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Community pharmacy is stuck in a vicious circle. Pharmacies are closing at an alarming rate whilst the government is talking about moving care away from hospitals and into the community to focus on preventative care. While the government talks about this vision for the future, the stark reality is that pharmacies are already struggling to meet the current Pharmacy First thresholds. And now we discover that one of the key components that could create capacity in pharmacy to deliver more clinical services has been put on hold…indefinitely. The recently published Darzi review, which was commissioned after the new government came to power to assess the state of the NHS, praised the value of community pharmacies and preventative services. But it recognised the level of pharmacy closures across the country and warned pharmacy access could be 'at risk'. Community pharmacy is ideally placed to deliver the government's vision of preventative care in the community. But let's all be clear, moving preventative services into community pharmacies has, so far, been nowhere near as successful as it could have been due to the current climate pharmacies find themselves in. The Pharmacy First scheme is a testament to this. Just this week it was announced that consultation thresholds for the Pharmacy First scheme have been reduced from 30 consultations to 20. It's the second time in three months that the thresholds have been reduced and it follows an intervention from Community Pharmacy England who wanted to "save many pharmacies from missing out on a vital payment this month." In June alone, 3,269 participating pharmacies failed to meet the threshold - that's almost a third of all community pharmacies in England.

The Pharmaceutical Services Negotiating Committee (PSNC)'s 2022 Pharmacy Advice Audit revealed that more than 1.2 million consultations a week - or 65 million a year - are now being carried out by community pharmacy teams in England. This is an increase from 2021, when the audit results suggested that in total pharmacies were providing 58 million consultations per year. PSNC has published the findings of the audit of over 4,000 community pharmacies carried out earlier this year. During the audit, 82,872 informal patient consultations were recorded, with the average pharmacy completing 19 consultations per day. This suggests that more than 1.2 million informal consultations are taking place in community pharmacies in England every week. The audit helped to quantify the number of informal referrals being made to pharmacies by GPs and NHS 111, with 7,774 informal patient referrals into pharmacy coming from these routes; grossed up to a national level that means 117,000 cases per week. These are all referrals that could and should have been made by the NHS Community Pharmacist Consultation Service (CPCS).

A recent analysis conducted by the Company Chemists' Association (CCA) has revealed stark disparities in patient engagement with the Pharmacy First service across the country, likening the pattern to a 'patchwork quilt'. It indicated that patients in the highest-performing Integrated Care System (ICS) received seven times more Pharmacy First consultations than those in the lowest-performing regions. As of April 21, more than 3,000 CCA member pharmacies had delivered 126,484 Pharmacy First consultations since the programme's launch. However, the analysis found significant regional variations, with nearly 13,000 consultations completed in the North East and North Cumbria ICS, while only 948 were completed in Gloucestershire ICS. The CCA calculated that if every ICS had as many consultations as the highest-performing ICS, there would have been an additional 600,000 Pharmacy First consultations nationwide.

EMIS Pinnacle, the leading Pharmacy First IT supplier, has begun implementing the GP Connect Update Record feature to all community pharmacies in England that use PharmOutcomes. Starting June 28, this new feature was made available for use with the Hypertension case-finding service and the Pharmacy contraception service, as announced by the Community Pharmacy England (CPE). The GP Connect Update Record will enable community pharmacies to securely share "structured" information with GP practices regarding consultations conducted under the Pharmacy First programme, which includes minor illness and clinical pathways, along with Hypertension Case Finding and Pharmacy Contraception services Live testing is underway with EMIS Pinnacle for Pharmacy First minor illness and clinical pathways. There are plans to expand the system in the future to include updates for urgent supply of medicines under the Pharmacy First service. EMIS Pinnacle is the third CPCF IT system supplier to offer this functionality, following Cegedim's Pharmacy Services system and Positive Solutions' HXConsult system.

