EXCLUSIVE Expanding clinical opportunities in community pharmacy are not enough to make pharmacists working in GP surgeries want to reconsider a career in the sector, our snapshot survey has suggested.

Practice pharmacist respondents cited reasons including increased workload with fewer resources, a lack of structures and support in place, and a lack of opportunity to use IP qualifications as reasons not to return to a career in the community.

Some even said that Pharmacy First had put them off working in the community pharmacy sector, while one said that they had stopped working as a locum in community since the service was introduced.

Has Pharmacy First made pharmacists reconsider working in community pharmacy?

The majority (80%) of the 101 general practice and primary care network (PCN) pharmacists – who previously worked in the community – said that Pharmacy First had not made them reconsider working in community pharmacy, according to our survey results.

Just 9% said that it had, while 11% said they did not know.

‘Pharmacy First only adds to stress and pressure in community’

The most common reason given against returning to community pharmacy were concerns around increased workload, alongside workforce pressures.

One pharmacist said they had similar opportunities to use clinical skills in a PCN setting, with the benefit of a structured appointment system.

The community pharmacy negotiator has previously suggested that the recruitment of pharmacists currently working in GP surgeries and PCNs from community pharmacy has exacerbated workforce shortages in the sector. It had asked the NHS to consider the impact of the Additional Roles Reimbursement Scheme (ARRS) on community pharmacy.

As of July 2024 there were 5,330 pharmacists and 1,914 pharmacy technicians working within PCNs, the majority of which are likely to be at least partially funded through the ARRS, which supports PCNs with salary and recruitment costs.

Pharmacists are the most recruited ARRS role, but recruitment has slowed dramatically since the beginning of this financial year.

Pharmacy First needs to be 'smoothed out'

In our survey, several practice or PCN-based pharmacists also expressed concerns about the Pharmacy First service itself, with one respondent questioning whether training and support for the service was adequate, and another suggesting that access to more clinical information was needed.

And while one pharmacist said that once teething issues with the service were smoothed out Pharmacy First would make community pharmacy work more appealing in the future, others said that the clinical opportunities were still too limited.

Several GP/PCN pharmacist respondents said they thought their IP skills would go to waste in the community pharmacy sector through a lack of opportunities to use them.

‘GP surgeries need to better understand Pharmacy First’

Pharmacist Ayah Abbas, who works across both community and general practice, said she understood the concerns.

‘The workload has increased and sadly so has the abuse from patients who can get frustrated if they don't receive a treatment. The community pharmacist doesn’t have an allocated time for this service so there needs to be a better support in place for this to be successful,’ she told The Pharmacist.

But she also highlighted the need for GP surgeries to better understand Pharmacy First, which she said could make a positive impact on community pharmacies and help reduce GP workload.

Ms Abbas said she had experienced GP surgeries referring patients to community pharmacies who were not suitable for the service, as well as telling patients incorrect information including that they had an appointment with the pharmacist at a specific time.

‘This as a result causes the patient to be frustrated,’ Ms Abbas said.

‘Pharmacy First is unsustainable without sufficient funding and resources’

Meanwhile, Brendon Jiang, a PCN pharmacist and vice chair of the Royal Pharmaceutical Society (RPS) England Pharmacy Board, said that concerns raised by pharmacists in our survey echoed policy areas that the RPS was campaigning for, such as ‘protected learning time, access to patient health records and post-registration workforce development to empower a thriving pharmacy workforce across all sectors’.

While he said that Pharmacy First had ‘transformed community pharmacy, showcasing pharmacists’ clinical skills to support patients and encourage provider collaboration’, he added that ‘substantial reform and uplift for the community pharmacy contract’ was ‘essential to meet growing demands’.

‘Without sufficient funding and resources, services like Pharmacy First are unsustainable,’ he told The Pharmacist.

He also noted that the NHS IP pathfinder programme would provide ‘vital insights to scaling IP services’.

‘These insights must inform sustainable models that fully utilise the pharmacy workforce's capabilities,’ Mr Jiang said.

‘Until we fix the finances, we can't improve the work’

Dr Graham Stretch, practice-based pharmacist and president of the Primary Care Pharmacy Association (PCPA), suggested that community pharmacy prescribing services were a ‘chicken and egg’ situation.

‘You can't commission a service until everyone can prescribe, and nobody's going to go off and learn how to prescribe until there are services to deliver,’ he told The Pharmacist.

But he suggested that changes to the initial education of pharmacists to include prescribing training might push the legacy workforce into becoming independent prescribers, ‘because they don’t want to get left behind’.

He said he was unsurprised by the survey findings that highlighted concerns around workforce and workload pressures in community pharmacy.

And he suggested that with the current financial situation across primary care, ‘there's no realistic prospect of that changing anytime soon’.

‘Until we fix the finances, we can't improve the work, with the staffing and the ability to engage a locum and do some development work,’ Dr Stretch said.

And he said more pharmacists might be tempted to work in community pharmacy if there were opportunities to train and work as an independent prescriber, with the clinical work and access to patient notes that goes with that.

Portfolio careers could become more common

Dr Stretch also noted that along with the opportunity to learn and use different skills, many pharmacists choose to work in general practice due to other benefits such as flexible working arrangements. Many even take a pay cut in order to work in general practice pharmacy, he said.

And he suggested that in the future, more pharmacists may opt for portfolio careers across settings, particularly as multi-sector training becomes mandatory.

‘I sort of hope that happens, actually, because I think it benefits all parties, both the community and the PCN, and of course the individual who wants variety in their working life,’ he told The Pharmacist.

Patients would also benefit from more continuity of care with pharmacists able to ‘follow patients across the settings’, as well as from better working relationships between GP surgeries and community pharmacies.