consultations
February 2024	1
March 2024	5
April 2024	5
May 2024	10
June 2024	10
July 2024	10
August 2024	15
September 2024	20
October 2024	20
November 2024	20
December 2024	20
January 2025	25
February 2025	25
March 2025	30

Only clinical pathway consultations that cross the gateway point and reach an outcome set out in the pathway (without onward referral to another pharmacy), will count towards meeting the monthly minimum number of consultations for the block payment.

By 31st March 2025 at the latest, all pharmacy owners providing Pharmacy First will also have to provide the Pharmacy Contraception Service and Hypertension Case-Finding Service to qualify for the monthly fixed payment (as well as meeting the relevant consultation threshold).

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Cost control mechanism for Pharmacy First (clinical pathways consultations)

The additional funding made available for the clinical pathways consultation is sufficient for up to 12 million consultations per year.

In April 2024, an initial cap of 3,000 consultations per month per pharmacy was put in place. From 1st October 2024, new caps were introduced based on actual provision of clinical pathways consultations, designed to deliver 3 million consultations per quarter with any unused activity rolling forward to subsequent quarters of that financial year.

A list of pharmacy owners, their assigned Band and monthly cap can be found on the NHS Business Services Authority’s (NHSBSA) website. 

Read more information on the NHSBSA website about the Pharmacy First caps 

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Claiming payments

Data from the Pharmacy First IT system will be submitted to the MYS portal via an application programming interface and will be used by the NHSBSA to populate a payment claim within the MYS portal.

The pharmacy owner needs to review this payment claim and then submit it.

Claims for payment for this service should be made monthly, via the MYS portal and no later than three months from the claim period for the chargeable activity provided.

Claims which relate to work completed more than three months after the claim period in question, will not be paid.

The table below details the date on which pharmacy owners will receive their £1,000 monthly fixed payment (if the pharmacy has reached the minimum threshold of clinical pathway consultations for that month) as well as their consultation fees and reimbursement of medicines/appliances supplied.

Month in which Clinical pathway consultations that crossed the Gateway point were conducted	Date by which consultations were claimed for on MYS/ minimum threshold of consultations is reached	Date on which pharmacy owner receives £1,000 monthly fixed payment, consultation fees and reimbursement of medicines/appliances supplied
February 2024 (includes consultations carried out on 31st January 2024)   Minimum threshold = 1	By 5th March 2024	1st May 2024
	By 6th April 2024 (extra day due to Easter)	31st May 2024 (1st June falls on a Saturday)
	By 5th May 2024	1st July 2024
	By 5th June 2024 (final deadline to claim for February 2024 Pharmacy First consultations)	1st August 2024
March 2024   Minimum threshold = 5	By 6th April 2024 (extra day due to Easter)	31st May 2024 (1st June falls on a Saturday)
	By 5th May 2024	1st July 2024
	By 5th June 2024	1st August 2024
	By 5th July 2024 (final deadline to claim for March 2024 Pharmacy First consultations)	30th August 2024 (1st September falls on a Sunday)
April 2024   Minimum threshold = 5	By 5th May 2024	1st July 2024
	By 5th June 2024	1st August 2024
	By 5th July 2024	30th August 2024 (1st September falls on a Sunday)
	By 5th August 2024 (final deadline to claim for April 2024 Pharmacy First consultations)	1st October 2024
May 2024   Minimum threshold = 10	By 5th June 2024	1st August 2024
	By 5th July 2024	30th August 2024 (1st September falls on a Sunday)
	By 5th August 2024	1st October 2024
	By 5th September 2024 (final deadline to claim for May 2024 Pharmacy First consultations)	1st November 2024
June 2024 Minimum threshold = 10	By 5th July 2024	30th August 2024 (1st September falls on a Sunday)
	By 5th August 2024	1st October 2024
	By 5th September 2024	1st November 2024
	By 5th October 2024 (final deadline to claim for June Pharmacy First consultations)	29th November 2024 (1st December falls on a Sunday)

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Schedule of payments

As a result of the launch of the Pharmacy First service the method and quantum of pharmacy owner payments will change. To reflect this, NHSBSA has made changes to the Schedule of Payments and E-Schedules to provide more detail for pharmacy owners. As part of this exercise, broader changes were also made for consistency and to provide as much detail as possible of the breakdown of payments.

