The NHS is under tremendous pressure and patients are increasingly struggling to access appointments and urgent care. In a bid to improve primary care for patients, the UK government recently outlined a number of changes it plans to implement in England.
One of these proposed initiatives is allowing pharmacists to supply a number of prescription-only medicines for common conditions – including sinusitis, shingles and uncomplicated urinary tract infections – without patients needing a prescription from their GP.
It’s hoped that this scheme, called Pharmacy First, will help save 10 million GP appointments yearly (alongside the other proposed changes) once scaled up across the country.
Not only are pharmacists very well-equipped in terms of knowledge and skills to provide these services, we also know from equivalent trial schemes that such programmes work well for patients. But Pharmacy First will only work if adequate funding is provided to pharmacies to ensure they can provide these additional services.
Pharmacists are more than capable of providing patients with good-quality care, which is why it makes sense to expand the role they have in providing patients with this care.
To become a pharmacist, you need to complete a four-year degree. Many of the skills learnt during study are similar to what GPs would learn – such as understanding how to make a physical assessment of a patient, in addition to the science of medicines.
Pharmacists must also complete a one-year work placement with a national exam at the end – after which they register with the regulator, the General Pharmaceutical Council. This means pharmacists are regulated in a similar way to doctors to ensure they practise in a safe way.
After graduating, pharmacists are required to complete professional development courses in order to develop specialist expertise and maintain their competence. This means pharmacists are very well-qualified to provide care to patients which complements that already provided by GPs.
Furthermore, some pharmacists (mainly in hospitals and general practice) have already been able to prescribe medicines to patients without medical practitioner sign-off since 2006. This prescribing programme has successfully shown that pharmacists are able to prescribe medicine in hospitals, care homes and GP surgeries without any compromise to patient safety.
In order to be able to prescribe medicines, pharmacists need to complete an accredited programme which is regulated by the General Pharmaceutical Council. This course ensures that pharmacists have the relevant diagnostic and prescribing skills to be independent prescribers, and to ensure safe prescribing for patients.
Prescribing skills are now being taught within the MPharm degree in the UK. This means all pharmacists joining the workforce from 2026 onwards will already be qualified to prescribe and supply prescription-only medicines.
Making it work
In Scotland and Wales, similar national initiatives to Pharmacy First have been in place since 2006. Based on the research we have so far from these programmes, allowing pharmacists to supply prescription-only medications has been a benefit to patients.
Studies have found that these initiatives are associated with improved access to care and have alleviated pressures in other parts of the NHS.
Expanding the powers of pharmacists throughout the country to supply prescription-only medicines may also be extremely beneficial to people living in deprived areas, for whom pharmacies are often their only source of health advice and medicines. As such, the Pharmacy First scheme may ensure more people are able to access the healthcare they need.
But a major concern with the government’s plan regards the funding that will be provided. Since 2015, funding for community pharmacies has been cut by 30% in real terms, leading to the closure of 720 highstreet pharmacies in England. In addition, pharmacies currently rely on NHS England for more than 90% of their funding.
While community pharmacists have been calling for the Pharmacy First scheme for several years, the government’s plans will only work if there’s an immediate injection of funding. This will halt closures and alleviate the already existing pressure on community pharmacies – ensuring these additional services can readily be provided. While the government has promised £645 million for the Pharmacy First scheme, this will not be enough to close the funding gap that already exists while ensuring new services can be provided.
Pharmacists are already experiencing numerous work-related pressures. Prescription numbers continue to rise dramatically. Paired with the fact that patients are already being encouraged to use pharmacies for advice and treatment without appointment, many pharmacists are struggling to keep up with their workload.
In addition, staffing levels are difficult to maintain, as pharmacists and pharmacy technicians are being recruited to work in general practice. If more isn’t done by the government to recruit pharmacists or encourage students to enrol in pharmacy courses, it may hinder the success of the Pharmacy First scheme once it’s introduced – and in the longer term, the role of community pharmacy in providing vital patient care.
While it’s far from certain if these plans will actually save 10 million appointments for GPs a year, it’s clear that pharmacists could be of even greater benefit to patients. But this ambitious scheme will only work if measures are taken to increase pharmacy funding and staff numbers.