If you are serious about ‘Pharmacy First’, which was launched at the end of January 2024, then you need to ensure the technology that underpins it actually works properly.
At present, it is not clear that the government and the leadership of the NHS in England are indeed serious about this, despite NHS England’s promises that the system would be ready for pharmacists to access GP records from January 2024.
It is not news to readers of The Pharmaceutical Journal that records sharing between GPs and pharmacists — which is required to make a ‘Pharmacy First’ approach safe — was not perfect (nor indeed fully operational) at launch. The journal covered this and I touched on this in my previous column.
As I said then — OK, we expect some teething troubles. On 6 February 2024, health minister Lord Markham promised Parliament that patient information exchange and updating was a priority, stressing “the idea is that it has to be two way”.
“You want to make sure that pharmacies have access to doctors’ records. That is not ready today, but it will be in the next few months. Likewise, you want to make sure that whatever the pharmacies do gets updated to GP records,” he said, adding at the time that this part would involve “re-keying” a PDF document.
Alas, the noble Lord failed to explain why PDFs were used, when stripping the information out of a simple text document would be quicker for the period of manual inputting at GP surgeries. This data “re-keying” was yet further unfunded ‘make work’ imposed on a system that is already making work for hardly unpressured GP practices: it certainly allows for considerable user error.
NHS England has since announced that pharmacists can now update GP records through GP Connect, but they are still waiting on the ability to view records.
Counting challenges
‘Pharmacy First’ is of course a capped scheme, budget wise. Both the payers and the providers need to know accurately where they are in terms of the available funding and associated rules. So this has to be working properly, right?
Wrong. The National Pharmacy Association (NPA) issued a press release on 8 March 2024, warning that the NHS’s ‘Manage Your Service’ portal was flawed after pharmacies reported that it failed to report correct figures for the number of consultations delivered under the scheme.
It works jolly well for the payers, but dreadfully for providers
Pharmacies are required to make submissions to the NHS by the 5th of each month to be paid for the service. However, NPA members warned of discrepancies that meant ‘Manage Your Service’ recorded fewer consultations than the number entered by pharmacies. This problem has inevitably raised suspicions. It works jolly well for the payers, but dreadfully for providers.
The press release added that the NHS Business Services Authority told the NPA that this problem with the ironically-named ‘Manage Your Service’ system had been fixed, and the deadline for submission of claims for payments extended from 5 March to 21 March 2024.
Yet, as the NPA press release stated, pharmacies have still been reporting problems in the wake of this alleged fix.
Paul Rees, chief executive of the NPA, called it “deeply alarming that pharmacies have found the computer system does not correctly record their work”.
“At a time when the issues around the Post Office Horizon system are fresh in everyone’s minds, it’s vital we get IT issues sorted so hard-pressed pharmacies can have faith they will be paid correctly for the work they have done for the NHS,” he added.
“We need full assurances for the future that this system is robust and reliable, and complete transparency so we can ensure the brilliant service offered by pharmacies can continue.”
Budgeting for IT
Chancellor Jeremy Hunt (formerly the longest serving health secretary) used the 2024 spring Budget to make a significant new sum of £2bn available for NHS IT, as part of an extra £3.4bn to improve NHS productivity.
This is to cover the implementation of electronic patient records across the NHS in England by 2026 (a mere eight years after Hunt called for the NHS to be paperless by 2018 in his former role), but obviously there is a trick not be missed here.
Simply put, if ‘Pharmacy First’ is to become anything other than rhetoric and marginal activity, then the pharmacy sector needs to be part of this IT modernisation (and, crucially, of its funding).
That means paying proper attention to the community pharmacy sector’s potential to do more to relieve burdens on other parts of the system. Recommendations to share patient records with community pharmacy are nothing new, but the roll out of efforts to achieve it has been extremely patchy across England.
If we see plans for patient records to be shared smoothly across sectors of the NHS in England, including community pharmacy, then we can take ‘Pharmacy First’ rhetoric more seriously.
Andy Cowper is the editor of Health Policy Insight
