GP concern as Pharmacy First ‘directs patients back to general practice’

A number of GPs have raised concerns around the Pharmacy First scheme, with some pharmacies reportedly directing patients back to general practice for a variety of reasons.

Under the scheme, GP practices started referring patients to community pharmacies for seven common conditions – including sore throats and ear infections – two weeks ago.

According to NHS England, which is due to launch a marketing campaign for the scheme this week, the service will ‘save up to 10 million general practice team appointments a year’ and help patients ‘access quicker and more convenient care’.

Last week, health minister Lord Markham told Parliament that around 3,000 Pharmacy First consultations were carried out over the first three days after the service was launched.

But GPs have told Pulse 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.

Dr Emma Nash, a GP in Hampshire, told Pulse that her practice has had patients redirected due to capacity issues.

She said: ‘We’ve been in touch with local pharmacies and told that they will accept one or two referrals from us per day.

‘The pharmacy nearest to us, who hasn’t put a limit, can’t actually take referrals (although redirections are fine – but that brings risk of non-payment to the pharmacy) as the referral IT system still doesn’t have them listed on it, despite the pharmacist having spent months trying to get them on the community pharmacy referral scheme.

‘I’ve also been told by other GPs that skills such as otoscopy are just self-declared competencies and they are refusing to use it at all because of this issue.’

Other GPs voiced their concerns on X and said that some patients seen as part of the scheme ended up being redirected to general practice.

Oxford GP Dr Helen Salisbury said: ‘I met my first patient yesterday who had been through [Pharmacy First] – and the advice they took away was “take these antibiotics but I’m not allowed to give you enough so you’ll have to see your GP”.’

Out-of-hours GP Dr Mohamed Kamal said: ‘It’s disappointing to see that Pharmacy First launched without the necessary staffing to effectively handle the job. Numerous patients have been directed to visit their GP or call 111 for conditions that Pharmacy First was supposed to address.

‘Regrettably, it seems to be another instance of resources not being utilized as intended.’

Dr Phil Williams, a GP partner in Lincolnshire, said that there is ‘insecurity and a lack of confidence’ around the scheme.

He told Pulse: ‘There’s also a lack of national patient-facing material on the new system. Some pharmacists seem to be applying CPCS exclusion criteria to Pharmacy First.’

And Doctors’ Association GP (DAUK) spokesperson Dr Steve Taylor told Pulse he has had patients ‘unable to have earache looked at’ due to pharmacists ‘not having the equipment to look in ears’.

It was known in advance that some pharmacies may not be offering consultations or treatment for otitis media (earache) until 1 April as NHSE allowed them to delay that part of the service if they had ordered otoscope equipment that had not yet arrived.

From this month, pharmacy contractors delivering the service will receive a fixed payment of £1,000 per month, subject to delivering a minimum number of consultations.

The number of consultations required per month starts at one in this month and will gradually rise to 30 in October 2024.

For the first six months, pharmacies will need to do no more than 10 consultations a month to get the £1,000 payment.

Dr Taylor said: ‘The reality is that in the first few months it is not financially incentivised to see patients. In February, one consultation will trigger the gateway payment of £1,000.’

Following the scheme’s announcement, the DAUK urged the Government to urgently review why pharmacies are paid ‘more than double’ per consultation compared with GPs.

And GPs told Pulse they believed that the Pharmacy First money would be better off spent in general practice.

Under the scheme, community pharmacies are allowed to prescribe antibiotics, which led GPs to raise concerns surrounding antibiotic stewardship, however NHS England has said it will monitor the service for any impact on antimicrobial resistance.

Berkshire West LMC chair Dr Mark Green told Pulse he didn’t encounter issues so far, adding: ‘It’s still early days since it started, I guess. So you’d hope any issues get ironed out swiftly.’

As part of the service, community pharmacy IT systems will automatically send details of patient consultations to general practice clinical IT systems via GP Connect.

However, GPs raised concerns around unintended workload consequences from having to check record updates made under the scheme.