Pharmacy First

Stop Smoking

Contraception

Hypertension Case Finding

The Pharmacy First service builds on the NHS Community Pharmacist Consultation Service which has run since October 2019. The consultation service enables patients to be referred into community pharmacy for a minor illness or an urgent repeat medicine supply.

The new Pharmacy First service, launched 31 January 2024, adds to the existing consultation service and enables community pharmacies to complete episodes of care for 7 common conditions following defined clinical pathways.

The benefits of Pharmacy First

In May 2023, NHS England and the Department of Health and Social Care announced a Delivery plan for recovering access to primary care. Part of the plan includes enabling patients to get certain prescription medications directly from a pharmacy, without a GP appointment.

This new service is expected to free up GP appointments for patients who need them most and will give people quicker and more convenient access to safe and high quality healthcare. It includes the supply of appropriate medicines for 7 common conditions including earache, sore throat, and urinary tract infections, aiming to address health issues before they get worse.

Currently, NHS patients in England must visit their GP to access prescription only medication, meaning repeated GP visits and delays in treatment.

Community pharmacies offer a more convenient way to access healthcare that includes support with healthy eating, exercise, stopping smoking, monitoring your blood pressure, contraception, flu and covid vaccinations.

The public perceptions of community pharmacy survey found that over 90% of patients who sought guidance from a community pharmacy within the past year reported receiving good advice.

The government and NHS England are committed to ensuring patients receive the right treatment at the right time. The NHS Long Term Plan highlights the need to make greater use of community pharmacists’ skills and opportunities to engage patients. This is why we have launched a new Pharmacy First service.

NHS Community Pharmacy Smoking Cessation Service

NHS community pharmacies are a great place for patients to receive stop smoking advice and support. Through this service hospitals can refer patients to community pharmacy to continue the stop smoking journey they started in hospital.

The service:

  • supports patients who started a stop smoking programme in hospital to continue their journey in community pharmacy upon discharge
  • promotes healthy behaviours to service users

Smoking cessation and why it’s important

The NHS Long Term Plan focuses on the importance of preventing avoidable illness and more active management of the health of the population. Smoking cessation is specifically identified as a key service that can improve the prevention of avoidable illness. The Long Term Plan suggests that existing smoking cessation services can be expanded to further support patients who are looking to quit smoking, as well as those affected by second-hand smoke.

Smoking is one of the biggest avoidable causes of disease and premature death in the United Kingdom (Allender, 2009), and smoking-related illness puts a considerable strain on NHS resources. In 2015-16 there were 474,000 hospital admissions and 79,000 deaths caused by smoking, which cost the NHS £2.5 billion (NICE guideline NG92).

This service is a branch of the wider aim of supporting hospital patients to continue their stop smoking efforts after discharge, which is expected to increase one-year quit rates by 11% and, when implemented, is expected to save the NHS £85 million in healthcare resource use within one year (Mullen, 2010; Royal College of Physicians, 2018).

Bridging the gap between secondary care smoking cessation services and those based in community pharmacy provides further support to the stop smoking campaign across the UK at a time when there is an increased need for patients to quit to protect their health.

According to Action on Smoking Health, smokers who are hospitalised with COVID-19 are more likely to suffer severe outcomes than non-smokers.

From March 2022, the service will be rolled out in community pharmacies across the country, supporting the implementation of the NHS Long Term Plan commitment that by March 2024, everyone admitted to hospital will be offered NHS funded tobacco treatment services.

What the service will provide

Inpatients who start a stop smoking attempt in hospital will be able to be referred to a community pharmacy to continue their stop smoking journey once they are discharged.

People can choose the community pharmacy they wish to be referred to.

A pharmacist will meet with the person stopping smoking or carry out consultations over the phone to discuss their quit progress for up to 12 weeks. They will review the nicotine replacement therapy (NRT) prescribed by the hospital team and make any necessary adjustments to support the continued quit attempt and provide ongoing supplies free of charge as required.

How patients access the service

To access the service, patients must:

  • have been referred by a participating hospital
  • have started a stop smoking programme in hospital and not completed this before being discharged

The service specification can be found here: Community pharmacy advanced service specification: NHS Smoking Cessation Service (SCS)

Watch this video to find out more about the service.

NHS Pharmacy Contraception Service

Contraception management and why it’s important

NHS community pharmacies are an accessible and convenient place for people to receive advice and support for contraception management.

The NHS Long Term Plan highlights the importance of NHS services complementing the action taken by local government to support the commissioning of sexual health services and exploring the future commissioning arrangements to widen access and create capacity where it is needed.

The Public Health England resource for commissioners highlighted the role community pharmacy can play supporting ongoing contraception. In areas that do not already offer commissioned contraceptive services, appropriately trained and skilled community pharmacists could provide access to their ongoing supply of their oral contraception to relieve the burden on general practice and allow GPs to concentrate on more specialist services.

