With GPs under increasing pressure, the NHS Long Term Plan aims to increase pharmacists’ powers so that they can offer one-to-one appointments and advice, take NHS 111 referrals, make medical assessments, and give medicines, all without the patient being seen by their GP.

This article looks at some of the benefits of increasing the pharmacists’ role and cautions that some symptoms may be red flags for medical emergencies which need urgent attention from a doctor.

What is the Pharmacy First scheme?

The Pharmacy First scheme was rolled out nationally in October 2019. It gives pharmacists the power to help patients in new ways. The Department of Health and Social Care (DHSC) and the NHS began the scheme to encourage patients to go to their pharmacist for help with minor illnesses, urgent medicines or repeat prescriptions.

In addition to a national advertising campaign designed to make patients think of pharmacists as the natural first port of call for minor illnesses, a new NHS Community Pharmacist Consultation Service (CPCS) has been set up to refer patients directly from NHS 111 to community pharmacies. Other referral routes are currently being trialled and may be implemented in the coming years, including allowing GPs to refer patients to pharmacists for assessment.

The NHS Long Term Plan has committed almost £13 billion to community pharmacy, proving that it believes pharmacies are an integral part of the NHS vision for the future. This investment is being driven by the need to relieve the pressure currently faced by GP surgeries and other frontline NHS services.

What are the intended benefits of Pharmacy First?

Early indications suggest that the scheme is working to relieve pressure on GPs. The Pharmaceutical Journal reported that empowering pharmacists to manage medicine reviews has enabled GPs at one practice to release an additional 28 hours of GP time per month. DHSC reported that more than 100,000 patients had appointments with pharmacists in the first 10 weeks of the scheme’s operation, again demonstrating the potential to use community pharmacists to reduce pressure on other NHS services.

Many patients feel reassured by having a face-to-face appointment to seek help for a health issue. The changes mean that they can make an appointment to see a pharmacist, often in a private room, about a minor illness without taking up a GP’s time.

One of the aims of the scheme is to provide proactive care ‘putting prevention at the heart of the NHS.’ Plans are being considered for pharmacists to help detect undiagnosed cardiovascular disease, support stop smoking programmes, carry out routine monitoring of patients and administer vaccinations and immunisations.

What training do pharmacists have?

The General Pharmacy Council (GPhC) explains that qualifying as a pharmacist takes a minimum of five years and includes the following steps:

  • Successful completion of a GPhC accredited Master of Pharmacy degree
  • A year of supervised training whilst the trainee works in a pharmacy and gathers a portfolio of evidence to show their skill
  • Successful completion of the GPhC's registration assessment
  • Meeting fitness to practise requirements

What are the risks possibility of missing red flag symptoms?

Many patients will be advised and treated without seeing a doctor. Patients may be referred by NHS 111 call handlers directly to their pharmacist. Inevitably there will be an increased risk that diagnosis and treatment of potentially serious illness will be delayed if the patient is not seen by a doctor.

Pharmacists are well trained for their traditional role of dispensing medicines which have been prescribed by a doctor who has assessed the patient. GPs have a much wider range of experience and training. They need this to perform their vital role in recognising when patients with a wide range of conditions need urgent or specialist treatment. Pharmacists do not have this level of training but will be expected to perform the GP’s role.

Without increased training and experience in recognising red flag symptoms of serious illness, pharmacists cannot be expected to replace an assessment by a GP for anything that is outside their current expertise. To do so risks delay in treatment and serious injury to patients whose apparently minor symptoms should be recognised as a red flag indicator of a more serious problem.

Delays in recognising red flags and diagnosing and treating conditions, such as cauda equina and sepsis, which commonly present to GPs with apparently minor symptoms, can lead to severe injury to patients. These patients require skilled examination, proper advice, correct diagnosis and urgent referral to avoid them suffering serious harm.

Mistakes and delays in referral or treatment of these conditions also lead to expensive compensation claims, which must be paid by the negligent practitioner’s indemnity insurers.

Where a GP is negligent, they are covered for their liability by the Clinical Negligence Scheme for GPs (CNSGP) and their claim is handled by NHS Resolution. CNSGP covers pharmacists employed by GP surgeries but specifically excludes cover for community pharmacists. Pharmacy First therefore leaves community pharmacists, and their indemnity insurers, exposed to greater liability than ever before.

Boyes Turner regularly recover compensation for clients who have been seriously injured and permanently disabled by GP delays in diagnosis and treatment of conditions, such as cauda equina, infections and sepsis, diabetes, cancer, ischaemia and tuberculosis (TB).

We recognise the valuable work that pharmacists provide in their own clinical area of expertise and the benefits that extending role can offer patients in appropriate circumstances. We are concerned, however, about the potential for further avoidable harm being caused to patients with red flag symptoms who are not seen by a doctor, and the lack of NHS indemnity for their potential claims.

If community pharmacists’ mistakes are not insured by the NHS, we expect injured patients’ claims to become more complex, lengthy and expensive as pharmacists’ insurers are faced with new and more expensive claims

The NHS seems to have shifted not only the burden of seeing patients, but also the responsibility and cost of their injury claims, onto the community pharmacists.