Pharmacy First has demonstrated the enormous value of community pharmacy in providing accessible front-line care. However, pharmacists continue to face several challenges in delivering the service. "Pharmacy First is a success, but it needs proper support to reach its full potential," said Numark chairman Harry McQuillan. In the first year alone, community pharmacies in England delivered an incredible 2 million consultations, highlighting the vital role pharmacists and their teams play in supporting the NHS. "This significant number shows the high demand for accessible healthcare and the trust patients place in their local pharmacy teams. It's clear that when empowered, community pharmacy delivers," McQuillan told Pharmacy Business. Key challenges in providing the service While Numark members have embraced Pharmacy First, McQuillan pointed out several challenges that persist: "Workforce capacity continues to be a concern, with patient demand sometimes outpacing available resources. "The administrative burden, particularly around IT interoperability, data capture, and reimbursement processes, adds complexity." "Additionally, some geographical areas are still struggling with public awareness, meaning more work is needed to ensure patients understand when and how they can access Pharmacy First."

In response to concerns raised by pharmacy owners, the government has decided to adjust the August threshold for the Pharmacy First service from 20 to 15 clinical pathways. The ability of pharmacy owners to achieve the thresholds for the monthly Pharmacy First payments has been a topic of great concern. Community Pharmacy England (CPE) has been actively discussing this issue over the last few weeks with the Department of Health and Social Care and NHS England. Ministers have now decided to adjust the August threshold for the Pharmacy First service to 15, CPE announced today (July 31). Commenting on this decision, Janet Morrison, CEO of Community Pharmacy England said: "We are pleased that Ministers have listened to our concerns and acted quickly to make an adjustment so soon after coming into office."

Pharmacies are valuable healthcare assets, meeting increasing public demand. However, a substantial portion of their capacity is consumed by unfunded work. According to Community Pharmacy England's (CPE) 2024 Pharmacy Advice Audit, community pharmacies conduct over 1.3 million unfunded consultations each week, equating to 69 million annually. The average pharmacy completes around 22 of these consultations daily, each taking approximately 5.6 minutes of staff time -adding up to over two hours daily. This represents nearly 50 per cent more consultations than in 2020 and a 78 per cent increase in time spent on unfunded healthcare advice since the 2020 audit. The audit, which surveyed over a third (3,916) of community pharmacies in England earlier this year, also highlights that pharmacies handle nearly 150,000 informal referrals from GPs and NHS 111 each week. All these referrals could have been routed through the Pharmacy First service, which would have potentially secured over £115 million in funding for the sector, the CPE noted.

Community pharmacy continues to play a crucial role in providing patients with access to essential NHS care through the Pharmacy First service, especially when other parts of the healthcare system are difficult to reach. According to the Company Chemists' Association (CCA), the sector delivered an estimated 65,000 Pharmacy First consultations in the week leading up to Christmas, marking a 10 per cent increase compared to previous weeks. At a Rowland's Pharmacy in Warsop, Mansfield, pharmacist Taseta saw a notable rise in the number of patients seeking consultations for sore throats, particularly among school children and staff. The pharmacy also experienced an increase in urinary tract infection (UTI) consultations, while earache cases remained consistent. Taseta explained the surge, noting, "Lots of people do not want to be ill over Christmas so [they] wanted easy and quick access to care, which we could do in the pharmacy." They also saw more patients engaging with the Pharmacy Contraception Service, which Taseta attributed to time constraints at the local surgery.

NHS England announced at the Pharmacy Show this morning that Ministers have decided to amend the Pharmacy First thresholds for the remainder of the year. This decision follows concerns raised by Community Pharmacy England (CPE) regarding difficulties faced by pharmacy owners in meeting the required number of clinical pathway consultations for monthly Pharmacy First payments In response to CPE's representations to the Department of Health and Social Care (DHSC) and NHS England, the threshold was earlier reduced from 20 to 15 in August, and from 30 to 20 in October. At the Pharmacy Show on Monday, Ali Sparke from NHS England announced the revised thresholds, setting them at 20 for November and December 2024. Starting in January and February 2025, the number of clinical pathway consultations needed for the monthly Pharmacy First payment will rise to 25, with a further increase to 30 in March.

Northern Ireland's chief pharmaceutical officer paid a visit to a community pharmacy in Belfast on Monday (November 7) - marking the end of this year's Ask Your Pharmacist week, an annual public awareness campaign launched by the National Pharmacy Association. Cathy Harrison interacted with patients and staff in the pharmacy before recording a video to promote NI's 'Pharmacy First' service in which she described community pharmacies as "one of the front doors to the health service" with over 500 outlets located across the country. "In our community pharmacies you can always rely on friendly staff, medicines expertise, and walk-in access to face-to-face advice," she said. First launched in Scotland, the NHS Pharmacy First service enables patients to have a consultation with a pharmacist for advice on minor ailments. Ms Harrison also drew attention to community pharmacy's role in cancer awareness and helping people to quit smoking, as well as managing patients with urinary tract infections, in addition to playing their part in delivering Covid-19 and flu vaccinations.

