Pharmacy First got under way in England on 31 January 2024. It is clearly too early to declare this newly launched initiative in England either a failure or a success. (Rhetoric about Pharmacy First has been with us for so long that the very idea of it as a new launch made me blink, but there we are.)
Naturally, it would be reasonable to expect some teething troubles in the new system, and indeed such troubles were reported by the GP publication Pulse.
The article picked up on GPs’ concerns as patients trying to get their needs met at a pharmacy first were passed back to general practice.
Pulse’s Anna Collivicci writes about GPs’ concerns that “the implementation has not so far worked as expected, with pharmacies lacking capacity to see the patients or the appropriate equipment to carry out the consultations”. The article gives specific examples of pharmacies lacking necessary equipment; being unable to provide adequate quantities of antibiotics to address a health problem; and not being listed on the ‘redirect’ IT system.
Multiple handling
‘New system in teething troubles shock’ wouldn’t make much of a headline, rightly. But this flagged up to me three concepts from the retail sector, which seem relevant to our attempts to improve access to healthcare services.
The first of these is the concept of ‘multiple handling’. I was first introduced to this as a child, on the weekly supermarket shop with my parents, when I started taking items from the trolley and putting them on to the end of the checkout, just before the conveyor belt started. My Dad (a scientist) pointed out that this was a classic case of multiple handling: adding a redundant make-work stage into what should be a single-stage process (trolley to conveyor belt). I took the point.
There’s a lot of multiple handling in our health system. A classic example is test results only being sent from pathology labs to GPs, creating avoidable extra work for patients in phoning up to get results and for general practice staff, adding to a demand-burdened sector.
A well-run system would be curious about incidents of multiple handling and iterate improvements to reduce or eliminate them
At the start of Pharmacy First, we can reasonably expect a certain amount of multiple handling, as all involved (pharmacies, GP practices and the all-important patients) go through the ‘learning by doing’ stage.
A well-run system would be curious about such incidents of multiple handling and iterate improvements to reduce or eliminate them. Mistakes are learning opportunities, but in well-run systems, processes find and fix them.
Do we think there are plans and people in place to do this? If not, then fixing issues with multiple handling will not happen.
Failure demand
The absence of self-performing miracles is seen in the more widely-known concept of failure demand. A system such as the NHS, with its current huge access backlogs (whether that is those that are measured, as in the cases of referral to treatment for elective care and A&E waiting times, or those unmeasured) is basically awash with failure demand, and has been for many years now.
It is very clear when you talk to GPs that a significant amount of their ongoing high workload (which Pharmacy First aims to help cut) is driven by failure demand created by the system’s inability to offer timely care. People who are having to wait in pain and deterioration, who can’t get timely access to diagnostics; they don’t just sit at home stoically, swallowing painkillers — their unmet needs can trigger new needs.
Pharmacy First might, in time, be able to expand its scope towards improving the management of long-term conditions, which is such a central part of healthcare demand. Clearly, this won’t happen without shifting resources and growing capacity in the sector, but it is, in theory, a possible means of rebalancing and relocating total demand away from the heavily-stressed areas of primary and elective care. By making some headroom in those sectors, they might be able to make better progress on their backlogs, and thus eventually cut failure demand burdens for the whole system — and, of course, for users.
User experience
A great deal of the NHS tends to treat user experience as a source of huge danger and something that needs to be defused.
I exaggerate slightly here, but only slightly. The Pulse article makes some reasonable points about early evidence of weaknesses in this scheme — they will need prompt fixes putting into place. Users need Pharmacy First to work for them. There may be some initial willingness for patients to ‘give it a try’ and not expect perfection first time, but adequacy would be nice.
Community pharmacy has insights into the value of user experience (although we should be honest enough to admit that it is still wildly variable). Can the sector use its experience to help NHS colleagues (whether through Pharmacy First, or more broadly) to think about how to iteratively improve user experience? Let’s hope so.
Andy Cowper is the editor of Health Policy Insight
