Interview: Pharmacy First saves time, prevents escalation, and frees up capacity

Community pharmacist Athif Arif shares his experience of working with three Luton PCNs and more than 30 community pharmacies on Pharmacy First as engagement lead for Bedfordshire, Luton and Milton Keynes ICB.

Victoria Vaughan (VV): How is Pharmacy First working for your community pharmacy Woodlands in Luton, Bedfordshire?

Athif Arif (AA): It has enhanced the community pharmacist’s professional role, recognised our expertise and expanded our scope of practice.

There are a few ways people can access the service. They can self-refer, for the seven clinical pathway conditions, and we see them straight away, if we're free, or otherwise we give them an appointment to come back. The other referral route, where we get most patients from, is from the GP practice. NHS 111 can refer into us too.

VV: How many referrals are you seeing for the GP surgery?

AA: We can do anything from two to five per day but it can be anything from 10 to 60 a week. But I am the community pharmacy lead for three different networks, Oasis, Phoenix and Medics and the pharmacies within these PCNs have never complained of too many referrals. The capacity is there but consistent referrals can help pharmacies organise the workload better.

VV: How does it benefit your pharmacy, PCNs and patients?

AA: There's a lot you can do for patients, practices and PCNs and I am really hoping that Pharmacy First expands as are many of my colleagues in both pharmacy and the wider professions.

For pharmacy and pharmacists it has enhanced our professional roles, and development and how we use our clinical skills. Once upon a time people thought we just sold things, but we do a four year masters degree and a further year to get qualified, so it’s good to recognise that we actually have a lot of knowledge that can help benefit patients.

There is a financial benefit as it is an additional revenue stream and it has increased footfall. It has a positive impact on community health and it's great to be part of the PCN team.

For patients there’s better patient access. Such as better access for school children, they can be seen same day, treated if necessary and return to school quicker, resulting in better attendance. This is popular in winter for sore throats.

Quicker treatment also increases patient satisfaction and it’s convenient for patients due to our location in the community and we are a trusted local resource. All this will lead to better public health outcomes.

It also means earlier intervention - faster access to treatment for minor ailments can prevent escalation to more serious conditions requiring GP or hospital care.

There is also a health promotion benefit as pharmacies can provide preventative advice, such as vaccination awareness or smoking cessation.

For PCNs and practices it relieves some pressure on GP practices by reducing workload and frees up time for GPs to focus on more complex cases.

The service fosters a more collaborative healthcare environment with pharmacies, GP practices and PCNs working together. This partnership can strengthen communication and referral pathways between practices and pharmacies, improving patient care overall.

It improves GP appointment availability - practices can offer quicker appointments for patients with more serious health concerns, improving access and reducing wait times.

It also means better use of healthcare resources: pharmacists can provide high-quality care for many common conditions like coughs, colds, and skin issues. This efficient use of healthcare resources helps reduce costs and maximizes the skills of both pharmacists and GPs.

It used to feel like me against the world, but now I can speak to the network for support and refer patients appropriately and we have a bypass number to the practice for more urgent referrals.

VV: How much capacity do you think you have for this service?

AA: It’s difficult to say as every pharmacy is different. It is about communication. It will help having a platform where pharmacies can communicate with PCN stakeholders.

Consistent referrals and adding more conditions to the list would help organisation and expansion of the service.

It can be expanded. There's enough capacity, because obviously pharmacists are getting paid £15 per consultation and as long as it becomes consistent we can plan and hire extra staff if needed.

VV: What particular areas would you like to see expanded?

AA: Upper respiratory tract infections, acne, eye infections, skin infections are areas which I would like to become part of Pharmacy First Clinical Pathways - patient can self-refer for clinical pathway conditions, all other conditions require a referral from GP practice or NHS 111 - in the near future.

With the current conditions they could expand the ages, for sore throat it’s from the age of five, we could see someone younger, for earache we can see up to 17 but we could see someone over 17 for example.

VV: A complaint around Pharmacy First is that patients bounce back into practice. What’s your view on that?

AA: It’s about communication. Setting up PCN meetings involving GP practices and pharmacies can greatly help. Agree referral pathways such as urgent and non-urgent referrals.

Dr Manraj Barhey, clinical director of Medics PCN, has been a massively positive influence in rollout of Pharmacy First in Medics PCN. PCN clinical directors are in a great position to positively influence Pharmacy First within their respective networks. Gail Meakins, a practice manager at Woodland Avenue Practice, has also seen the mutual benefits of Pharmacy First and actively promoted it within her practice and shared best practice with other practices in our PCN. A willing and enabling attitude is required by all stakeholders.

Find out which pharmacies and practices are having success and share best practice and expertise. It's about taking the time to set up a solid foundation. Work as a network, even with your local ICB, sit round a table together, sacrifice one evening, and in turn will make many future days go more smoothly.

VV: How do you communicate with the PCN and the practice, as data sharing and interoperability is often an issue?

AA: Pharmacy First referrals are generally sent via NHS Mail using NHS Mail or Accurx. Pharmacy can feedback via NHS Mail or a communication system such as Pharmoutcomes. GP connect is a new feature being rolled out that allows easier transfer of information to patient record – saving GP practices time.

VV: What other benefits are there to the scheme?

AA: We are picking up on things and preventing escalation. I saw a patient who was referred because of long term feeling of a sore throat. I thought I saw something there and she was having trouble swallowing. So, I sent her back as an urgent referral and she’s was referred onward urgently to ENT.

It saves time and it prevents escalation, and it frees up capacity - it means the more complicated patients are seen and going forward there are less complaints. And it just becomes more of an efficient system with higher patient satisfaction and better use of the limited resources that we have in healthcare. It also encourages closer collaboration between us, the pharmacy, the GP world, we can work together. Bring on optoms, bring on dentists, so we can all work together.

We are another Avenger. We are like Thor and GPs are Hulk and the optoms are Captain America.

For the big issues like patient access we need to come together and beat Thanos. Not one of these professions can do it alone.

I think it's been a massive success.