Pharmacy First – where is it going next?

On the whole the implementation of Pharmacy First has been a positive experience with lots of support from local GPs, says community pharmacist Reena Barai, However, community pharmacy will need to think differently about how it organises some of its services and make plans to accommodate and retain the 2026 cohort of pharmacy graduates who will all be independent prescribers.

Beyond the pathways

“GPs can refer patients to us under the minor illness umbrella, which includes a lot more conditions than just those seven pathways[of Pharmacy First]. So, we are seeing more things actually in pharmacy than we’ve seen before, but to be honest since the Covid pandemic that’s been happening too because people just learn to use pharmacy in a different way”, says Ms Barai.

The PGDs and the training that Ms Barai and her team have undertaken have been helpful in developing further skills to help distinguish between common, simple conditions and complex or uncommon problems. “I think what we’re developing is our own kind of pharmacy ‘radar’ and our own kind of way of understanding – you know – which patients can I help, which patients can’t I help and actually which patients could I maybe help for a few days and then see if it works but actually give them support to know how to get back into the NHS if they need to if things don’t work out”, she explains.

During a consultation one patient had said to her, “Reena you’ve been my best-kept secret for a long, long time. Whenever I’ve got health problem I can just come and talk to you”. She added that she hoped the service did not get so busy that an appointment was needed. Ms Barai says “for patients who are ‘in the know’ pharmacies are the best kept secret because we really can help people – sometimes when they don’t know what to do or we can help signpost [them] to where they may need to go. And so I think ….. there is a really important role there for pharmacy in that primary care navigation”.

GP reaction

“On the whole, the majority of my GPs have been really, really supportive. Many have said come and come and spend some time in our clinics. We’ll help you look in people’s ears to get you more comfortable with doing things like that. They want to work with us so that we make sure that they send the right patients to us and then work with us in case we need to escalate a patient back”, explains Ms Barai. There will always be practices that do not wish to participate and some that struggle to adopt the referral mechanism, she acknowledges. However, “on the whole it’s been a really positive experience”, she says.

Tips for success

The introduction of Pharmacy First Services represents a considerable change and this comes on top of a day job that is already challenging. “My message to colleagues is – think differently about the team,  think differently about your day,  think differently about the services you offer and how many of those support the actual agenda of the business. So, I’m thinking about my team – in particular I have a dispenser who I’m training up to become an accredited checking dispenser which will allow us to have a bit more free time to be able to offer these consultations. I’m thinking about my pharmacy and my day and how can we make …. Pharmacy First consultations fit into our day. So, we’ve decided to do appointment systems between 10 and 12 and then two and four”, says Ms Barai.  Pharmacists might also need to think about whether one consultation room is sufficient and whether to invest in expanding the premises, she adds.

Next steps

Pharmacy services in Scotland, Northern Ireland and Wales already deal with a wider range of conditions and Ms Barai believes that parallel developments should now take place in England.  She identifies three key considerations for ongoing development: first, there needs to be a fully integrated IT system that supports smooth working for community pharmacists and their general practice colleagues. Second, the community pharmacy sector needs time for the changes to bed in. “We need to make sure that everybody’s on board and everyone’s doing a good job and providing a good service before we …. bolt on more”, she says. Third, is preparation for the arrival of the 2026 cohort of pharmacy graduates, all of whom will be independent prescribers.  Ms Barai explains, “My biggest concern is that they’re going to come out and work in community pharmacy and they may not be able to use their skills – and if they’re not using their skills in community pharmacy …. they’re going to go [and] work somewhere else where it’s sexier and possibly easier.”  The 2026 graduates will look for places where they can use their skills in satisfying jobs “and so actually it’s in our interest to do well with Pharmacy First. It’s in our interest to do well with all the services and to really show how we can safely supply using PGDs so that we can hopefully move that to independent prescribing and support a clinical decision-making model in Community Pharmacy……. I think that would be the future because of our future workforce. We can’t afford to lose those people. ….. and if we start to lose [them] because we’re not able to offer services that match the skills of our future workforce then we’re in trouble”.

About Reena Barai

Reena Barai started her career as a hospital pharmacist 25 years ago and then took over her family (community pharmacy) business 20 years ago. She works in the pharmacy six days a week, running the pharmacy. In addition, she is a co-founder and co-host of the Female Pharmacy Leaders Network and until recently she was the co-chair of an Integrated Neighbourhood Team. Previously  she has worked in primary care and as a GP practice pharmacist and has been a CPP tutor. She has also served as a  board member of the National Pharmacy Association and as a Committee Member of what was the Pharmaceutical Services Negotiating Committee (PSNC),  now Community Pharmacy England (CPE).

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