Example Pharmacy First Schedule of Payments

Example Pharmacy First E-Schedule (ZIP file)

This Zip file contains:

• E-Schedule Map (Excel)
• Sample E-Schedule (DAT)

Visit the Pharmacy First service FAQ page 

Visit the Pharmacy First service myth busting page

Guidance and resources for pharmacy owners

Pharmacy owner implementation checklist: Pharmacy First service
This checklist details the actions pharmacy owners need to undertake to prepare to provide the Pharmacy First service.

The following briefings provide summary information about what the overall agreement on the Delivery plan for recovering access to primary care negotiations means in practice.

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Guidance for pharmacists

Pharmacist implementation checklist: Pharmacy First service
This checklist provides suggested actions that pharmacists need to undertake to prepare to provide the Pharmacy First service.

SPS Pharmacy First podcast series
In the podcast series, pharmacy colleagues and expert clinical speakers cover the clinical conditions included in the Clinical pathway strand of the service, as well as an additional episode dedicated to paediatrics.

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Resources to use during/after consultations

Pharmacy First clinical pathways – online information sources for patients
When pharmacists are providing a consultation for one of the seven Pharmacy First clinical pathways, there are several leaflets/websites for patients to be pointed to which are listed in the PGDs and treatment protocol.

This resource lists all the patient-facing leaflets/website links listed in the PGDs and treatment protocol, excluding the marketing authorisation holder’s patient information leaflets (hard copies will be available within the medicine’s packaging, with copies also being available from medicines.org.uk/emc).

Hyperlinks to the leaflets/websites are listed, alongside QR codes for each leaflet/website so patients can scan this to access the leaflet/website link on their mobile phones.

The Pharmacy First service – When can you claim?
There are many different scenarios which can occur within the service, so to help pharmacy owners and their teams know when you can make a claim for a payment, we have published a resource to assist with this. It lists the different scenarios, whether you need to make an entry in your Pharmacy First IT system for that scenario and whether you can claim payment.

The following resources are available to support pharmacy teams to promote the online Pharmacy First patient survey to patients following a consultation for the Minor illness (referrals) or Clinical pathways (referrals and walk-in) strands of the service:

• Poster
  The poster highlights the survey and includes a short link or QR code for the patient to scan. It could be displayed or kept in the consultation room to show to patients at the end of a Pharmacy First consultation.
• Small flyers
  These can be handed out to patients if they do not want to complete the survey at the end of the consultation, so they have the details of how to complete the survey later.

The short link to the survey is: bit.ly/PharmacyFirstSurvey

PDF copy of the survey questions

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Information for pharmacy teams

Briefing 010/24: Briefing for pharmacy teams – the Pharmacy First service
This Briefing provides information for pharmacy teams on the Pharmacy First service.

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Information for Local Medical Committees and general practices

Pharmacy First checklist – Promoting the service to your GP practice
This checklist provides suggested actions that pharmacy owners and their teams can choose to undertake to help promote the Pharmacy First service to their local GP practice team.

Pharmacy owner template email/letter to GP practices

Briefing 009/24: Briefing for Local Medical Committees and general practices on the Pharmacy First service

Pharmacy First template PowerPoint presentation aimed at GP practice teams
A template presentation on the service that can be used by pharmacy owners or members of the team to present to GP practice teams, for example, at a practice meeting.

PowerPoint presentation aimed at patients
A template presentation on the service that can be used to present at events such as Patient Participation Group meetings at GP practices.

