Pharmacy First — striking the right balance

Further to the recent launch of the Pharmacy First Service (PFS), patients in England are now able to obtain treatment for seven common conditions at their pharmacy without needing to see a GP.

Here, Partner and former pharmacist Richard Hough explains why this scheme creates a tension between the commercial interests of the pharmacy owner and the responsible pharmacist who is employed by them.

This article was first published by Independent Community Pharmacist.

What is the purpose of Pharmacy First Service

More than 90 per cent of community pharmacies in England have signed up to the PFS which enables pharmacists to assess and treat patients for sinusitis, sore throat, earache, infected insect bites, impetigo, shingles and uncomplicated urinary tract infections in women under the age of 65 without the need for a GP appointment or prescription.

It is hoped that the PFS will give the public more choice in where and how they access healthcare services and free up approximately 10m GP appointments a year. The Government has made £645m of ‘additional’ funding available to support the continued expansion of community pharmacy services.

Assessing safety

So, what are the risks and liabilities facing pharmacy contractors and pharmacists?

Pharmacy owners and superintendent pharmacists (SPs) have recently been told by the General Pharmaceutical Council (GPhC) (in its email of 1 February 2024) that they will need to continually assess whether enough trained and competent staff are available at their pharmacy to provide PFS safely and effectively.

The GPhC said that in order to ensure patient safety, owners and SPs would need to “continually assess staffing levels and skill mix to make sure that there are enough staff who have sufficient training, knowledge, and skills to be able to provide all pharmacy services safely and effectively.”

So, if a pharmacy owner or SP fails to make such assessments and take appropriate action to ensure that all existing core pharmacy services and also newer ones — such as those provided under PFS and the Pharmacy Contraception Service (PCS) — comply, it can expect scrutiny and the prospect of sanctions from the GPhC for breach of its standards for registered pharmacies.

Competency is a key consideration

But what of the pharmacy professionals (both employees and also self-employed locums) who will be required to provide the PFS on a day-to-day basis?

The GPhC stated that it expects “pharmacy teams to be supported and empowered to exercise their professional judgement in the interests of patients and the public.” Therefore, a pharmacy professional might exercise their professional judgement to refuse to provide the PFS if they felt incompetent to do so due to a lack of training or experience, or if they considered that the pharmacy premises or work environment wasn’t suitable to provide the service safely and effectively — due to under-staffing, for example.

The PDA has said in a recent communication to its members (on 19 January 2024) that operating the PFS “is at the sole discretion of the Responsible Pharmacist (RP) on the day, as [s72A(1)] the Medicines Act [1968] places a legal duty on the Responsible Pharmacist to secure the safe and effective running of the pharmacy. The pharmacy owner is also required under the legislation to enable the Responsible Pharmacist to exercise his/her professional judgement, as appropriate, in relation to the safe and effective running of the pharmacy concerned.” This reflects the GPhC’s position.

The PDA also noted that a safe and effective service can only be delivered “if the pharmacist and other team members are trained and competent to provide the service being offered” and if it is sufficiently resourced — without compromising the delivery of essential services and safe care for other patients.

Avoiding the risk of misconduct

Section 72B(1) of the Medicines Act 1968 states that: 

“The failure by a person to comply with any requirements of section 72A…of this Act, or of rules or regulations made under section 72A, may constitute misconduct for the purposes of section 80 of this Act, article 51(1)(a) of the Pharmacy Order 2010…and the relevant disciplinary committee may deal with such a failure accordingly.”

It is clear from section 72B(1) that if an RP — whether through lack of training, competence or adequate staffing support — fails to secure the safe and effective running of the pharmacy in respect of either core dispensing activity or ancillary services (such as the PFS or PCS) they may find themselves subject to a misconduct investigation and possible fitness to practise proceedings.

What this means for pharmacy owners and pharmacists

As ever, a tension exists between the commercial interests of the pharmacy owner — who understandably, (given the appalling state of underfunding in the sector) wishes to maximise access to the much-needed additional revenue associated with delivering PFS — and the RP who is engaged or employed by them, who is duty bound to ensure that delivering the PFS is done safely and competently and not at the expense of the safe delivery of core pharmaceutical services to the pharmacy’s patients. 

With each party’s legal position now clear, everyone should be able to crack on with delivering this transformative service for community pharmacy and the patients whom they dutifully serve without further impediment or delay.

Did anyone mention IT systems and GP records access, I hear you say…?

Talk to us

If you’d like to discuss how the Pharmacy First Service scheme may impact you, our specialist healthcare lawyers have a unique understanding of pharmacy businesses.