Pharmacy First service – Community Pharmacy England

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 will commence on 31st January 2024 (subject to the required IT systems being in place), 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 new Advanced service involves pharmacists providing advice and NHS-funded treatment, where clinically appropriate, for seven common conditions:

• sinusitis
• sore throat
• acute otitis media
• infected insect bite
• impetigo
• shingles
• uncomplicated urinary tract infections in women.

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

The service will also incorporate the existing 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 a referral from NHS 111, general practices and other authorised healthcare providers (i.e. patients are not able to present to the pharmacy without a 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

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

Download the final PGDs and protocol

Draft versions of the PGDs and protocols were published on the NHS Business Services Authority’s website on 1st December 2023, to help pharmacists and pharmacy owners to start to prepare to provide the service. However, pharmacists must read and sign-up to the final versions of the PGDs and protocol, rather than the draft versions, before providing the service.

The draft versions of the PGDs and protocol are not signed by NHS England and therefore do not provide organisational authorisation for pharmacists to authorise supply of medicines at NHS expense, where clinically appropriate, following a consultation for one of the seven conditions for the Pharmacy First service.

While the PGDs have been published, these have been published as PDFs. We are currently working with NHS England to ensure there is a Microsoft Word version of the authorisation sheet (which pharmacists and authorising managers need to sign) so that pharmacy details can be added to this. We will alert pharmacy owners through our normal communication channels when this is available.

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

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 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 Directions for the Pharmacy First 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, while waiting for further information and resources to be published.

Pharmacist implementation checklist: Pharmacy First service

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

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).

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.

Standard Operating Procedure

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.

Various pharmacy support organisations provide template SOPs which their members can personalise for use in their pharmacy.

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:

Cliniskills training (NHS England funded) for Pharmacy First, including otoscope training webinar on 18th Jan 2024

Agilio iLearn Pharmacy First training

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.

Select an IT system

As with the current 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.

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 are currently working 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:

Read more about the IT requirements for all CPCF clinical services

Sign 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.

Registrations opened on MYS on 1st December 2023; further information is included in the Funding and claiming payment section below.

Pharmacy owners providing CPCS and wanting to provide Pharmacy First must sign-up via MYS; there will be no rollover of the registrations for CPCS to the Pharmacy First service.

Withdrawal from CPCS or the Pharmacy First service

If your pharmacy is providing CPCS and you do not wish to provide the Pharmacy First service from 31st January 2024, you can notify NHS England you will not provide the service via MYS. Your declaration regarding the Pharmacy First service will act as your 30 day notice to cease provision of CPCS.

If your notice occurs fewer than 30 days before 31st January 2024, the notice period will be reduced to the number of days remaining before this date, and the final date of CPCS provision will be 30th January 2024.

In due course, 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.

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 (‘the global sum’).

Initial fixed payment

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

The initial fixed payment will be reclaimed if pharmacy owners do not provide five clinical pathways consultations by the end of March 2024 (minor illness and urgent medicines supply consultations do not count towards this minimum consultation requirement).

Pharmacy owners can sign up to provide the service from its commencement date and claim the initial fixed payment by making a declaration on the NHSBSA’s Manage Your Service (MYS) portal by 23:59 on 30th January 2024. Declarations could be made from 1st December 2023.

Pharmacy owners who make the declaration on MYS before 23:59 on 31st December 2023 will receive the £2000 payment on 1st February 2024, with those that subsequently make a declaration before 23:59 on 30th January 2024 receiving the payment on 1st March 2024.

Consultation fees and monthly fixed payment

Pharmacies will be paid £15 per completed consultation.

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).

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.

From April 2024, an initial cap of 3,000 consultations per month per pharmacy will be put in place. From 1st October 2024, new caps will be 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. The mechanism to set these caps will be agreed jointly by Community Pharmacy England, DHSC and NHS England and will be reviewed once we have data from actual service delivery.

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