What is Pharmacy First?
NHS England launched the Pharmacy First Service in January 2024 with the aim to ease pressure on General Practice and improve patient access to care as part of the Primary Care Access Recovery Plan (NHS England » Delivery plan for recovering access to primary care).
The service is an update of GPCPCS; Community Pharmacies signed up to deliver the Pharmacy First Service are now able to provide treatment, including antibiotics where clinically appropriate to patients seeking treatment for seven common conditions.
Pharmacy First consists of 3 elements.
- Clinical Pathways (7 common conditions – patients can be referred by General Practice or can present to pharmacy directly).
- Urgent Repeat Medicines Supply (previously commissioned as CPCS.
- Minor Illness (previously commissioned as CPCS - requires a General Practice digital referral).
Pharmacy First
Clinical Pathways |
Urgent Repeat Medicines Supply |
Minor Illness |
|---|---|---|
|
The element of this service allows for the management of seven common conditions by community pharmacists via Patient Group Directions. Pharmacists may offer:
|
Allows NHS111 and UEC to refer patients to community pharmacy for an urgent repeat medication. General Practices are not able to refer patients to community pharmacy for this. |
Requires digital referral from General Practice, UCE or NHS 111. Community Pharmacist can assess patients presenting with minor illness and offer:
|
*General practices cannot refer patients to pharmacies for urgent medicines supply using Pharmacy First but should refer appropriate patients for the other two elements (clinical pathways and minor illness).
What are the new elements of the service?
The seven clinical conditions which form the new part of the Pharmacy First service are shown in the table below. It is important to note the applicable age ranges for each of these conditions to be treated in community pharmacy.
Clinical Pathway |
Age Range |
|---|---|
| Uncomplicated UTI | Women 16-64 years |
| Shingles | 18 years and over |
| Impetigo | 1 year and over |
| Infected insect bites | 1 year and over |
| Sinusitis | 12 years and over |
| Sore throat | 5 years and over |
| Acute Otitis Media | 1 to 17 years |
These seven common conditions are treatable by community pharmacy, following detailed clinical pathways and treated using 23 Patient Group Directions, making the service robust and safe.
The full documents for these can be found via the links below;
The patient journey
Why is Pharmacy First important/ helpful for General practice?
Background to Pharmacy First (PCARP)
On the 9th May 2023, NHS England and the Department of Health and Social Care published the Delivery plan for recovering access to primary care.
Part of the plan includes enabling patients to get certain prescription medications directly from a pharmacy without a GP appointment.
The community pharmacy elements of this plan are:
- A Pharmacy First service which includes GP referrals to Community Pharmacist Consultation Service (CPCS) and 7 new clinical pathways.
- Increase the provision of the NHS Pharmacy Contraception Service and the NHS Blood Pressure Checks Service.
- Improve the digital infrastructure between General Practice.
Why are referrals important?
Referring patients for Pharmacy First from General Practice is important to:
- Help with capacity in the practice so practice appointments can be used for patients who really need them.
- To improve access for patients with minor illnesses.
- To change patient behaviour so they go to community pharmacy as the ‘first port of call’ for minor illness and medicines advice.
- To support the integration of community pharmacy into the PCN team.
- To create improved relationships between practices and community pharmacies to deliver high quality and integrated care to patients.
- To help patients self-manage their health more effectively with the support of community pharmacists.
Can I just ask patients to ‘go to the pharmacy’?
Many people visit community pharmacies every day for many different reasons, such as to collect their prescriptions, to purchase medicines for self-care, for advice on health matters, for vaccinations, and other pharmacy services i.e. blood pressure checks or smoking cessation support.
GP practices should continue to digitally refer patients to Pharmacy First as per the former GPCPCS as opposed to signposting.
How to identify patients suitable for PFS referral
Below you will find quick referral reference guides for the 7 common conditions and minor illnesses covered by the Pharmacy First Advanced service.
Quick reference referral guide for Pharmacy First
Please note that these are the main exclusions. Each Pathway has additional specific exclusions which will be considered by the community pharmacist during the consultation.
How to make a referral
You can refer patients to Pharmacy First, whether they have contacted the practice by phone, online or in person.
Everyone in the practice who makes appointments for patients must know how to refer patients to Pharmacy First.
Where a patient is suitable for a Pharmacy First referral:
Ask which pharmacy the patient would like to be referred to.
Send a referral to the pharmacy using EMIS local, PharmRefer or NHS Mail. The referral contains information about why the patient is being referred.
Step by step guides to making referrals can be downloaded here:
Useful wording when referring patients to Pharmacy First
When referring patients to community pharmacy it is important to ensure that the patient understands that this referral is not dismissing their concerns but that the pharmacy is now able to help them and provide medications if required which are the same that their doctor would be able to provide.
