Pharmacy First is a step too far unless staffing issues are addressed

I have never felt the need to express my frustrations with our profession so strongly. Over the past ten years or so, we have just had more and more dumped on us. We are dispensing more prescriptions than ever and yet staff have been reduced to dangerously low levels everywhere owing to the increasing costs and reduced payments to contractors. 

Pharmacists are being asked to do too much and the Pharmacy First service is a step too far, unless we address the staffing issues in community pharmacy. For it to work, we will need two pharmacists in every pharmacy. There is a cap of 3,000 consultations per pharmacy per month, and while I don’t expect it to reach these levels, there seems to be no control over how many referrals we are expected to manage.

From 2025, the service is planned to include blood pressure and contraception. How many more services are going to be added? A GP has a limited number of appointments in a day. Why are we expected to deal with referrals in addition to everyone who walks through the door or telephones for advice? I have completed some online training via the Centre for Pharmacy Postgraduate Education — consultation skills, dermatology, minor ailments, child sexual exploitation, urinary tract infections, otitis media, sinusitis, sore throat, urgent care — and I still don’t feel confident that I can provide the Pharmacy First service in its entirety. I was more than happy to continue with minor illness referrals and urgent supply referrals and to deal with some of the clinical pathways.

I am not comfortable with examining children with an otoscope. I find it ridiculous that we are expected to examine a child but we cannot treat an adult.

I am not happy with some of the inclusion and exclusion criteria. We have always been taught to refer pregnant women to their GP and now it is OK for us to prescribe antibiotics.

For several of the clinical pathways we have to exclude pregnant individuals aged under 16 years. Am I expected to ask a 14-year-old if they could be pregnant? 

As it is all or nothing, as the Responsible Pharmacist, I will be declining to offer this advanced service as we cannot possibly offer it alongside everything else we are doing. I am not prepared to declare myself competent when I am not. I will not compromise patient safety and my own professional standards.

I am a self-employed locum and, obviously, if I am unwilling to offer this service, I will not be getting much work. I have been a pharmacist for 34 years with an impeccable reputation and I feel I am now being pushed out of a job that I love. 

How many other pharmacists will be brave enough to echo my thoughts? I suspect many will go along with it, just to keep their jobs.

Jillian Gough, MRPharmS