Primary care in England is broken. GP numbers are falling, demand for appointments is rising and patient satisfaction with the service is at an all-time low. To overcome this bottleneck and create a more effective health service, we need to give people new choices in accessing health care.
A key part of the solution must be the creation of a “Pharmacy First” service. This will give patients easier access to care and provide much-needed relief to over-burdened GPs. Under the Pharmacy First model, patients can have a prescribed set of routine ailments assessed by a community pharmacist and can then receive follow-on treatment, advice or appropriate onward referral to other health-care specialists.
The government knows this is needed and has previously indicated it would like to use community pharmacies to relieve pressure on the NHS frontline. However, as months roll by and pressures continue to mount, there is still no planned launch of a Pharmacy First service – although a call for research is anticipated. The National Institute for Health and Care Research suggested that if it goes well, England could see a Pharmacy First service commissioned from the end of October.
Of course, expanding services offered by community pharmacies would require investment. Right now, pharmacies are closing across England because of financial pressures. Figures published by the Company Chemists’ Association (CCA) show that under the current five-year contract, there is an annual shortfall of more than £750 million per year, an average of £67,000 per community pharmacy.
However, investment in a Pharmacy First service is an investment in health that could quickly become a cost-saver by relieving pressure on GPs and A&E. A 2022 report estimated that delivering walk-in services in pharmacies would cost around £560 million. This is a sizeable sum, but it’s dwarfed by the £1.2 billion currently spent on approximately 40 million annual GP appointments that could be moved into pharmacies, creating a net saving of around £640 million a year.
We know the model works; the Pharmacy First Scotland service and Common Ailments Service rolled out in Scotland and Wales respectively provide a clear roadmap for England. These programmes, which have integrated well with existing primary-care services, each treat around 25 additional conditions, many of which could be treated in community pharmacies in England with relative speed and ease.
The government needs to act, otherwise patients and GPs in England will continue to suffer. Between 2015 and 2022, England saw a net reduction of 343 GP practices, which has made it increasingly difficult to access GP appointments. Patients are noticing; overall satisfaction with the NHS fell to 29 per cent in 2022, the lowest level since 1997.
Expanding the role of community pharmacies is part of the solution. Shifting certain services into pharmacies could release about 12 per cent of annual GP appointments. This is already happening in Scotland, where their Pharmacy First service has removed the need for 200,000 GP and A&E appointments between July 2020 and November 2021 alone.
Pharmacies are also one of the most accessible points of care. In England, around 50.8 million people live within a 20-minute walk of a pharmacy, compared to around 47.4 million people who live the same distance from a GP (calculated from 2021 census figures). This rises in areas of higher deprivation, with over 99 per cent of people in the most deprived areas living within 1 kilometre of a pharmacy.
Integrating Community Pharmacies Into a Modern Primary-Care Model
Yet while there is a general consensus that expanding services provided by community pharmacies in England would deliver benefits, funding as well as outdated regulations, workforce limitations and a lack of digital integration remain challenges.
Therefore, alongside the select group of services that can be shifted into pharmacies in the short term, the government should be thinking strategically about deeper reforms to the sector and the integration of community pharmacies into a more modern primary-care model in which the GP is no longer the single point of entry into the NHS.
Short-Term Recommendations (1-2 years)
1. Invest in a Pharmacy First service.
Government investment is needed to capitalise on the long-term potential of community pharmacies. To enable the rollout of a Pharmacy First service, the government must address the sector’s funding shortfalls. The Pharmaceutical Services Negotiating Committee reported that with inflation and increases in business and staffing costs, funding for community pharmacies is decreasing year on year.
Analysis of NHS data by the CCA found that between 2015 and 2022 there was a net loss of 670 community pharmacies across England. Without new funding, this trend will continue or potentially worsen given that the cost of doing business continues to rise.
2. Accelerate plans to digitally integrate community pharmacies into the wider NHS.
Often care provided in pharmacies is restricted by limited access to patient information. Care is also not included in patients’ records as relevant systems are not yet integrated. Yet examples such as influenza vaccinations have shown the value of seamless integration between pharmacies and the wider NHS.
There is a clear need for pharmacists to have access to relevant patient information for the services they are commissioned to deliver. Similarly, GPs and others need to know what care has been provided – without any additional administrative burden. Existing NHS plans tackle many of these needs but must be accelerated to prevent them blocking new services. In the future, all primary-care practitioners should be able to view the information they need and update others about the care they are providing regardless of their IT systems or location.
3. Ensure community pharmacy is a core component of the NHS workforce strategy.
The government’s long-promised NHS workforce strategy must address the needs of the pharmacy sector, given pharmacists have been on the Home Office’s Shortage Occupation List since March 2021. As the Hewitt Review makes clear, this shortage has been exacerbated by the recruitment of pharmacists into primary-care networks.
To address staffing challenges, the strategy should address funding, training and incentives for pharmacists to work in community pharmacies. It should also capitalise on the increase in pharmacists qualifying as independent prescribers (PIPs) from 2026 to increase community prescribing and enable improvements in patient access and outcomes.
The NHS England Independent Prescribing Pathfinder programme is a good start to providing prescribing services in pharmacies for non-complex conditions. But the government needs to think creatively about how to attract more people to the profession, ensuring that pharmacy remains a career of choice. This could include initiatives such as active promotion, investment in further commissioned services, setting out a roadmap for independent prescribing or regulatory easements to build greater capacity within pharmacy teams.
Long-Term Recommendations (2+ years)
1. Allow pharmacists to use their prescribing capabilities, with the aim of rolling out a “Pharmacy First Plus” service in England by 2026.
In England, all pharmacy graduates from 2026 will qualify as PIPs at the point of registration. The aim should be to make use of this capacity in community pharmacies as soon as possible, so more patients can get faster access to treatment. If the NHS fails to commission additional services from PIPs, these valuable skills will atrophy and the additional capacity will go unused. Action on this issue needs to take place now because some services can take significant time to be commissioned and established.
2. Invest in technology to streamline pharmacy functions and increase efficiency.
An expanded role for pharmacists should be supported by the integration of technology and automation. As we’ve called for previously, the NHS App should be built upon and integrated into pharmacist care, for instance to support digital triage.
Similarly, pharmacies should capitalise on automation technology to sort, package and dispense medication more efficiently. With 1.14 billion prescription items in 2021-2022, the use of automated dispensing systems can free up time for pharmacists to focus on tasks such as consulting with patients. There is also potential for the future development of AI to support automated clinical checking and triage, further improving patient experience and reducing wait times.
Technology will continue to change the way we deliver care across the health system and community pharmacies should make use of relevant innovations emerging across the NHS.
Putting Patients First
England needs a Pharmacy First service. The evidence is clear; we do not need to look any further than Scotland and Wales to see the impact that such a programme can have on a patient’s experience with the health system. A Pharmacy First service is about putting patients first, making it make it quicker and easier for patients with minor aliments to receive the care they need.