Some phrases you may find useful when communicating with patients are:
- ‘Having listened to your symptoms, I am arranging a same day consultation for you with an NHS community pharmacist working with our practice.’
- ‘Pharmacists can now do more assessments and issue prescription only medications for particular conditions if needed’.
- ‘You can telephone or visit the pharmacy to have a discussion with the pharmacist in their confidential consultation room. The pharmacist will ask questions about your health and your symptoms, including any allergies or any medications you’re currently taking. In some cases, based on your symptoms, they may need to do a quick examination such as if you have earache, they may look in your ear with an otoscope.’
Which Community Pharmacies are participating?
More than 94% of Cambridgeshire and Peterborough pharmacies are signed up to provide Pharmacy First. Community Pharmacies currently registered to provide the service within Cambridgeshire and Peterborough.
How do we receive back community pharmacy consultation records?
On the launch of Pharmacy First on 31 January 2024, Pharmacies had access to new consultation templates for Pharmacy First from whichever of the 4 approved suppliers they contract with (PharmOutcomes, Sonar, Cegedim or Positive Solutions).
Practice teams are asked to continue to electronically refer in the same way they have done previously for GPCPCS. For most EMIS practices that is by the integrated EMIS option and for most SystmOne practices it is by PharmRefer. Practices can send referrals by NHS mail, but it is more time consuming for both practices and pharmacies.
Information will be returned to practices from pharmacies in the same way it was previously – from most pharmacies this is the post event message.
Digital improvements (delivery date TBC)
As part of the improved digital connectivity between practices and pharmacies, community pharmacists will be able to view parts of the patient records via GP Connect. They will also use GP Connect to send a structured message of the consultation record and any medicines supplied back to the practice using GP Connect.
- It is important that the structured message is ingested into the patient record at the practice so if the patient visits another setting for the same episode of care (the practice or another pharmacy) then previous actions and medicine supplies can be seen.
- All structured messages will appear in the GP system generic workflow ‘for action’. Messages must be acknowledged/ actioned by GP staff after which information will be ingested into record without the need for transcription or coding.
Resources for General Practice
A variety of resource to promote the Pharmacy First Service have been developed by the Department of Health and Social Care (DHSC) and Community Pharmacy England.
Frequently Asked Questions
Q. How is Pharmacy First different to CPCS?
The Pharmacy First service replaces and expands upon the previous Community Pharmacist Consultation Service (CPCS). There are 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 clinical pathways consultations of the service allow pharmacists to review patients presenting with one of seven common clinical conditions and to provide them with advice or NHS-funded treatment (via Patient Group Directions) where appropriate.
Q. Which conditions can be referred for the Pharmacy First clinical pathways consultations?
The seven common conditions which can be reviewed and treated via PGDs by a pharmacist are:
- Sinusitis
- Sore Throat
- Acute otitis media
- Infected insect bites
- Shingles
- Uncomplicated UTI
Exclusions apply, please see referral guides for more information.
Q. Is the Pharmacy First Service only used out of hours, when general practices are closed?
No. Where appropriate patients should be referred to the pharmacy during normal working hours. The Pharmacy First service is available throughout the opening hours of the community pharmacy. Exceptions to this should be notified to General Practice.
Q. Do referrals for Pharmacy First need to be sent digitally, or can the patient be verbally signposted?
A digital referral is required to access the minor ailments and Urgent medicines supply elements of the pharmacy first service. A digital referral should also be made for those patients who are eligible for the clinical conditions pathway that present to General Practice, this ensures that this patient will be followed up by the Community Pharmacy even if the patient does not present to them in person.
If a patient is not digitally referred for the clinical conditions pathway but is instead advised to attend the community pharmacy for review, this is not a referral but a signposting. Where a patient is signposted, the Community Pharmacy is not aware of the patient being directed to them. This means that the patient will not be followed up if they do not present at the Community Pharmacy.
Q. What are the benefits of general practices sending a formal referral for minor illness consultations and clinical pathway consultations?
Submitting a formal referral offers several benefits when compared to signposting. If referred:
- Patients will receive a confidential consultation with the pharmacist in the consultation room or remotely. If signposted, they may be assisted under the Essential support for self-care service, potentially being seen by another pharmacy team member.
- Patients may be more reassured that their concern has been taken seriously and the pharmacist will be expecting them.
- If the patient does not contact the pharmacy, the pharmacy will follow up with the patient, based upon clinical need.
- Referrals enable the pharmacy to plan and manage workload, helping them to see patients in a timely manner.
- Clinical responsibility for that episode of patient care passes to the pharmacy until it is completed or referred on.
- There is a record of referral and clinical treatment, which will support future patient care.
- Referral data can demonstrate that patients are actively being supported by their general practice to access appropriate treatment.