The nationwide implementation of the Pharmacy First service is viewed as a significant development that benefits pharmacies, primary care, and the broader National Health Service (NHS). Pharmacy teams are striving to ensure its success despite challenges within the industry landscape. However, not all pharmacists are able to reap the benefits from it. Recently, two members of Numark shared their experiences of how the scheme is impacting their pharmacies. Graham Phillips, who owns Letchworth Pharmacy in Hertfordshire, revealed that patients are responding favourably to the service. "It's all good, people are just delighted to have easier access to care," he said. In its first month, Letchworth Pharmacy provided around 100 consultations, and Phillips envisions that as the service matures, they will be able to conduct an average of 200 interventions per week. "That will make it financially viable for us and mean that we're acting at scale from an NHS perspective. That's 200 GP appointments we've freed up in a week - that's a huge capability and capacity bump for the NHS," he added. Graham credits part of his success with Pharmacy First to the strong relationship he has established with local GPs in his area.

Labour's Paulette Hamilton has raised concerns regarding the increasing reliance on pharmacy technicians in clinical practice due to staffing shortages within pharmacies. At the recent Pharmacy Inquiry session, Hamilton highlighted the mounting pressure on technicians to take on more responsibilities beyond their qualifications, attributing it to the launch of Pharmacy First in January. With almost 50,000 Pharmacy First consultations conducted in the first month alone as per a report by the Company Chemists' Association, Hamilton expressed apprehension about technicians being classified under the broad term of "pharmacy professionals," blurring the distinction between their roles and those of clinical pharmacists. She further drew parallels between this situation and the scrutiny faced by physician associates (PAs) in GP practices following a patient's death due to misdiagnosis and cautioned against technicians performing tasks beyond their expertise and urged policymakers to prevent similar incidents in pharmacy settings. Health Minister Dame Andrea Leadsom responded by defending the current approach, denying any "blurring of the edges" and emphasizing patient safety as the top priority.

Pharmacy Minister, Will Quince received flu vaccination and blood pressure check at his visit to a Boots pharmacy in Westminster arranged by the Company Chemists' Association (CCA). The Boots pharmacist, Flavia, explained to the Minister the broad range of services the pharmacy delivers, from the new medicines service to emergency contraception and the community pharmacy consultation service. The Minister witnessed first-hand much of what the community pharmacy sector has to offer patients and the NHS. Malcolm Harrison Chief Executive of the CCA said: "We share the Minister's vision on how community pharmacies and their teams can contribute to the 'Plan for Patients' set out by the Secretary of State. It is great to have the support of the Minister and we are excited for the future of pharmacy.

Pharmacy owners can make their claims for February Pharmacy First consultations until 5pm on Friday 15 March 2024, the NHS Business Services Authority (NHSBSA) announced on Monday. The deadline for Pharmacy First submission was extended following a technical issue in the NHSBSA Manage Your Service (MYS) portal, which led to the claims appearing incorrectly in the portal. The NHSBSA has been working with suppliers and NHS England to investigate and address the problem. While the problem has been resolved, the NHSBSA has advised pharmacy owners to check their submissions carefully before submitting. If any issues persist, they are advised to contact their Pharmacy First IT system supplier helpdesk to escalate the matter and not to confirm their claims in MYS until the issue has been resolved. Pharmacy owners are informed that the extended deadline is for February only and it includes any consultations completed on 31 January 2024.

The Community Pharmacy Walk-In Consultation Service (WICS), offering treatment for various minor ailments, recorded 19,567 consultations in 2024. This marks a 61 per cent increase compared to the 12,138 consultations recorded in 2023, according to data released by Community Pharmacy Cornwall (CPC) and obtained by The Pharmaceutical Journal. Launched in community pharmacies across Cornwall and the Isles of Scilly in January 2021, the minor ailment scheme is commissioned by the NHS and CPC. It enables locally accredited community pharmacists to supply prescription-only-medicines (POMs) for the treatment of several common conditions utilising patient group directions (PGDs) that Pharmacy First does not currently cover. These include vaginal candidiasis (vaginal thrush), dermatitis, migraine, conjunctivitis, and emergency hormonal contraception. Since its launch, the service has facilitated over 38,000 consultations, with 80 per cent of them resulting in advice or treatment that concluded the consultation in the pharmacy. WICS data also indicates that the service has helped avoid an estimated 30,000 GP appointments and more than 500 inappropriate A&E visits since its inception.