In response to this, and in line with the Community pharmacy contractual framework commitment to “test a range of prevention services’, a tiered pharmacy contraception service has been designed to include:

  • Ongoing monitoring and supply of oral contraception prescriptions
  • Initiation of oral contraception

Supplies of oral contraception are made by a pharmacist via a Patient Group Direction (PGD).

The aim of the Pharmacy Contraception Service (PCS) is to offer people greater choice and access when considering starting or continuing their current form of oral contraception. The service supports the important role community pharmacy teams can play to help address health inequalities by providing wider healthcare access in their communities and signposting service users to local sexual health services. It also aims to create additional capacity in primary care and sexual health clinics (or equivalent) to support meeting the demand for more complex assessments.

From Spring 2023, pharmacies have had the option to register for the NHS Pharmacy Contraception advanced service for the ongoing supply of oral contraception. All community pharmacists offering the service will have demonstrated competence in the specific skills and knowledge required.

From 1 December 2023 the service expanded to give people the option of being able to have a confidential consultation with a community pharmacist to request a prescription of the contraceptive pill for the first time directly from their pharmacist, rather than from their GP or sexual health clinic.

The service is an integrated pathway between existing services and community pharmacies to enable greater choice and to widen access to services and support for high-risk communities and vulnerable patients.

A person may self-refer or be referred by their general practice, sexual health clinic or equivalent, to a participating pharmacy. A pharmacy may also identify a person is suitable for the service and highlight it to appropriate individuals. The pharmacist will offer a confidential consultation and as part of that, will reach a shared decision with the person on the ongoing supply of their current oral contraception, ensuring clinical appropriateness.

This is an NHS service and so the supply of oral contraception will be exempt from any prescription charges.

Individuals do not need to be registered with a GP to access this service. Pharmacies will only inform the GP practice that individuals have accessed the service, with their consent.

To be eligible to access this service a person must be an individual seeking to be initiated on an oral contraception (OC), or seeking to obtain a further supply of their ongoing OC:

  • Combined Oral Contraceptive (COC) – from menarche up to and including 49 years of age; or
  • Progestogen Only Pill (POP) – from menarche up to and including 54 years of age.

NHS Community Pharmacy Blood Pressure Check Service

The NHS Community Pharmacy Blood Pressure Check Service supports risk identification and prevention of cardiovascular disease (CVD).

This service will:

  • identify people over the age of 40 who have previously not been diagnosed with hypertension (high blood pressure), and to refer those with suspected hypertension for appropriate management.
  • promote healthy behaviours to service users.
  • undertake ad hoc clinic and ambulatory blood pressure measurements at the request of general practice.

CVD and why it is important

Cardiovascular disease (CVD) is the second most common cause of premature death in England, after cancer, affecting seven million people. One in four premature deaths are caused by CVD, and 1.6 million disability adjusted life years can be attributed to it.

High blood pressure significantly increases the risk of having a heart attack or stroke, but early detection and treatment can help people live longer, healthier lives. The NHS Long Term Plan focuses on tackling health inequalities and the prevention of ill health and aims to prevent 150,000 strokes and heart attacks as a result of CVD, over the next ten years.

High blood pressure and CVD

The NHS service is based on published research, previous pilots and the NICE guidance for high blood pressure, which includes using ambulatory measurement to confirm a diagnosis of hypertension. It suggests that people aged over 40 years should be considered for treatment of hypertension if they have a confirmed high blood pressure reading following ambulatory monitoring and taking certain risk factors into account.

What the service will provide

A community pharmacist will opportunistically measure the blood pressure of consenting adults who come into the pharmacy, by offering anyone a free blood pressure check who:

  • is over the age of 40;
  • has not previously been identified as having hypertension or a related condition; and
  • has not had their blood pressure measured by a health professional within the previous six months.

At the end of a consultation, where readings indicate:

  • normal blood pressure, the pharmacist will promote healthy behaviours.
  • high blood pressure, the pharmacist will offer Ambulatory Blood Pressure Monitoring (ABPM) from the pharmacy and will also promote healthy behaviours.
  • very high blood pressure, the pharmacist will urgently refer the patient to see their GP within 24 hours and the pharmacist will inform the patient’s GP practice by NHS mail or via another locally agreed platform.
  • low blood pressure, the pharmacist will provide appropriate advice and may also refer the patient to their GP if there are any concerns.

All blood pressure readings are sent to the general practice from the community pharmacy so records can be updated and appropriate action taken.

In addition

  • General practices can refer patients to a participating community pharmacy for a clinic blood pressure reading or for 24 hour ambulatory blood pressure monitoring.
  • There are no specific requirements set for referrals from general practice to allow contractors to work with general practices to agree a local process which will work for both parties. Different practices may require different levels of support, so an open approach allows flexibility for contractors to support each practice as needed, at a local level.