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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).

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.

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.

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."

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.

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."

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.

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.

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.

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.

The Royal Pharmaceutical Society (RPS) in England has published a review of its 10-year Vision for Pharmacy Professional Practice that was launched in December 2022 in collaboration with The King's Fund. The 'one year on' vision report highlighted key milestones achieved in the first 12 months since its publication as well as opportunities for further progress. It identified the publication of the NHS Long Term Workforce Plan, which recognises the significant role that pharmacists play in healthcare and commits to growing and expanding the pharmacy workforce, as one of the positive policy developments made since the launch of the vision. The development of a Vision for Community Pharmacy by Community Pharmacy England, the Nuffield Trust and The King's Fund; work on digital integration to enable community pharmacists to update a clinical record; the launch of Pharmacy First scheme; and the publication of the public consultation of pharmacy supervision were other key milestones mentioned in the report.

Community pharmacies in Cornwall have delivered more than 8000 face-to-face consultations over last 12 months. Walk In Consultation Service (WICS) began 12 months ago when pharmacies in Cornwall started offering face-to-face consultations for a wide range of minor ailments, and NHS treatment as required - the first service of its kind in England. Cornwall & Isles of Scilly Scilly Local Pharmaceutical Committee (LPC) Chief Officer Nick Kaye joined Operations Manager Drew Creek in Parliament recently by invite of Steve Double MP, St Austell and Newquay to meet with Minister for Health Neil O'Brien MP to present the service to them and Senior Civil Servants from DHSC and NHSE with a view to rolling this service out nationally. The data from these consultations show that over 6000 GP appointments were averted as a result of the service being available. After each consultation a record was sent to the patient's GP for information.

Community pharmacy chain Jardines Pharmacy has partnered with patient relationship management platform Charac to launch a new app designed to digitalise its services, enhance operational efficiency, and elevate customer satisfaction. The app allows patients to order repeat prescriptions, access medicine home delivery and book consultations with their pharmacist all in one place, enabling faster pharmacist-to-patient care. By incorporating Charac's platform into its business, Jardines is able to boost prescription dispensing efficiency, helping reducing wait times for patients. Additionally, its delivery feature enables patients to track their orders directly through the app, thereby streamlining the overall patient experience. The app also minimises administrative and manual tasks for pharmacists, giving them more time to focus on helping patients and delivering the outstanding customer service. Patients of Jardines can also use the app to book appointments digitally for Pharmacy First consultations, blood pressure checks, earwax removal, travel vaccinations, and emergency contraception services. Santosh Sahu, Founder and CEO of Charac, said: "We are pleased to support Jardines Pharmacy and its patients across England. Our mission is to ensure that community pharmacies are empowered to digitalise, making care easier and more accessible for patients.

Community Pharmacy England (CPE) is organising a series of webinars to help pharmacy owners and their teams to prepare for the implementation of new Pharmacy First service, and changes to the Contraception and Hypertension Case-Finding Services. Beginning from 5th December, the webinars would be conducted throughout December and January, with support from NHS England and the Centre for Postgraduate Education (CPPE), the organisation announced on Thursday (30 November). During the online seminars, pharmacy teams will be explained about the individual services announced, and things to consider before they start providing, or expand their offering of, these services. Each webinar will have CPE's Services Team, who would be leading the team, and policy experts from NHS England and CPPE as speakers.

Researchers from the London School of Hygiene & Tropical Medicine (LSHTM) have been tasked to evaluate the impact, safety and effectiveness of the Pharmacy First service, which was launched across England in January 2024. They have been awarded £2.4million by the National Institute for Health and Care Research (NIHR) to generate evidence on the new service that allows pharmacies to provide advice and treatment for seven common conditions without the need for a GP appointment. After consultation, if necessary, a community pharmacist can supply some prescription-only medicines to treat earache, sore throat, sinusitis, impetigo, shingles, infected insect bites or uncomplicated urinary tract infections in women. The LSHTM researcher team will be working together with experts at the UK Health Security Agency (UKHSA) and the Universities of Oxford, Manchester and Nottingham on the project. Dr Rebecca Glover, assistant professor in Antimicrobial Resistance at LSHTM, who will lead the three-year project, said they will evaluate "Pharmacy First's impact on GPs and the wider NHS, pharmacy services and patients."

Community pharmacists in England have launched a new digital platform called My Local Surgery, enabling patients to access Pharmacy First consultations online. This initiative, a part of the NHS Pharmacy First scheme, facilitates free video consultations for six common conditions, connecting patients with community pharmacists for clinical advice and treatment. The platform, spearheaded by a team of pharmacy, tech, and clinical services experts, including experienced community pharmacists Darren Lingaloo and Gulraj Dhillon, tech specialist Nav Ramiah, and Dr. Adam Kirk, a seasoned NHS and digital healthcare professional, seeks to meet the rising demand for clinical services. Darren Lingaloo, co-founder and chief pharmacist at My Local Surgery, said: "The evolving role of pharmacists is long overdue and has the potential to save millions of GP appointments every year.

Community pharmacy contractors eligible under the revised Pharmacy Access Scheme (PhAS) will receive their first of the new monthly payments with the January reconciliation payment due on April 1, 2022. Details of the revised version of the PhAS that commenced from January 1, was published in August 2021, with contractors receiving letters from the NHS Business Services Authority (NHSBSA) indicating their eligibility in the Autumn, PSNC said in an update. Payments under the scheme are dependent on registration on NHSBSA's Manage Your Service (MYS) portal to provide the Community Pharmacist Consultation Service(CPCS). Meanwhile, the review application window is now open for contractors, which would enable the NHS England and NHS Improvement (NHSE&I) to correct inaccuracies related to a pharmacy's distance criteria/calculation.

Marking Pharmacy First's first anniversary in England, the Company Chemists' Association (CCA) has called on policymakers to expand the service, highlighting that there's still "significant room for growth." In a report released today, the association estimates that expanding the service could free up 40 million general practice (GP) appointments every year - more than four times the current potential - and around a tenth of all GP appointments. In its current form, the service is expected to free up more than 9 million GP appointments annually. The CCA has recommended expanding the criteria and treatments available for the existing seven conditions and introducing new conditions. According to the report, community pharmacies provided nearly 1.5 million consultations for the seven covered conditions -earaches, urinary tract infections, sore throats