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The expansion of Pharmacy First might create a big opportunity for independent pharmacies but simply adding five more conditions to the clinical repertoire might not be enough, says Trevor Gore…

The real opportunity is to change patient behaviour and make the pharmacy the first place people think of when everyday health problems occur.

There is potential with Pharmacy First, that we could become very good at delivering it, without necessarily being very good at making the most of it.

The latest expansion is significant, with five new conditions (acne, migraine, scabies, ear infections and rhinitis), potentially moving millions more consultations into community pharmacy.

Clinically, that is a big deal, and commercially, it could be an even bigger one. But here's the question I'd ask every independent pharmacy owner – when someone in your community gets a migraine, develops acne or can't stop sneezing, do they automatically think of your pharmacy?

If the answer is no, the opportunity isn't simply to improve the service, it’s to change the behaviour.

Patients don't think in pathways, and I know that sounds obvious, but it is remarkably easy to forget. Pharmacy teams think about pathways, eligibility, protocols, clinical assessment and remuneration.

Patients think in terms of what’s wrong. “I've got a migraine, my child's got an earache, what can I do about my acne?”

That distinction matters because the Pharmacy First opportunity isn't simply about creating five new clinical services, it’s about positioning the pharmacy as a trusted place to go when something goes wrong with your health, and that means starting with the patient problem rather than the service.

The consultation should, of course, be clinically excellent, with an appropriate assessment, identification of red flags, treatment where appropriate, advice and safety-netting.

But it can also be the start of something much bigger, because a good consultation creates trust, and trust creates future behaviour, which leads to value creation.

People can walk past a Pharmacy First poster every day and never consciously register it. The opportunity for independents is to make the service salient, make it relevant, make it local, and make it about the problem the patient has today, and don't underestimate the pharmacy team as a behavioural trigger.

A medicines counter assistant who says ‘would you like to speak to the pharmacist about that?’ may be more powerful than another expensive poster.

Let's address the elephant in the dispensary. Pharmacy First has to make financial sense for an independent pharmacy, because we cannot build sustainable businesses by treating clinical services as something we do despite the economics.

The financial calculation shouldn't stop at the payment attached to an individual consultation, rather start thinking about the lifetime value of the patient relationship.

That next visit might be for another Pharmacy First condition, but it might also be self-care advice, a vaccination, a blood-pressure check, medicines support or another appropriate service.

Or perhaps they simply stop going elsewhere for their everyday healthcare needs, and that is commercially valuable. The consultation may be the beginning of the relationship.

Five things I would advise independents to do now.

1. Decide what you want to be known for: Don't just add five conditions to a list of services, but ask ‘what do we want people in this community to think of us for?’ Convenient clinical care? Self-care? Family health? Women's health? Supporting older people? Your Pharmacy First offer should reinforce your proposition.

2. Train the whole team, not just the pharmacist: The consultation may belong to the pharmacist, but the opportunity belongs to everyone, so make sure every team member knows what the expanded service covers, who might benefit and how to start the conversation.

3. Think market problems (and solutions) not pathways: Patients don't wake up wanting a Pharmacy First consultation, they wake up with a migraine, that they want fixing, or reassurance it’s not something worse, so use language that reflects their problem.

4. Measure more than consultations: Of course, count consultations, but also consider how many new patients did Pharmacy First attract? How many came back? What other services did they subsequently use? How has patient feedback changed? Are GP practices referring appropriately? Because what gets measured gets noticed.

5. Build relationships beyond the pharmacy: Pharmacy First works best when it’s a collaboration. Talk to local GP practices, PCNs, care homes and other HCPs to ensure they understand what your pharmacy can do. Because the biggest opportunity may not be taking patients away from general practice but rather helping the whole local system decide who is best placed to do what.

We have spent years talking about the need to shift care closer to people's homes, and Pharmacy First gives us a practical mechanism to do exactly that, but success will be when people stop saying “that's where I get my medicines’ and start saying ‘that's where I go when I have a health problem’.

So, don't just deliver Pharmacy First. Own it, make it visible, make it relevant and make it easy. Because the biggest opportunity isn't the five new conditions, it’s the millions of behaviours that could change because of them.

Trevor Gore is the founder of Maestro Consulting, a Self-Care Forum trustee and associate director at the Institute for Collaborative Working.