Community Pharmacy England (CPE) have introduced a new advanced service called Pharmacy First where community pharmacists are able to diagnose and treat seven minor illness conditions (called Clinical Pathway Consultations) which may require prescription-only medications such as antibiotics being given to relevant patients under Patient Group Directions (PGDs) from 31st January 2024 (subject to IT). The seven clinical pathways cover sinusitis, sore throat, acute otitis media, infected insect bite, impetigo, shingles and uncomplicated urinary tract infections in women. This is in addition to other Community Pharmacist Consultation Service (CPCS) such as NHS Referrals for minor illness and Urgent Repeat Medicine Supply.
The Pharmacist Cooperative does support community pharmacists to undertake more clinical services and upskill themselves but in a pragmatic and safe manner. We would have grave reservations about any service that would act to increase pharmacists burnout. Further, we believe that any services which are not deemed essential under the pharmacy contract must attract an additional professional fee, to be paid directly to the pharmacist, if that pharmacist is to undertake additional and high-risk workload which will significantly reduce day to day workload from general practices. However community pharmacists are currently going to be doing more work for effectively nothing or even less.
We are concerned that such services will be treated as a KPI as there is a potential for community pharmacists to claim maximum 3000 consultations per month i.e. £45K per month. We are concerned that community pharmacists will fear they will be under pressure to deliver these consultations under duress. If a patient or their carers are demanding antibiotics for example and the pharmacist appropriately refuses this based on their clinical expertise and consultation, will they be supported by their employers?
Some of the seven minor illness conditions can be treated from one years old and above such as impetigo, acute otitis media and infected insect bites as well as sore throat from five years old onwards. However most community pharmacists have not used or trained using an otoscope before, let alone using this on children. The fact that most of the limited face-to-face training is already full before the rollout of the service and the fact that the only other otoscope training available is an online webinar makes TPC very suspicious that this is a rushed rollout of these services. We are deeply concerned that some pharmacists will not be sufficiently competent ot confident in being able to use an otoscope from 31 January 2024. TPC are also aware that there are significant number of ANPs, ACPs and paramedics that don’t see or treat children under 2 years old, some don't even treat under 6 years old in general practice settings. Some community pharmacists have raised this concern about increased risk and whether their current indemnity insurance will be enough to address this. TPC join our colleagues in this concern. TPC are also concerned that there are some consultation rooms that are also not fit for purpose and so far, it is not clear who will enforce the standards that they are and where and who does the pharmacist report this to?
In summary, three main pressing issues with the Pharmacy First scheme in England are:-
1) Training and lack of protected learning time especially during the current winter pressures. Some of the face-to-training are already full before the service rollout. Also time required to read and sign all 23 PGDs which most likely will be done outside of working hours.
2) Workload pressures in community pharmacies at already an all-time high especially with trained staff and medicines shortages as well.
3) No extra remuneration for the pharmacists that are actually conducting the service in addition to being the responsible pharmacist and in charge of everything that happens in the dispensary and assuming full responsibility and accountability for the safe running of the pharmacy.
Here is a template that both employed community pharmacists can use and locums can modify where necessary
‘’I am writing to express my enthusiasm about the introduction of the new Pharmacy First service that our pharmacy is planning to implement. As an integral part of our team, I am eager and committed to upskilling myself to deliver this advanced service effectively.
I am excited about the opportunities this service presents for both our pharmacy and our valued patients. However, I wish to discuss the implications this additional responsibility might have on my role and the skills required to ensure its successful implementation.
The new Pharmacy First service is undoubtedly an advanced offering that will require dedicated training, skill development, and a deeper understanding of pharmaceutical practices. To provide this service at the standard expected by both the company and our patients, I am willing to invest additional time and effort into expanding my expertise in this area. There are 7 conditions with 23 PGDs that all pharmacists will require satisfactory competency by upskilling.
Given the specialised nature of the service and the increased responsibilities it entails, I would like to kindly request a review of my current salary package. I firmly believe that a salary increase commensurate with the added value and skills required for the successful execution of the Pharmacy First service would not only recognise my commitment but also further motivate me to excel in this capacity. I believe a supplementary base pay for being active in providing the pharmacy first service, and additionally a supplementary remuneration of £7.50 per consultation is a fair salary review.
I am genuinely dedicated to the success of our pharmacy and deeply appreciate your consideration of this request. I am confident that an adjustment in my compensation would not only reflect the increased expectations but also reinforce my commitment to delivering exceptional service to our customers.
I would welcome the opportunity to discuss this matter further at your earliest convenience. Thank you for your attention to this request.’’