The government should develop an independent prescribing service for community pharmacists in England, to expand their role in managing minor illnesses, a report backed by leading GPs has said.
The report, jointly published by the Royal College of General Practice (RCGP) and the Royal Pharmaceutical Society (RPS) on 18 November 2021, says the service should resemble “the ‘Pharmacy First’ and ‘Pharmacy First Plus’ services in Scotland”.
This comes after health secretary Sajid Javid said in October 2021 that he was asking the Department of Health and Social Care (DHSC) “to work with the NHS and look at a ‘Pharmacy First’ scheme for England”.
‘Making the Community Pharmacist Consultation Service a success’ also sets out a range of recommendations to improve uptake by GPs of the Community Pharmacist Consultation Service (CPCS).
The CPCS in general practices was rolled out nationally in November 2020, following a pilot phase in five locations in England, where nine in ten patient consultations referred to community pharmacists by a GP were completed by the pharmacist.
However, as of October 2021, the report says that “only 862 GP practices” out of 6,500 practices in England are referring to community pharmacists under this service.
In plans published on 14 October 2021, NHS England said all practices would be “encouraged” to sign up to the CPCS by 1 December 2021.
But the RCGP and RPS report said that in “some areas this requirement and timeline is being relaxed, according to local discretion, due to some of the challenges of implementation”.
The report says these challenges include an inability for pharmacies to ‘close’ some CPCS consultations because the patient required a prescription-only medicine (POM), along with advice.
“The community pharmacist would need to refer the patient back to general practice for an appointment with a prescriber for a prescription to be supplied,” the report said, which “was seen to produce extra workload on general practice … despite community pharmacists being more than capable of completing the episode of care and supplying a medicine”.
The report suggested “a more advanced service, which included the supply or prescribing of POMs by community pharmacist for minor ailments, would help general practice and patients even further” and cited the Pharmacy First and Pharmacy First Plus schemes in Scotland (see box).
Professor Martin Marshall, chair of the RCGP, said the CPCS is “potentially a part of the solution” to the pressures facing general practice.
“Pharmacists are highly trained and highly trusted healthcare professionals, who can play a vital role in supporting people with a range of minor ailments, freeing up GPs’ time for patients with complex health needs.”
Thorrun Govind, chair of the RPS in England, said the CPCS “is just one example of how we can use the skills of teams across community pharmacy, general practice and the wider NHS to help patients see the right clinician at the right time”.
“With continued pressures on teams across the health service, we really wanted to hear from healthcare colleagues as to how we can make the most of new services like the CPCS,” she said.
“We know there are challenges to getting this right and it is fantastic that some of the recommendations are already being discussed with the NHS and other key partners, as to how we can work together to achieve the best outcomes for patients.”
Alastair Buxton, director of NHS Services at the Pharmaceutical Services Negotiating Committee (PSNC), said: “PSNC has long called for an extended Pharmacy First/minor ailments service and indeed progressed negotiations on this back in 2015 when it was eventually abandoned by the NHS. We know that, since then, and in particular over the past two years during the pandemic, the landscape has significantly changed, and patients and local communities are increasingly relying on pharmacies for help with both minor and more serious conditions.
“PSNC wants the walk-in advice that pharmacies are now providing to be fully funded, and we were pleased to hear the secretary of state supporting an extended role for pharmacists in supporting people with minor conditions. We expect this to be a key topic for discussion in the upcoming negotiations on year four of the five-year [Community Pharmacy Contractual Framework] deal.”
NHS England was approached for comment.
What is ‘Pharmacy First’?
Pharmacy First launched across Scotland in July 2020, offering anyone living in Scotland the opportunity to visit a pharmacist as their first port of call for minor illnesses, such as urinary tract infections, impetigo and acne. It includes an assessment, referral, or treatment and has been described as “the art of pharmacy“.
In September 2020, an extended version, Pharmacy First Plus, was launched, with the aim of embedding pharmacist independent prescribing into everyday practice. Pharmacy First Plus allows pharmacist independent prescribers to manage the treatment of patients with common clinical conditions that may otherwise have needed referral to another healthcare provider, including allergies and eye infections.
READ MORE: Learning resources on minor ailments