There are currently no plans to replace the referral requirement of Pharmacy First with a walk-in approach, NHS England (NHSE) has suggested.

At the Clinical Pharmacy Congress last week, NHSE’s clinical strategy for community pharmacy lead Pallavi Dawda confirmed that it was not considering removing the need for a GP referral for minor illnesses and urgent repeat medicine supplies.

These two elements of the Pharmacy First service that build on the Community Pharmacy Consultation Scheme (CPCS) currently require a referral in order for a pharmacy to receive a payment under the scheme.

A third part of the service does enable walk-ins for seven common conditions, however concerns have been raised that a large proportion of these consultations are not meeting the threshold for Pharmacy First payments set out by NHSE.

At the conference held in London last week, Ms Dawda was asked whether there were plans to ‘open up’ the minor illness and urgent repeat prescriptions pathways with ‘a walk-in element – stepping away from that referral requirement’.

Asking the question, Katy Tennyson, community pharmacy clinical lead at Humber and North Yorkshire integrated care board, said: ‘We all know that we want it to be pharmacy first and not pharmacy second.’

Ms Dawda responded: ‘At this stage… we're not looking at walk ins from minor illness.’

She added that ‘there was never the intention to do a walk-in element’, but NHSE had ‘moved on that with the clinical pathways’.

The clinical pathways for seven common conditions, enabling pharmacists to supply specified medication under certain conditions through the use of a patient group direction (PGD), is the only element of the Pharmacy First service that is available to patients walking into a pharmacy.

And any advice given outside of these clinical pathways, including for minor illnesses or for the seven conditions that do not meet the ‘gateway’ criteria, is not considered part of the nationally commissioned Pharmacy First service and therefore is not eligible for a Pharmacy First consultation payment.

Pharmacies do receive a payment for all minor illness and urgent repeat medicines supply referrals from general practice, regardless of the outcome of the consultation.

In recent weeks, the community pharmacy sector has raised concerns that a large proportion of Pharmacy First consultations are not meeting the threshold for payments, while referrals from general practice are lower than they could be.

And Community Pharmacy England has said that since the launch of Pharmacy First it has heard of more people turning to pharmacies for health care information and advice that does not meet the gateway criteria for a paid consultation.

It plans to launch an ‘advice audit’ on Monday 3 June to gather data about the number of patients seeking informal advice from pharmacies outside of paid Pharmacy First consultations.

Recent data from Company Chemists’ Association (CCA) multiples found that just one in five patients eligible for Pharmacy First were referred from general practice, while 73% were signposted informally to the service or attended the pharmacy themselves.

And inadequate referrals from GPs were cited as a major reason for pharmacies struggling to meet Pharmacy First minimum consultation thresholds in a recent survey of 266 independent pharmacy owners conducted by the Independent Pharmacies Association (IPA).

Six in 10 independent pharmacy owners responding to the IPA survey also said that less than half of their Pharmacy First consultations pass the gateway point for a service payment, while the majority said they were spending an average of 20 minutes or more on each consultation.