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NHS England’s ‘Acute Sore Throat Pharmacy First’ scheme (ASTPF) is more than twice as likely to supply patients with antibiotics than Wales’s ‘Sore Throat Test and Treat’ service (STTT), according to study results.
The study, published in the Journal of Antimicrobial Chemotherapy on 12 March 2025, compared the antibiotic supply rates of the two schemes and found that, following consultation, 72.7% of patients in England were supplied antibiotics, compared with 29.9% in Wales.
The team analysed electronic pharmacy records from February–July 2024, which covered 27,684 consultations for acute sore throat recorded across participating pharmacies in Wales and 317,864 consultations in England.
Although in England, the FeverPAIN score required (4 or 5) to supply antibiotics is higher than in Wales, where patients with a lower FeverPAIN score (2 or 3) are eligible for antibiotics, pharmacies in Wales conduct swab testing to determine if group A streptococcus is present before deciding whether to supply antibiotics.
NHS England’s Pharmacy First scheme launched in January 2024, while the Welsh scheme launched in 2018.
The Welsh service was introduced gradually, initially being piloted at 70 pharmacies across two health board areas, while the service in England was implemented nationally alongside six other Pharmacy First clinical pathway services.
Both schemes allow participating pharmacies to supply prescription-only medicines for acute sore throat after consultation with a community pharmacist and are aimed to enable patients to seek treatment directly from a pharmacy without a GP appointment, to free up GP services.
Patients can access both services directly as well as through a referral from a healthcare professional.
Study author Ayodeji Matuluko, research fellow at the London School of Hygiene and Tropical Medicine (LSHTM), said: “We need to collectively consider ways to ensure the appropriate use of antibiotics, to stem the potential public health threat posed by bacterial resistance.
“It’s important that we now consider what factors may be influencing this disparity, such as variation in the service provided to patients or whether there may be differences in the demographics of those who attend pharmacies with sore throats, such as age and overall health.”
Study author Rebecca Glover, assistant professor in antimicrobial resistance (AMR) at LSHTM, added: “Our study indicates that the sore throat antibiotic supply pathways in England and Wales are quite different.
“We believe that one possible reason for the difference seen in antibiotic supply rates may be the presence of a diagnostic test for patients in Wales but this does not mean it’s the answer for pharmacies across England. Diagnostic tests can add additional expense to an already-burdened healthcare system and the tests themselves often vary in quality.
“While these services in England and Wales are similar, they are not direct comparisons, since the data are captured differently across the two nations. IT systems, scale, pace of programme uptake and training processes are also quite different.
“Our next steps will be to investigate the uptake, antibiotic use, safety and impact of the English Pharmacy First service as a whole in much greater detail, as part of a three-year evaluation commissioned by the National Institute for Health and Care Research.”
Commenting on the study, a spokesperson for the Welsh government said: “Community pharmacists are helping to improve patients access to safe, effective and timely care.
“This study shows the routine use of an antigen test alongside a pharmacist’s clinical assessment is not only ensuring people get the treatment they need promptly, but also supporting efforts to reduce unnecessary antibiotic prescribing, and tackle the threat of AMR.”
In November 2024, study results published in the Journal of Antimicrobial Chemotherapy revealed that the Welsh pharmacy-led STTT service had reduced antimicrobial prescribing, with 24% of consultations resulting in an antimicrobial supply compared with 39% of GP consultations.
A report published in December 2024 by the Company Chemists’ Association (CCA) called for the Pharmacy First service in England to include a wider range of treatment options to support antimicrobial stewardship.
