Pharmacy First service

Details of a new national Pharmacy First service have been announced as part of an an agreement setting out how the £645 million investment pledged within the Delivery plan for recovering access to primary care will be used to support community pharmacy services.

Under the agreement, a new Pharmacy First service which includes providing advice and NHS-funded treatment, where appropriate, for seven common conditions will be launched on 31st January 2024 (subject to the required IT systems being in place) as an Advanced Service.

Consultations can be provided to patients presenting to the pharmacy as well as those referred by NHS 111, GPs and others. The service will also incorporate the existing Community Pharmacist Consultation Service.

In the 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).

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.

Latest news on the service

Following agreement between the Department of Health and Social Care, NHS England and Community Pharmacy England, the service specification for the Pharmacy First service has been published.

Alongside the service specification, the clinical pathways for the seven conditions which will be included in the service have also been published.

Download the service specification and clinical pathways

The final outstanding set of documentation for the new service are the 23 patient group directions (PGD) and one protocol which will be used to authorise supply of medicines at NHS expense, where clinically appropriate, following a consultation for one of the seven conditions. These documents are expected to be published in draft form later in week commencing 27th December 2023.

All of these documents will be essential reading for pharmacy owners and pharmacists who will be providing the service.

We will be publishing more guidance on the service and resources for pharmacy owners and their teams over the next few weeks.

We will also, shortly, be publishing the details of a series of webinars on the services and service changes announced following the Recovery Plan negotiations, which we are organising with the support of NHS England and CPPE.

Headline detail about the new service

• The Pharmacy First service will launch on 31st January 2024 (subject to IT systems being in place).
• The service involves providing consultations to give advice and NHS-funded treatment (via Patient Group Directions), where appropriate, for seven common conditions (clinical pathways consultations). The consultations can be provided to patients who self-refer to the pharmacy (e.g. walk-ins) as well as those referred by NHS 111, GPs and others.
• The seven conditions are: sinusitis, sore throat, acute otitis media, infected insect bite, impetigo, shingles and uncomplicated urinary tract infections in women.
• Distance Selling Pharmacies (DSPs) will be able to provide six of the seven Pharmacy First clinical pathways remotely via video consultations but may not provide clinical pathways consultations on their premises (due to links with the support for self-care Essential service and restrictions regarding the provision of Essential services on the pharmacy premises). The acute otitis media clinical pathway requires the use of an otoscope, so that pathway will not be provided by DSPs.
• The Pharmacy First service will also incorporate the existing Community Pharmacist Consultation Service (CPCS). Pharmacies will be paid £15 per consultation.
• An initial fixed payment of £2,000 will be available to claim from December up to the launch of the Pharmacy First service, which will be reclaimed if pharmacy owners do not provide five clinical pathways consultations by the end of March 2024.
• From February 2024, 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).

• We will continue our work monitoring service delivery, feeding into a new tripartite implementation group to scrutinise uptake and activity volumes of Pharmacy First to set consultation caps for the second half of 2024/25.
• All parties will work together on the communications campaign for Pharmacy First: we will be seeking to balance driving uptake of the seven clinical pathways and the two re-launched services with preventing inappropriate demand being driven into community pharmacy.

Additional information

We bid for a Pharmacy First service back in March 2022 and followed up on our bid with an extensive influencing campaign to build support for the proposal.

The service 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.

Funding, caps and activity thresholds for the service have been the subject of much negotiation and we are pleased to have secured an initial payment of £2,000 per pharmacy to be made available ahead of the launch, as well as fixed monthly payments, subject to meeting activity thresholds.

Funding for the clinical pathways consultations within the new service will come from the new investment, which is outside of the Community Pharmacy Contractual Framework (CPCF) funding, and we have agreed to work at pace to establish a formula for managing activity volume caps going forwards.

Guidance for pharmacy owners

Detailed discussions on the implementation of the agreement are ongoing and we will issue further guidance once the service specification and PGDs are published. In the meantime these briefings give some information about what the overall agreement means in practice.

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

Frequently asked questions

Q. How will the national Pharmacy First service work?

The new national Pharmacy First service aims to support communities in staying well and local healthcare systems to meet the needs of their populations. The service will launch on 31st January 2024 (subject to the required IT systems being in place). The service involves providing consultations to give advice and NHS-funded treatment (via Patient Group Directions), where appropriate, for seven common conditions (clinical pathways consultations).

The consultations can be provided to patients who self-refer to the pharmacy (e.g. walk-ins) as well as those referred by NHS 111, GPs and others. The service will also incorporate the current Community Pharmacist Consultation Service (CPCS), meaning there will be three elements to the Pharmacy First service:

• Pharmacy First (clinical pathways consultations) – 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

The seven clinical pathways cover sinusitis, sore throat, acute otitis media, infected insect bite, impetigo, shingles and uncomplicated urinary tract infections in women

Q. How have concerns around antimicrobial stewardship been addressed in the design of the service?

NHS England has led work to ensure that the clinical pathways for the Pharmacy First service and the associated Patient Group Directions (PGDs) will allow community pharmacists to supply antimicrobials, only where clinically appropriate, without increasing the risks of antimicrobial resistance (AMR). A large number of experts have fed into this detailed programme of work, supported by clinical pharmacists from Specialist Pharmacy Service. The participating experts have included AMR Consultant Pharmacists, Infection Control Specialists (medical), the UKHSA’s ESPAUR team, senior GPs, academics, Primary Care Network clinical pharmacists, NHS England’s Medical Director and Chief Pharmaceutical Officer. The UK’s Chief Medical Officer has also been involved in decisions made on the approval of the clinical pathways and PGDs, alongside Government and NHS advisory committees on antimicrobial stewardship.