Pharmacy First template PowerPoint presentation aimed at Local Medical Committees and general practice colleagues – for use by LPCs
A template presentation on the service that can be used by LPCs to present to Local Medical Committees and general practice colleagues.

News story on the service
A template news story that could be used by GP practices on their website or in their patient newsletter.

Brief news story on the service
A shorter template news story that could be used by GP practices in their patient newsletter.

LPCs and pharmacy teams are encouraged to share the below animation and infographic with local GP practices, LMCs, PCNs and ICBs to improve understanding and engagement with the GP electronic referral pathway into the Pharmacy First service in their areas. You can show the animation at meetings directly from the Community Pharmacy England website, but if you need access to a downloadable version, please email: comms.team@cpe.org.uk

Watch the animation:

Pharmacy First: What GPs need to know infographic

Download this folder that contains the following resources:

• Clip 1: Introducing the service
• Clip 2: How the service works
• Clip 3: The value of the service
• Screenshots
• Social media tiles
• Suggested tweets/posts

Visit the Pharmacy First: Information for GPs webpage

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Other resources for Local Pharmaceutical Committees

Pharmacy First template PowerPoint presentation aimed at pharmacy owners and teams – for use by LPCs
A template presentation on the service that can be used by LPCs to present to pharmacy owners and their teams.

Pharmacy First template PowerPoint presentation aimed at other external audiences – for use by LPCs
A template presentation on the service that can be used by LPCs to present to other external audiences.

Nitrofurantoin analysis
The dashboard contains NHSBSA PCA data from May 2023 to April 2024 for the dispensing in the community of solid dosage forms of Nitrofurantoin. It also contains data from the same source on the supply of Nitrofurantoin via the Pharmacy First clinical pathways (just for February to April 2024).

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Promotion of the service to patients

Pharmacy First promotional resources

NHS England ‘Think Pharmacy first’ campaign materials

Pharmacy First checklist: Promoting the service to patients
Since the launch of the service, Community Pharmacy England and NHS England have published a number of resources (linked to above) to support pharmacy owners and their teams to promote the Pharmacy First service.

We have incorporated all of these into a Pharmacy First checklist so pharmacy owners can work through the checklist to see if there are any additional activities that they or their teams could participate in to promote the service to the public.

Pharmacy First template PowerPoint presentation aimed at patients
A template presentation on the service that can be used to present at events such as Patient Participation Group meetings at GP practices.

News story on the service
A template news story that could be used, for example, by GP practices on their website or in their patient newsletter.

Brief news story on the service
A shorter template news story that could be used, for example, by GP practices in their patient newsletter.

NHS England Pharmacy First leaflet (easy read)

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Pharmacy First Clinical pathways – medicines included in the PGDs and medicines protocol

Pharmacy First – medicines list for clinical pathway consultations

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NHS England video clips

David Webb, Chief Pharmaceutical Officer, NHS England talks about the Pharmacy First service

Pallavi Dawda, Head of Delivery – Clinical Strategy, Community Pharmacy, NHS England talks about the development of the Pharmacy First service clinical pathways and PGDs

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NHS England case study and podcast

West Yorkshire showcases partnership working to deliver Pharmacy First

Transforming Primary Care podcast: Pharmacy First – Reflections on the first nine months

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Statistics

Community Pharmacy England clinical service statistics dashboard
The dashboard presents data on the Pharmacy First service (as well as other Advanced services) at three levels (national, LPC and individual pharmacy) for each quarter. The dashboards are based on  the NHS Business Services Authority’s (NHSBSA) Dispensing Contractors’ data.

NHSBSA Dispensing contractors’ data
Data on the Pharmacy First service (as well as other Advanced services) can be found by clicking on the ‘Pharmacy and appliance contractor dispensing data’ dropdown tab.

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If having read the service specification and the information on this webpage pharmacy owners have outstanding questions regarding the service, they can email them to services.team@cpe.org.uk.