Informal referrals to community pharmacies deprive pharmacies of more than £115 million each year, Community Pharmacy England (CPE) has estimated.

This is the amount that would have been paid if existing referral routes had been used appropriately by GPs and NHS 111, rather than patients being signposted informally to their local community pharmacy.

Although funding is available through Pharmacy First to deliver consultations to suitable patients referred from GP surgeries or NHS 111, in reality this route is bypassed 150,000 times each week, CPE estimated.

Instead, pharmacies are spending more than two hours a day in unfunded consultations with patients who are simply told to visit their pharmacy but are not formally referred, or who walk in to pharmacies as a first port of call, CPE suggested.

Signposting rather than referring patients to pharmacies also generates a clinical risk, CPE warned, as there is no record of their clinical need and the community pharmacy team is not aware the patient was told to attend the pharmacy and so have no ability to follow up with the patient if they do not attend.

The figures are based on CPE's 2024 advice audit, the results of which were published today.

Incomplete walk-in minor illness service 'makes no sense'

The proportion of patients who self-refer to community pharmacies is higher than ever before, while the national average of 21.7 unfunded consultations delivered by each community pharmacy each day is nearly 50% higher than it was four years ago, CPE added.

And the unpaid work by community pharmacies saves saves 115.2 GP appointments per surgery every week, or a total of 38 million GP appointments each year, CPE estimated.

'It makes no sense that the core benefit of Pharmacy First – as a walk-in service – is not fully funded, and it is simply not fair that pharmacies on the edge of collapse are being expected to offer support for minor illnesses falling outside of its strict parameters for free,' Janet Morrison, CPE chief executive, commented.

At the recent Pharmacy Show, The Pharmacist asked NHSE clinical strategy for community pharmacy lead Pallavi Dawda if NHS England was considering enabling self-referrals for all parts of Pharmacy First.

Ms Dawda responded that NHSE was 'listening' to and 'hearing' concerns raised by contractors around gateway points and time spent on unpaid consultations, and was 'working to increase referrals'.

And The Pharmacist's recent roundtable involving GPs and community pharmacy representatives found cross-profession support to opening all parts of Pharmacy First to walk-ins.

Pharmacies able to resolve 85% of patient concerns

CPE's latest figures on unpaid consultations are based on a snapshot audit of 3,916 community pharmacies in England - around one third of the network - who were asked to record all patient consultations over the course of one day in summer 2024.

Some 61,837 patient consultations were recorded that were not funded as part of an NHS service, nearly half (47.6%) of which resulted in advice and the sale of a medicine.

But nearly four in 10 (39.5%) consultations had no direct remuneration and no linked sale of a medicine - equating to an estimated 8.6 consultations each day per pharmacy across the whole network.

And in 15.3% of the consultations, pharmacies were able to identify concerns that required onward referral to another healthcare professional.

While some consultations resulted in multiple outcomes - such as advice and an onward referral - pharmacies were able to fully resolve 85% of consultations, CPE said.

Pharmacies 'cannot keep giving this advice for free'

Ms Morrison said the audit results 'show once again just much the nation and the wider NHS rely on community pharmacies'.

'Millions of people are turning to them for trusted and accessible healthcare advice, reducing demand elsewhere in the health service.

'But community pharmacies are in a desperate state and cannot keep giving this advice for free; they urgently need a funding uplift to prevent further closures.'

She warned that if that did not happen, 'millions of people will not be able to access healthcare advice and will be forced to either let their health deteriorate or turn to general practice and hospitals'.

According to the 2024 audit, 54.6% of patients reported they would have visited their GP surgery had they not been able to visit their community pharmacy, while 6.3% would have visited A&E or a walk-in centre and 5.2% would have accessed NHS 111.

Ms Morrison suggested that this week's Budget could be a 'key moment for this government to demonstrate its commitment to shifting healthcare from hospital to community', adding: 'There’s no better way than investing in the incredibly valuable community pharmacy network.'

And she thanked the community pharmacy teams who took part in CPE's advice audit, despite this 'adding yet more pressure' to already busy days.

Paul Rees, chief executive of the National Pharmacy Association said the 'drastically' increased workload alongside 'significantly' reduced funding was 'simply not sustainable'.

'Pharmacies want to provide the best possible care to their patients and take pressure away from other parts of our overstretched system.

'However, they cannot do this without a long term funding increase and a new deal that will halt the closures and allow pharmacies to expand the care they can offer their communities,' he added.

In response, a Department of Health and Social Care spokesperson said that the current government had 'inherited a broken NHS where pharmacies have been neglected for years'.

'We are committed to supporting community pharmacists, which have a vital role to play as we pursue our mission to shift the focus of care out of hospitals and into the community,' they added.

NHSE has been approached for comment.