The clinical pathways for the service, set out requirements which the patient must meet (e.g. signs, symptoms and key diagnostic criteria, duration of illness, prior history of the same condition) to determine whether they may be suitable to receive a supply of an antimicrobial. The clinical pathways have been designed drawing upon the guidance provided to all primary care healthcare professionals in NICE’s Clinical Knowledge Summaries.

If those requirements are met, the requirements of the PGD will then be considered by the pharmacist, to assess whether it would be safe and appropriate to make a supply of the antimicrobial, or whether another option may be appropriate, such as delaying any treatment with an antimicrobial or referring the patient to their general practice, where clinically appropriate.

Pharmacists are highly trained healthcare professionals who understand medicines and their potential risks, and the experience of the Scottish and Welsh Pharmacy First schemes, not to mention many local services in England, suggests that pharmacists are more cautious about supplying antibiotics than other healthcare professionals. Pharmacists understand the issues and have already been contributing to anti-microbial resistance efforts for several years through their Pharmacy Quality Scheme.

Q. What digital systems will be in place to support the Pharmacy First service?
To support the launch, pharmacy owners will have access to clinical services IT systems in which to make their clinical records for the service. These systems will also automatically send data on service provisions to the NHSBSA’s MYS portal, via an application programming interface (API), which will populate the end of month payment claim. The systems will also allow more parts of the GP record to be seen, via GP Connect: Access Record and they will send automatic updates to the GP record on the consultation and any medicines provided. This is a significant step forward towards the integration of pharmacy and GP care records that will support the future development of community pharmacy services. We have been pressing for this interoperability for many years, so this investment in it is very welcome.

Work is also being undertaken with NHS Pathways to develop their clinical triage system to send electronic referrals from NHS 111 and Urgent and Emergency Care settings to community pharmacy that may otherwise go to a GP practice for the seven common conditions. Further work is ongoing with existing IT suppliers to streamline referrals from GPs to community pharmacies, moving those away from reliance on NHSmail.

Q. Can distance selling pharmacies offer the Pharmacy First service?

Where it is safe to do so, Pharmacy First clinical pathways consultations with patients can be provided remotely via good quality video consultation by all pharmacies. However, distance selling pharmacies (DSP) will not be able to provide these consultations on their pharmacy premises due to the link with the Support for the Self Care Essential service. They will also be limited to providing six of the seven clinical pathways – the acute otitis media pathway is excluded as it requires otoscope examination of ear.

Q. What will happen to any locally commissioned Pharmacy First services?

Where locally commissioned services include one or more of the seven clinical pathways, we expect those elements of the local services will be decommissioned by the commissioner. We are working with the affected LPCs to help them to identify other options which could potentially be discussed with the local commissioner.

Q. How will pharmacies be paid for providing the Pharmacy First service?
Pharmacy owners providing this service will be able to claim the following:

• Initial fixed payment: £2,000 can be claimed from 1st December 2023 up to the launch of the service. Note, the pharmacy must provide 5 clinical pathway consultations by 31st March 2024 otherwise the payment will be recovered.
• Service fee: £15 per consultation. Note, as CPCS becomes part of Pharmacy First, the current £14 fee will become £15 to align with the new service.
• Medicine reimbursement (where applicable): Where a medicine is supplied as part of this service, reimbursement will be paid, with details to be set out in the Drug Tariff.
• Monthly fixed payment: £1,000 monthly can be claimed from February 2024 onwards, subject to meeting the clinical pathways consultation thresholds (see the table earlier on this webpage).

Q. Will the activity around the Pharmacy First service be monitored?

Although extensive modelling and analysis has been conducted, the level of service delivery that can be expected upon the launch of the service is highly uncertain, and a very lenient service volume cap of 3,000 consultations per month per pharmacy has been agreed as a temporary measure. This level was agreed in order not to hinder the uptake of the service in its early months, and should not be seen as a ‘target’.

We have agreed to work at pace with DHSC and NHSE to establish a formula for managing activity volume caps going forwards. Once this is agreed and initial service volume data is available, the new approach will replace the initial temporary cap of 3,000 per pharmacy per month.

Q. Do pharmacies need to provide all three services (i.e. Pharmacy First, Pharmacy Contraception and Hypertension Case-Finding) to receive the monthly payments?

DHSC and NHSE want to encourage pharmacy owners to provide all three services, but we pushed back on a proposal for compulsory provision of the Pharmacy Contraception and Hypertension Case-Finding Services for those wanting to provide the new Pharmacy First service. Instead, provision of all three services in a bundle is due to become a requirement to receive the monthly £1,000 Pharmacy First payment by 31st March 2025. Delaying the pace of this change will give pharmacy owners more time to prepare for and introduce the three services.