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Pharmacy First … step to bigger things


Pharmacy First … step to bigger things

I would love to see Pharmacy First become the first stage to a two-pharmacist model, says Nick Kaye


And so, the wait is over. Pharmacy First in England is here and if we believe the rhetoric, it stands as a testament to the accessibility and the pivotal role of community pharmacies in meeting the nation's healthcare needs.

The hope is this will transform the way patients access primary care services, offering timely interventions and relieving the burden on traditional healthcare providers, but what about the burden on us on the frontline delivering the service?

I know that historically, community pharmacies have been seen as more than mere dispensaries of medications. Those of us working with local commissioned PGDs are testament to that and local PGDs have been successful as we serve as accessible hubs within local communities, offering professional advice and support.

What is different this time is the at-scale awareness shift that is needed in the general population from our traditional role of pharmacies primarily revolved around dispensing prescriptions and providing over-the-counter medications. What will the new scale of demand become? We know the implementation of Pharmacy First has been a strategic response to several pressing healthcare challenges.

One of the primary objectives is to alleviate the strain on GP services and emergency departments by diverting non-urgent cases to community pharmacies, but will we be able to deal with this demand?

My belief is that we will be able to cope but the first couple of months could be tricky until we know how the demands settle down. I have seen how my team in Cornwall deal with this demand with the walk-in consultation service but I think a great next step would be an online booking platform so that demand and capacity can be matched up.

During a recent weekend, I managed to book both my daughter and son into a high-street retailer to have their ears pierced and the team there managed their workload. So, surely we can do the same. That’s not to take away from the walk-in element of the service but we have to think this through.

I would love to see Pharmacy First become the first step in a two-pharmacist model. I have said this before but a second pharmacist could transform the way in which we practice. The help and support and the feeling of isolation would be reduced. Independent prescribing training could be made easier and individual pharmacists’ quality of life would be so much better.

I can see the scenario: ‘I am just popping out to see the kids’ school play, you clinically check this morning, I will run the clinic and then lets swap.’ That would be a great place to be but I fear the journey to that point could be difficult, which is why, again, I would urge the NHS to think about the additional roles reimbursement scheme for community pharmacy to allow that transition to take place.

I strongly believe that Pharmacy First will serve as a catalyst for innovation and service development within community pharmacies. If, and when, we get this right, so much more can follow. Yet, as we are encouraged to embrace more clinical roles, does this call into question the way in which we are currently funded?

Is it time to genuinely look at the community pharmacy contract and ask ‘is this working for independent pharmacy?’ Is purchase margin something we should be aspiring to and asking for?

I was recently in a meeting when the question ‘would contractors and owners like more margin’ was asked and the answer is obviously ‘yes.’ But does that feed a system which widens inequity in those with more buying power?

Should we be talking about fair share of margin? Now, I am a realist. I completely understand that those business with multimillion pound turnovers will be able to buy better than us smaller owners. However, is the gap too wide?

We all think we buy well and if the margin is a bell-shaped curve, we are winning. But I would challenge you to look at your purchase margin and see if you are getting your fair share. I hope you are but I don’t think as many of us are getting that fair share as you would expect, so is it time to start asking those difficult questions?

I hope cleverer people than me are looking at all of this in our new contract. And I hope your Pharmacy First journey is going well. I think this is start, not the end, of our clinical story.

Let’s hope, like Scotland and Wales, England continues to invest in us so we can continue to serve the people of our communities.


Nick Kaye is the chair of the National Pharmacy Association and a pharmacist in Newquay. These are his personal views.








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