Pharmacy First Service

The slides with the resources links with key messages from CPH Chief Officer, Helen Musson are available to access:

CPH Pharmacy First 22 January 2024

Please work with your Community Pharmacy PCN Engagement Lead regarding feedback on the Pharmacy First service including any challenges to delivery. Contact details of your PCN lead for your pharmacy is on the HWE ICB website.

Videos talking pharmacists through each of the clinical pathways in preparation for the service are on the CPE website.

The following four IT suppliers worked with NHS England to develop their systems to include functionality to support the service, further suppliers are expected to be added to this list so please check the CPE website (under the section “Getting ready to provide the service”) for further updates:

System and supplier

HxConsult (Positive Solutions)

Pharmacy Manager (Cegedim)

PharmOutcomes (Pinnacle Health)

Sonar health (Sonar informatics)

• In addition to the £15 consultation fee, a monthly fixed payment of £1,000 will be paid to pharmacy owners who meet a minimum activity threshold of clinical pathways consultations (the threshold will increase over time as set out below).
• Data from the Pharmacy First IT system will be submitted to the MYS portal via an application programming interface and will be used by the NHSBSA to populate a payment claim within the MYS portal. The pharmacy owner needs to review this payment claim and then submit it. Claims for payment for this service should be made monthly, via the MYS portal and no later than three months from the claim period for the chargeable activity provided. Claims which relate to work completed more than three months after the claim period in question, will not be paid.

Month	Minimum number of clinical pathways consultations
February 2024	1
March 2024	5
April 2024	5
May 2024	10
June 2024	10
July 2024	10
August 2024	15
September 2024	20
October 2024	20
November 2024	20
December 2024	20
January 2025	25
February 2025	25
March 2025	30

From 1 October 2024, new caps were introduced based on actual provision of clinical pathways consultations, designed to deliver 3 million consultations per quarter with any unused activity rolling forward to subsequent quarters of that financial year.

A list of pharmacy owners, their assigned Band and monthly cap can be found on the NHS Business Services Authority’s (NHSBSA) website. 

Read more information on the NHSBSA website about the Pharmacy First caps 

Full resources for the Pharmacy First service including videos and templates can be found on the CPE website.

HWE ICB recently held local webinar events for GP practices and community pharmacies on how GP practices can refer for Pharmacy First. A recording of these webinars is available below:

• Ardens SystmOne training webinar (24 September 2024)
• EMIS training webinar (17 September 2024)

Training Support Please note this information is not endorsed by CPH. 

CPPE Pharmacy First Information and Support: https://www.cppe.ac.uk/services/pharmacy-first/

In the SPS podcast series pharmacy colleagues and expert clinical speakers discuss issues surrounding the new service in community pharmacy and try to debunk some of the clinical myths. Each episode focuses on one of the clinical conditions, with an additional episode dedicated to paediatrics: https://www.sps.nhs.uk/articles/pharmacy-first-podcast-series/ 

Pharmacy Magazine has useful information including a section on Pharmacy First, news articles and training modules to help you stay up to date and is free to sign up: https://www.pharmacymagazine.co.uk

Agilio’s free Courses for Pharmacists has been developed to support the rollout of the NHS Pharmacy First Service that includes 7 e-learning courses available on the iLearn platform for these common conditions. These accredited courses are based on NICE CKS and aligned to the NHS England clinical pathways and PGDs. All these courses are free to access and include a case study and multiple-choice questions to test understanding, with a certificate of completion: https://cpherts.org.uk/wp-content/uploads/sites/66/2024/01/Pharmacy-First-Agilio-Software-003.pdf 

Campaign and promotional materials are now available, please visit the CPE website.

NHS Pharmacy First: Essential skills e-course – has a module which covers record keeping

NHS Pharmacy First: Clinical assessment – essential skills online workshop, covers record keeping

Documenting in patient clinical records e-learning

NHS Pharmacy First service – service specification, clinical pathways and PGD’s, self-assessment framework, competency requirements and learning resources

Primary Care Pharmacy Association and CPNEL – Pharmacy First Tutorials

Where can I find information about training to support me? Information is available above as to known training availability that can support you both locally and online. Please remember that there is no mandatory training and that the requirements of the service are as follows:

• The pharmacy owner must ensure that pharmacists providing the service are competent to do so, including the use of an otoscope (except for DSPs) and be familiar with the clinical pathways, clinical protocol and PGDs. This may involve completion of training.”
• “The pharmacy owner must keep documentary evidence that pharmacy staff involved in the provision of the service are competent and remain up to date with regards to the specific skills and knowledge that are appropriate to their role, and to the aspects of the service they are delivering.”

Pharmacists do not need to undertake huge amounts of training to get ready to provide the service other than to ensure that they are competent to deliver the service. The clinical pathways are very clear about red flags, safety netting and being able to refer to another provider e.g. the GP practice if they are unsure.

Do pharmacists need to complete a Declaration of Competence before providing the service? There is no requirement to complete a Declaration of Competence, but pharmacy owners must ensure pharmacists are competent to provide the service. One way for pharmacists to demonstrate they have reviewed their own competencies is by working through the Pharmacy First self-assessment framework, developed by CPPE and NHS England.

