Three-quarters of pharmacists do not believe that the pharmacies in which they work are adequately staffed to safely deliver Pharmacy First and other NHS contracted services, according to a survey by the Pharmacists' Defence Association (PDA).

Reflecting on the first year of the service, the majority of respondents (93%) said staffing levels had not been uplifted to support the new service, despite it meaning more work for pharmacy teams.

This comes amid ongoing concerns about workload pressures and workforce shortages in the community pharmacy sector, with 49% of respondents to last year's PDA survey warning that they did not have sufficient staff to safely provide existing services, even before Pharmacy First was introduced.

Improvements needed

Most pharmacists responding to the survey (69%) said they supported the continuation of a Pharmacy First service in England.

But they called for increased resourcing, improved referral processes, and the removal of payment thresholds.

And a significant 75% of respondents said they did not believe that the pharmacies in which they worked are adequately staffed to safely deliver Pharmacy First and other NHS contracted services.

This month, an exclusive white paper launched by our publisher Cogora highlighted the rapid increase in pharmacists moving from the community sector into practice roles. 

And a survey by The Pharmacist last year suggested the launch of Pharmacy First had not yet tempted practice pharmacists to return to the sector.

Pharmacy organisations have long called for more investment into the community pharmacy sector, with the National Pharmacy Association (NPA) suggesting that pharmacies will reduce their services if the upcoming pharmacy funding offer is inadequate.

Majority of pharmacists don't get protected learning time

This year, 65% of pharmacists responding to the PDA survey also said they received no protected time (or additional payment if outside of work hours) to complete the training necessary to deliver the service.

But 97% said they thought this was necessary.

Payment thresholds 'leads to target setting', says PDA

The PDA suggested that the requirement for each pharmacy to undertake a certain number of clinical pathway consultations each month to be eligible for a £1,000 monthly payment 'introduces commercial incentives and leads to target setting'.

In its survey, 73% of respondents said that they have been put under pressure to undertake Pharmacy First consultations.

And more than half (60%) of those said the pressure to meet targets came from area managers.

The latest available figures show that fewer than half of the pharmacies that originally signed up to deliver Pharmacy First in England were able to meet the thresholds when they rose to 20 in September and October.

Clearer communication with patients and practices needed

Pharmacists responding to the PDA survey also reported patient frustration and anger when they were ineligible for the service or for antibiotics, and said that the clinical pathways, exclusions and the fact that medicines supply is subject to consultation with a pharmacist needed to be made clearer.

One respondent commented: 'The way the service has been advertised is ridiculous and has directly led to many problems encountered by pharmacies across the country. For example, advertising the Otitis Media pathway with an adult (when the service is only available to children aged between 1 and 17 years).'

And another said that better training for general practice staff who signpost patients to pharmacies was needed. 'I have never received a formal referral,' the respondent commented.

Conditions need to be met if Pharmacy First expanded

While most pharmacists said they would like to see Pharmacy First expanded, the majority said there should be certain conditions in place if this were to happen.

This included, in order of preference:

  • The ability to electronically refer patients to their GP practice if they presented with certain red flags, or did not meet the criteria for the pathway/PGD
  • Protected learning time in support of new clinical pathways being introduced
  • An increase in the number of trained and competent support staff working in community pharmacies
  • A phased introduction of new clinical pathways
  • A second pharmacist in pharmacies offering the Pharmacy First service
  • Improved access to Pharmacy First training for locums
  • Improvements to current IT systems to record and submit Pharmacy First consultations
  • Avoidance of large-scale advertising campaigns, so that the service grows organically

And to manage workload, respondents suggested that pharmacies could have specific ‘clinic times’, use a booking system within the pharmacy, use an integrated triage service to book appointments, or use the NHS app to book appointments.

The PDA also said that the voice of employed pharmacists should be included in any future negotiations on the service.

'Hurried introduction' of Pharmacy First 'extremely challenging'

Jay Badenhorst, PDA director of pharmacy, noted that 'the hurried introduction of the Pharmacy First service, along with the volume of training which needed to be undertaken, was extremely challenging for those already working at capacity on the frontline of pharmacy in England'.

'Based on the survey, PDA members have suggested several improvements to deal with the additional demand and enhance the patients’ experience. These include ensuring appropriate staffing levels throughout the opening hours of pharmacies and considering key factors, such as protected learning time, before any new services are launched or future service expansions.

'The PDA is calling for representatives of the pharmacy workforce to be involved in meaningful discussions with commissioners and contractors during service developments and how they are better resourced. This is to ensure that the perspective of pharmacists delivering the services are featured, from the onset, in any future pharmacy contractual framework developments,' he added.

The PDA snapshot survey was conducted online between 16 January and 26 January 2025, and 924 PDA members responded.

A Department of Health and Social Care spokesperson said: 'Community pharmacy has a vital role to play as we shift the focus of the NHS out of hospitals and into the community, through our 10 Year Health Plan.

'We will work with the sector, making better use of the skills of pharmacists and pharmacy technicians, to build a service fit for the future.'

A new report from the Company Chemists' Association (CCA) last week showed pharmacies were seeing 'double' the demand for Pharmacy First consultations on Sundays than would be expected in line with reduced opening hours.