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Axing of local pharmacy-led scheme could lead to extra work for GPs

by Emily Roberts
24 March 2023

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A 20-year NHS contract for the Pharmacy First scheme in Nottinghamshire is coming to an end at the end of March following a change in commissioning arrangements, which could result in extra pressure on GPs and hospitals.

Nick Hunter, of Nottinghamshire Local Pharmaceutical Committee (LPC), said that the service is being decommissioned this month because of changes to commissioning moving from NHS England to Integrated Care Boards (ICBs).

A total of 81 pharmacies in the county have been actively participating in the Pharmacy First scheme, which enables over the counter medicines to be provided free of charge for minor ailments, such as for hayfever, headlice and conjunctivitis.

Pharmacists have been asked to brief their teams, and patients, on the changes and are being warned that it could result in additional workload for GPs as patients seek an alternative way to obtain free medication for minor ailments when the scheme ends on 31 March.  

Mr Hunter said that the challenge was to let everyone who uses the service know that it is coming to an end, and that there are currently no plans to replace it with an equivalent service.

He said: ‘It’s part of the life-blood of Nottingham City. We have people who are now parents using the service and their first experience was as a child.

‘Everyone working in care, schools, health, even the paramedics working in ambulance. It’s so widely used.’

He added: ‘We need GPs to be really clear that it’s decommissioning. There’s no alternative. Our fear is that patients will be bounced around.’

Mr Hunter said he hoped an alternative scheme will be commissioned by the ICB, however, he said this will not be implemented in time for hay fever season when patients use the scheme for free antihistamines.

‘We fully understand why it’s going down this route and if we didn’t have the NHS structural changes with transition of commissioning going from NHS England to ICB, it would probably carry on.

‘It’s because of this transition it’s put everything under scrutiny, everything is being challenged and questioned.’

Mr Hunter said that changes to commissioning have highlighted issues with the Pharmacy First scheme, explaining: ‘The old scheme has done its time and we’ve said for a long time we need to review it because it’s poorly funded and doesn’t fit with new services. It doesn’t connect with other services and is in isolation.’

He added: ‘Whatever we have as a minor ailments service in Nottingham needs to connect with other services and work alongside what’s going on in general practice.

‘Commissioning isn’t connected, it’s all done in pockets and isolation and the NHS doesn’t get the best value for money because it doesn’t commission smartly.’

However, he fears that the end of the scheme will impact some patients who rely on it.

‘If you look at it as a population basis, the impact will be relatively small, but it will impact on some patient groups significantly, such as those with protected characteristics or ethnic minority groups,” he said.

Mr Hunter added: ‘It’s certainly a worry for some GP practices and they fear that they will get a significant increase in footfall in patients as a result.’

While there is no direct replacement service, NHS England has suggested that the Community Pharmacist Consultation Service (CPCS), where practices can refer patients to pharmacies for minor ailments, can be used as an alternative.

However, CPCS is a consultation service whereas Pharmacy First is primarily about supply of over-the-counter medicines.

Patients cannot access CPCS by walking into the pharmacy without a referral from a practice or 111.

Mr Hunter said: ‘What we are trying to do is work with practices to implement the CPCS service, but we have struggled a bit partly because the Pharmacy First scheme has been there and it’s been easier to say ‘go to the pharmacy’.

‘There may be a silver lining but I think it’s going to be a bumpy road for the next few months because everyone is under pressure.’

An NHS Nottingham and Nottinghamshire ICB spokesperson said: ‘NHS England has informed GPs, pharmacy staff, stakeholders and the public about the end of the Pharmacy First service and we have worked with them to support this.

‘We are currently scoping out what future pharmacy services will look like in the area.’

It comes after pharmacies were asked to expand their services within primary care as part of former health secretary Dr Thérèse Coffey’s plan for patient access and the new pharmacy contract.

NHS England also recently launched an ad campaign to direct patients to pharmacies instead of GP practices.

A version of this story was first published by our sister title The Pharmacist.