Almost half of pharmacies in England have seen a reduction in Pharmacy First electronic referrals from GP practices since many GPs began 'working to rule' last month, a poll by Community Pharmacy England (CPE) has suggested.

A survey of 4,589 pharmacy premises in England in September has revealed the impact of collective action taken by GPs since 1 August.

It comes after GP practices voted overwhelmingly in favour of participating in a choice of actions proposed by the British Medical Association (BMA), including limiting daily contacts per clinician to 25, limiting referrals, and switching off the  GP Connect Update Record functionality.

Since the working to rule action began, 48.54% of pharmacy survey respondents told CPE they had seen a reduction in Pharmacy First electronic referrals from GP practices.

In addition, some 47.61% of pharmacies surveyed noted an increase in patients voicing frustration about GP services.

Nearly half (45.06%) of pharmacies surveyed said that GP practices were taking longer to issue repeat prescriptions since 1 August.

And around a quarter (26.48%) said they had noticed an increase in people being signposted to the pharmacy by general practices.

Just 3.91% said they had not seen any effect of the GP action in their pharmacy, while 0.81% did not know.

CPE said it was concerned that 'pharmacies could be overwhelmed with displaced and unfunded patients at a time when capacity in the sector is already so stretched'.

And it said it would continue to monitor the impact of the collective action.

More than 60% pharmacies not confident about meeting Pharmacy First thresholds

To be eligible for a monthly £1000 payment for the service, pharmacies must carry out a minimum number of clinical pathway consultations, with the threshold increasing each month.

In September, pharmacies must complete 20 clinical pathway consultations that pass a 'gateway' point for payment, and this threshold is set to increase to 30 from October.

But more than 60% of the community pharmacies surveyed by CPE in September said they were ‘not at all confident’ about meeting the Pharmacy First thresholds in September and October.

And less than a third were 'slightly confident'.

Some 86.4% said they thought low numbers or no GP referrals were a reason they were unable to meet the increasing thresholds for clinical pathway consultations.

Some 81.42% cited insufficient advertising of the service, while 77% cited low public awareness of the service.

Over two-thirds (67.89%) of the pharmacies surveyed said that the gateway points in the clinical pathways were to restrictive.

And 46.77% said they were not getting enough referrals from other providers, such as NHS 111.

A majority of respondents said that if they were unable to meet the thresholds, they would first seek greater engagement from local GP practices to try to increase referrals to the service.

Just 8% said that would carry on providing the service without trying to secure any increase in referrals, CPE said.

The Pharmacist's recent roundtable with community pharmacy and general practice representatives highlighted concerns around referrals to the service, and opened dialogue about how GP confidence in Pharmacy First could be increased.

And CPE told The Pharmacist that it wanted to see minor ailments and urgent medicines supply be made available to walk-in patients through Pharmacy First.