Community Pharmacy England (CPE) is asking community pharmacies how confident they feel about meeting the Pharmacy First clinical pathway thresholds as they rise in September and October.

The survey, for independent and non-CCA multiples, also asks what the impact of GPs 'working to rule' has been since action began earlier this month.

And CPE has approached CCA multiples separately to understand their experiences.

In September, pharmacies will need to conduct 20 Pharmacy First clinical pathway consultations that pass the gateway point and reach an outcome set out in the pathway in order to qualify for the £1,000 monthly payment for the service.

And from October, this threshold will increase to 30 consultations.

Recent data has revealed that one in five community pharmacies participating in Pharmacy First in England failed to meet the minimum threshold of five clinical pathway consultations required in April.

Around 11% of participating pharmacies delivered no clinical pathway consultations at all during April; 65% delivered fewer than 15; 76% delivered fewer than 20, and 89% delivered fewer than 30.

And the August threshold was recently lowered to 15 following concerns from the sector that pharmacies were unable to meet the 20 originally proposed.

CPE's survey, which is open until 11.59pm on Monday 26 August, asks pharmacies what factors they think are responsible for pharmacies not being able to provide enough clinical pathways consultations to meet the increasing thresholds.

It suggests this may include insufficient advertising of the service, low public awareness of the service, a lack of GP referrals or referrals from NHS 111, or overly restrictive gateway points within the clinical pathways.

And it asks pharmacies whether they will stop providing Pharmacy First if they cannot keep up with the increasing monthly thresholds.

Currently, 96.5% of pharmacies in England have signed up to provide Pharmacy First, according to the latest figures from CPE.

The CPE survey also asks contractors what the impact of GP 'collective action' has been since some GP teams began 'working to rule' from 1 August.

Practices can 'pick and choose' from a list of actions proposed by the British Medical Association, which might include limiting daily contacts per clinician to 25 and switching off the  GP Connect Update Record functionality that permits the entry of coding into the GP clinical record by third-party providers.

Pharmacy owners are asked whether they have seen a reduction in Pharmacy First electronic referrals from general practices, more people being signposted rather than referred to the pharmacy by general practices, longer waits for repeat prescriptions to be issued, longer times to resolve prescription queries, increased complaining from patients about GP services, or other or no impacts from the GP action.

And CPE has continued to track ongoing pressures on community pharmacy, including instability in the medicine market, inflation and utility bills, increased demand for services, increased demand for healthcare advice, workforce costs, increasing rental rates and unpredictable revenue streams.