If a patient returns to the pharmacy i.e. 3-5 days later as per the clinical pathway after receiving an initial Pharmacy First consultation and were not dispensed antibiotics, can the pharmacist undertake another Pharmacy First consultation and dispense antibiotics if clinically indicated? Yes. The first consultation is considered closed as you provided support as required at that point in time. Pharmacists would open a second consultation with the patient and proceed as per the clinical pathway.

Can the pharmacists sign the master PGD authorisation sheet instead of each of them individually? Yes. Please note all pharmacists, including locums, providing the Pharmacy First service and hence operating under the PGDs and protocol are required to sign the PGD authorisation sheet. That also needs to be authorised by an authorising manager, who may be the pharmacy owner or a manager employed by the pharmacy owner. A copy of this completed PGD authorisation sheet should be retained by the pharmacy owner as a record of those practitioners authorised to work under the PGDs and protocol.

Can a pharmacy deliver one of the seven pathways for Pharmacy First by telephone? No. You can deliver consultations for six of the seven pathways remotely via live video link from the pharmacy premises and in person for the Otitis Media clinical pathway.

Can a pharmacy claim for a Pharmacy First consultation as part of the seven pathways if a patient has been supported remotely via live video link but they cannot attend the pharmacy where there is a clinical need to supply a product? No. A pharmacy would be unable to claim for a consultation if there is a clinical need to supply a product and the pharmacy cannot do so. It is appropriate to refer the patient onwards (i.e. to another pharmacy) but no fee is payable to the referring pharmacy.

If the patient passes the gateway point and the end point of the pathway for them is not to supply a medicine then this would be claimable.

Does a clinical pathways consultation i.e. one of the seven pathways referred by another provider e.g. GP practice count towards the minimum activity threshold in order to receive the monthly fixed payment and avoid the initial fixed payment being reclaimed? Yes. Please note minor illness and urgent medicines supply consultations do not count.

Could a pharmacy end up claiming two fees one for the local acuity, minor illness referral and the clinical pathways consultation referral? No. If the gateway criteria is met when the patient has been referred then the pharmacy would undertake this via the clinical pathways consultation. If the gateway is not met when the patient has been referred then the pharmacy would undertake this via the low acuity, minor illness consultation.

Please note that if the patient presents at the pharmacy and the gateway criteria is not met then the pharmacy would be expected to provide support for self care as part of the essential service provision with or without OTC supply or onward referral as appropriate. The low acuity, minor illness element of Pharmacy First can only be undertaken with a referral from another provider.

Will the pharmacy’s indemnity cover Pharmacy First? Pharmacies should check with their indemnity provider about the provision of Pharmacy First.

What happens if a pharmacy cannot provide the service at any point during its opening hours? If the service must be temporarily withdrawn by the pharmacy contractor due to circumstances beyond the scope of the business continuity plan, they must inform the NHS Directory of Services (DoS) Provider and Commissioner Helpline (0300 0200 363) as soon as possible to stop referrals being made to the pharmacy. GP practices and UEC settings within the local primary care network (PCN) must also be contacted to prevent them making further direct referrals. The pharmacy contractor must also inform the local commissioner of the service of their temporary withdrawal from the service.

Is there a timeframe in which community pharmacies have to respond to patient referrals for the Pharmacy First service? The pharmacy contractor must ensure that the service is available throughout the pharmacy’s full opening hours (i.e. core and supplementary). Where a contractor has received a referral but has not been contacted by the patient within 30 minutes of the referral, the pharmacist should consider whether they should contact the patient using the contact details set out in the referral message. The decision to contact the patient or not is for the pharmacist to make based on their clinical judgement. If the patient has not made contact before the next working day, then the pharmacist can close the referral as ‘no intervention or no supply made.’ No payment is due where there is no consultation (remotely or face-to-face) with the patient.

What medications can be provided as part of the Pharmacy First urgent supply service? As per the guidance, technically, any medicine or appliance that can be supplied on an NHS prescription – in line with the provisions of the Human Medicines Regulations – that has previously been prescribed on an NHS prescription to the patient can be supplied as part of the service, where the Pharmacist determines that it is appropriate to do so. Further FAQ’s and guidance can be found on the CPE website.

Can patients who do not live in England, such as temporary visitors or tourists, obtain an urgent supply of a medicine or appliance via Pharmacy First? An urgent supply via the service is available to anyone in England who has recently been treated by the NHS and has received an NHS prescription for the item that is being requested. Patients treated in Wales, Scotland & Northern Ireland would be eligible, as would patients with prescriptions generated from other NHS organisations, for example, acute trusts.

For overseas patients visiting from countries outside the UK, an urgent supply under the service could be made for a patient who was receiving ongoing care under the NHS with an NHS prescription and needed an urgent supply of medicines to continue treatment. For example, this might include a patient who was recently discharged from an NHS hospital or who were treated on the NHS and had received an NHS prescription under a reciprocal healthcare arrangement.

Visit the CPE website for more information on Pharmacy First.