The National Pharmacy Association (NPA) has urged the NHS to take urgent action to prevent faults in the IT system underpinning the government's flagship programme. The NHS Business Services Authority (NHSBSA) recently confirmed that the issue in the Manage Your Service (MYS) portal had been resolved, and consequently, the deadline for submission of claims for February Pharmacy First consultations was extended until 15 March 2024. However, NPA members said that they are still facing problems, with the portal recording fewer consultations than entered by pharmacies, potentially leaving them out of pocket by thousands of pounds. Paul Rees, chief executive of the NPA, highlighted the significant achievement of pharmacies in delivering tens of thousands of consultations in the first month of the Pharmacy First programme, stating that this accomplishment is "a testament to their skill and dedication."

Preet Kaur Gill, Shadow Minister for Primary Care and Public Health, has paid a recent visit to a community pharmacy in Staffordshire to personally experience the services it provides to patients, while staying updated on the latest sector developments. Her visit to Eason's Pharmacy in Tamworth on September 22nd marked her first since assuming new responsibilities for pharmacy policy matters within Labour's health team. Gill was also joined by a member of the National Pharmacy Association staff. The Minister received a comprehensive briefing on Eason's Pharmacy from its third-generation owner, Kieran Eason (R). He outlined the NHS services, which include the New Medicines Service and blood pressure monitoring, and showcased two consultation rooms and an operational dispensary. "It's great that Preet came to learn firsthand about the challenges we face and the substantial potential of community pharmacies nationwide," Eason said. "As an independent prescriber, I have the expertise to provide even more convenient care, but the current funding levels severely limit our contribution."

Health secretary Wes Streeting has pledged to stabilise the community pharmacy system before enabling it to take on a broader role in healthcare, as he addressed the Health and Social Care Select Committee in Parliament on Wednesday (18 December). "Now that we have got the budget set, we will be consulting with Community Pharmacy England shortly in the New Year," Streeting stated. "I do want to reassure pharmacists across the country that we are taking into account the enormous pressures they are under when thinking about allocations so that we can stabilise the system and create the foundations from which to recover." The health secretary emphasised that his top priority is to "stabilise the [community pharmacy] system" before expanding initiatives such as Pharmacy First and independent prescribing. He also expressed a vision for community pharmacies to play "a bigger role… as part of the shift from hospital to community," but stressed that immediate steps are required to address the sector's current financial strain. The announcement that Community Pharmacy Contractual Framework (CPCF) negotiations will commence early in the New Year was reaffirmed by Streeting, echoing a statement made earlier in the week by minister for care Stephen Kinnock during a Westminster Hall debate.

Since its launch on January 31st, the Pharmacy First service by the Company Chemists Association (CCA) has achieved a significant milestone, completing over 200,000 consultations to date. This milestone underscores the service's vital role in providing same-day NHS care through community pharmacies across England. Recent analysis by the CCA has revealed a pressing need to bolster GP referrals, with disparities observed between different Integrated Care System (ICS) areas, resulting in what's described as a 'postcode lottery' for patients. CCA Chief Executive, Malcolm Harrison, emphasised the importance of sustained funding for Pharmacy First beyond 2025, ensuring its availability for patients, community pharmacies, and the wider NHS.

Community Pharmacy England (CPE) has taken an interesting step to increase public awareness and understanding of the Pharmacy First service. The organisation has launched a new video animation that provides clear and concise information about the service, highlighting the seven conditions covered, the eligible age ranges within the clinical pathways consultations, and explaining how patients can access these services. Pharmacy owners and their teams are encouraged to use the new animation with existing resources to communicate the benefits and scope of the service to their  patients. The animation can be linked to pharmacy social media content and downloaded for display on digital screens in pharmacies. General practices are also encouraged to use the animation on digital screens in their practice waiting areas.