By Mark Gilchrist, Chair of RPS Antimicrobial Expert Advisory Group
Pharmacy First is a significant shift in the delivery of patient care, empowering pharmacists to take on a more proactive role in managing common infections while safeguarding against the looming threat of antimicrobial resistance (AMR).
By embracing specialised training, clinical pathways, and stringent antimicrobial stewardship measures, pharmacists are making significant strides in promoting patient health and combatting AMR effectively.
Strategies built into Pharmacy First to reduce the threat of AMR:
- Clinical Pathways: The service adopts a clinical pathway approach to supporting patients with infections, designed by a multi-professional expert group co-ordinated by the NHS England Primary Care Team. The pathway starts with patient interviews and physical examinations where necessary. This is followed by providing advice, information and reassurance, options for self-care and symptom relief, alternatives to antibiotics including over the counter medicines – and safety netting guidance in the event the patient’s condition becomes worse. Antibiotics or antivirals will only be offered if needed and supplied in accordance with NICE guidelines.
- Specialist Training: Antimicrobial stewardship has long been a priority for pharmacy teams in England through the Pharmacy Quality Scheme, outlined later in this blog. The training provided alongside Pharmacy First builds on pharmacists’ expertise in this area, including clinical examination skills so they are fully equipped to manage patients effectively and identify potential red flags.
- PGDs: Antibiotics are supplied under the legal authority of Patient Group Directions (PGDs), ensuring compliance with strict inclusion and exclusion criteria. Multi-professional expert groups developed the PGDs, incorporating antimicrobial stewardship requirements and offering a limited range of narrow-spectrum antibiotic treatments.
- Digital Connectivity: Improved connectivity between general practice and community pharmacy enables seamless sharing of clinical information. This facilitates informed decision-making and enhances surveillance of antibiotic usage as it allows community pharmacists to establish whether a patient has had episodes of infection in the past and any previous antibiotic exposure or resistant infections. It will also ensure that general practice is alerted promptly when a patient consults a community pharmacy to access Pharmacy First and whether they have been dispensed an antibiotic or antiviral.
- CPPE Self-Assessment Framework: The Centre for Pharmacy Postgraduate Education (CPPE) offers a self-assessment framework, guiding pharmacy staff through relevant resources and training to enhance their proficiency in the Pharmacy First Service.
- Service payments: The Pharmacy First Service will reimburse community pharmacies for providing a clinical service. Pharmacists are not incentivised to supply antibiotics or antivirals.
Success stories
Successful management of AMR risks have been evidenced in Scotland and Wales:
- Scotland's Pharmacy First Service: Operating for five years, Scotland's Pharmacy First Service has demonstrated tangible results. During that time around 12% of orders for antibiotics has shifted from general practice to community pharmacy accompanied by a 0.6% decrease in total antibiotic orders for urinary tract infections. [data provided by Scottish Antimicrobial Prescribing Group for 2017 to 2022].
- Wales' Common Ailment Service: Wales' national pharmacy Common Ailment Service and Sore Throat Test-and-Treat (STTT) service has proven effective in managing common infections. Evaluation studies indicate consistent antibiotic exposure between GP-community pharmacy clusters providing the service and those that did not.
Prioritising Antimicrobial Stewardship
Antimicrobial Stewardship (AMS) also forms a cornerstone of the Pharmacy Quality Scheme, which provides targets for all community pharmacies to meet in terms of clinical effectiveness, patient safety and patient experience.
- Sepsis awareness: All pharmacy professionals undergo comprehensive sepsis training from CPPE, ensuring early identification and management of this critical condition.
- Cancer awareness: Training modules focus on identifying red flag symptoms of cancer, facilitating timely referrals and interventions.
- Infection prevention and control: Training enhances infection control measures, promoting safe practices within pharmacy settings.
- AMS education: Pharmacists receive specialised training in antimicrobial stewardship, reinforcing responsible antibiotic use and adherence to best practices.
- RCGP TARGET tools: Pharmacists use the RCGP TARGET antibiotic checklist and Treating Your Infection leaflets aids when advising patients, supporting appropriate use of antibiotics.
With the ongoing challenge that AMR continues to present, the NHS Pharmacy First service in community pharmacies in England is a significant initiative which also prioritises antimicrobial stewardship, aligning with the broader healthcare agenda.
Through collaborative efforts and a commitment to excellence, the Pharmacy First Service exemplifies the pivotal role of pharmacists in patient care whilst shaping the future of healthcare delivery.
Read RPS policy on antimicrobial stewardship.
Read more RPS blogs.