The policy of ‘Pharmacy First’, rolled out at the end of January, is designed to cut the size of the NHS backlog by diverting patients to their local pharmacies – taking pressure off overburdened GPs and hospitals.
Under this policy, pharmacies have now been charged with treating various minor ailments and prescribing certain medications. The policy is starting to put pharmacies at the heart of primary care, giving them a more active role on the frontlines of healthcare.
Britain’s pharmacies are taking on a whole roster of new responsibilities, and the sector needs reform in a number of areas, such as staffing, funding, and technology in order to fully integrate itself into an expanded primary care ecosystem.
New normal
Since the end of January, Britain’s 11,500 community pharmacies can now treat sinusitis, sore throats, earaches, insect bites, impetigo, shingles, and urinary tract infections in women under 65.
Patients can now receive treatment for these ailments without having to see a GP or obtain a prescription from them, as was the requirement previously.
Pharmacies now can also empower women to take charge of their reproductive health and choices by offering contraceptive pills directly, eliminating the need for a prior visit to a GP.
This represents a significant operational task for pharmacists – who were busy enough before Pharmacy First. Pharmacists must learn new skills, new medical procedures, and the use of new kinds of medical equipment.
One major adjustment that is currently being made is in record keeping – an essential component of good primary care practice. An old maxim of primary care is that: ‘if it’s not documented, it didn’t happen’.
Primary care is an incredibly complex undertaking, with high stakes for all parties.
Therefore, there has always been a need for meticulous organisation and record-keeping in this field – both to achieve the best possible outcomes for patients, and also to protect primary care professionals from legal liability.
Should something go awry, thorough documentation can demonstrate that a nurse, doctor, or GP acted in good faith and followed best practices.
As community pharmacies start to take on these primary care functions, there is thus an urgent need for the mass adoption of easy-to-use primary care documentation systems.
Another key task for pharmacists is to find ways to manage this more demanding workload. Pharmacists already work very hard for their communities, managing dozens of different medicines and the specific health needs of their patients – all while running a business at often tight margins.
This has, in some cases, led to stress and overwork among pharmacists. Adding these extra primary care functions is – before anything else – an extra demand on pharmacists’ time and energy.
Given this, it is surely time for the sector to give some serious thought as to how workflows might be streamlined.
Cultural shift
To make Pharmacy First a success for patients, pharmacists, and primary care, both policymakers and the sector itself should consider making a series of changes to how community pharmacies are funded, hire personnel, and embrace technology.
For one, pharmacies must receive the subsidies they need to carry out these new mandated responsibilities. The Pharmacy First policy has come with £645 million in funding, but the Department of Health and Social Care (DHSC) has estimated that community pharmacies still face an annual shortfall in funding of over £750m – around £70,000 per pharmacy.
This affects the scheme’s rollout , with thousands of pharmacies opting out of the new contraception service for lack of funds to help deliver it. Recently announced reforms to incentivise uptake with more funding are a good start – and there is an urgent need to go further, fully plugging this fiscal gap.
Pharmacies should also redouble their efforts to address understaffing, a perennial problem for the sector.
Pharmacy staff vacancies have doubled between 2017 and 2023, and a survey conducted by the Pharmaceutical Services Negotiating Committee in 2023 found that 81% of pharmacy staff are ‘struggling to cope’ with growing demand. But nothing about this is inevitable.
New apprenticeships as a complement or even an alternative to the standard MPharm degree would create a new pipeline of talent for community pharmacies.
Growing the number of MPharm and overseas pharmacist assessment programme places could also be considered. These courses are oversubscribed; the demand is certainly there.
Tech is key to supporting pharmacies as they take on new responsibilities. Further, the mass adoption of cost-effective technology would streamline operations, cut costs, and increase revenue.
For one, better promotion of community pharmacies via things like social media would help increase footfall and awareness – a week before the launch of Pharmacy First, a Charac poll conducted in partnership with YouGov revealed that close to half of the public had not even heard of the scheme, still less the new services on offer.
Secondly, the digitalisation of the sector will be crucial. Many community pharmacies have antiquated record-keeping systems, and some still rely on paper.
This creates a considerable amount of administrative work for pharmacists, and, as pharmacies now deliver primary care, risks leaving them with insufficient documentation to protect them from liability should something go wrong.
Fortunately, digital record-keeping services are inexpensive and can be onboarded quickly; the mass adoption of this technology should be accelerated to help pharmacists meet new regulatory requirements and streamline workflows.
Thirdly, digital enhancements to pharmacies can help them increase profitability, giving them the funds they need to execute their new primary care tasks.
Some of these allow pharmacists to claim NHS payments. By digitising their operations, pharmacists will be better able to check their payment eligibility and streamline the booking process for this service.
Other innovations, like an online dashboard that lets pharmacists track orders and book appointments, payroll, and deliveries would do much to cut down on menial tasks, cut costs, and increase revenues.
Final analysis
Community pharmacies serve as essential pillars of local communities, growing even more indispensable in the era of Pharmacy First.
Through these straightforward reforms and enhancements, pharmacies can seize the opportunity presented by the new policy, addressing longstanding sector challenges.
This proactive approach ensures their continued operation, fosters profitability, and reinforces their vital role in serving communities.
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