Antimicrobials are being managed ‘appropriately’ under Pharmacy First, NHS England (NHSE)’s Head of Delivery for Community Pharmacy Clinical Strategy has told general practitioners.

Pallavi Dawda also revealed that, as of mid-last month, community pharmacies in England had delivered 32,000 Pharmacy First consultations.

And she told GPs concerned about patients being ‘bounced back’ to general practice that this may be ‘completely appropriate’ for community pharmacists to do.

Speaking to the Best Practice conference in London last week, Ms Dawda told an audience of general practitioners and general practice staff that community pharmacies were ‘managing anti microbials appropriately’ under the service, highlighting work already done on antimicrobial stewardship (AMS) as part of the pharmacy quality scheme (PQS).

She highlighted that pharmacists were ‘carrying on as business as usual’ and continuing to supply over-the-counter products where appropriate.

And she said that the percentage of Pharmacy First consultations that result in an antimicrobial supply or an alternative would be monitored and compared to general practice.

Ms Dawda also addressed concerns raised by GPs about referrals being ‘bounced back’ from community pharmacy to general practice.

‘Quite often we hear about referrals being bounced back: “I sent them for a sore throat from general practice and the pharmacist has sent them back.”

‘Well, that might be completely appropriate,’ Ms Dowda said, highlighting that the patient group directions set out inclusion and exclusion criteria.

‘It could well be that patients will be excluded and do need to come back,’ Ms Dawda added, suggesting that in some cases there could be ‘all these other symptoms’ and ‘you do need to be seen by someone of a higher acuity’.

‘That's acceptable, but having those processes in place really will help,’ she said.

And she added that under the Community Pharmacy Consultation Scheme (CPCS), only around one in 10 patients were referred back from community pharmacy to general practice.

Ms Dawda also said that NHSE was ‘absolutely overwhelmed with the support from the sector’, with over 95% of contractors having delivered the service.

And as of 12 February 2024, over 32,000 consultations had been delivered in community pharmacy in England under the seven Pharmacy First clinical pathways.

But some within the community pharmacy sector have raised concerns about the way that Pharmacy First consultations are recorded.

Speaking to contractors at the Sigma 2024 conference last week, Salim Jetha, community pharmacist and Avicenna chair, highlighted how pharmacists could spend time assessing a patient for one of the common conditions, only to find that they do not meet the gateway criteria for it to be recorded as a Pharmacy First consultation.

In a recent poll of 109 Avicenna members, the majority reported that less than a third of consultations met the gateway criteria, Mr Jetha told conference delegates.

And Pharmacy First consultations could take between 15-30 minutes on average, the poll suggested.

‘We’re spending a lot of time and not getting paid for it,’ Mr Jetha said, saying that he had raised the issue with Community Pharmacy England (CPE) who said that the monthly fixed payment for the scheme was designed to account for consultations that failed to pass the gateway points.

And he highlighted the importance of ‘bearing in mind that this is relatively new’.

‘We are going to get better and better as we go along,’ Mr Jetha said.

Also at the conference, president of the National Association of Primary Care Ash Soni suggested that contractors should collect data about consultations that result in an over-the-counter supply of medicine or a patient that goes elsewhere, in order to record information on health inequalities and patients who cannot afford medication.