NHS Pharmacy First FAQs

NHS Pharmacy First FAQs

What counts as a consultation/activity?

It’s too early to tell. The Directions and Service specification will give us the answer once they are published, which we will then communicate to the network as a priority.

For launch, not having been able to confirm the detail with SG, our working definition is that pharmacy teams can record a consultation where there has been an assessment of symptoms and the pharmacy team have recommended a course of action. When this question is raised, we recommend that we give this answer along with a disclaimer that this definition may be refined as we learn more.

ing at the working definition is as is follows:

  • If we are bold and say that any OTC activity can be converted to a Pharmacy First consultation, the risk is that SG’s view is less permissive and we have to backtrack on our messaging. This may also drive behaviours that significantly dilute the activity pool
  • Anything more restrictive will become difficult to understand or apply in practice
  • There had been a suggestion that the distinction could be between a patient seeking advice being in, with patients making direct product requests being out – this is also a clear and simple message, but goes against the last 3 years of SG-funded OTC training which encourages teams to open up direct requests into full conversations to address patient safety issues. Doesn’t sit well with the WHICH report and upcoming BBC2 Horizons programme on purchasing of opioids either

What is on the Approved List?

It’s too early to tell. The Area Drug and Therapeutics Committee Collaborative (ADTCC) have been tasked by Scottish Government to finalise this – the starting point was pulling all of the local formularies together and considering other items commonly used (e.g. dressings). We appreciate the need to know for stock control purposes and will continue to make the publication of the approved list a priority.

What will the base payment be?

In year one, the base payment will be set at a level that is, as a minimum, equal to the average capitation payment from the current model. Because everyone gets the same base payment, this will mean an uplift for a lot of contractors. For those who currently receive more than the average, the activity pool will provide the opportunity for further remuneration.
Our data analysts have built a predictive model based on current activity and we are confident that very few contractors will be worse off – and this will only be true if they do not change their approach to delivery in line with the new service.

Why are we using our own funding/mapped money?

Keeping the bulk of the mapped money in the dispensing pool is untenable in the long term. We aspire to have a funding model that recognises increasing business costs by pursuing annual Global Sum uplifts and rewards contractors directly in line with their activity.

Using mapped money demonstrates our commitment to the new service and secures it for the future. It is important to associate the money to a service that – delivered well – will be indispensable to the people of Scotland.

What if patients come into the pharmacy with a “shopping list”?

Just as is the case now, the pharmacy team should explain how the service works and offer a consultation for the presenting symptoms, recommending the most appropriate course of action.

I’m really worried about the workload – do you think we will be able to cope?

Yes. In replacing MAS with a more streamlined service, pharmacy teams will find delivery much more straightforward than MAS ever has been. By securing an appropriate level of funding and building a model which remunerates contractors in line with their activity, the service will be sustainable for the future as well. The service and the funding will evolve over time, and we will take on board member feedback – what is clear though is that we need to deliver and evidence this service well to ensure its’ continued existence.

There are a lot of variables involved, so it will be difficult to predict the traffic into the service, but all the information we have from the pilot in Inverclyde would suggest that the change in public and patient behaviour will be gradual. There is nothing to suggest that we will have an influx of people accessing the service at launch.

Will my PMR system be ready to deliver everything it needs to by April 1st?

No. All the information we have suggests that PMR systems will be able to record and claim for all Pharmacy First interactions on the 1st of April. However, some functionality will be delivered after launch and so will require temporary processes to be put in place. For example, the ability to record advice only or referral for UTI and Impetigo will not be ready for launch. Pharmacy teams will record advice or referrals for the PGDs under the MAS module in UCF.

The white list will also be integrated into PMR systems so that it will not be possible to prescribe anything that does not appear on it – but this may not be ready for launch, so pharmacy teams will have to work from an online or paper copy in the meantime.

Where does IP come into all of this?

It is our intention that, in the long term, every pharmacy in Scotland will be able to offer a common clinical conditions service utilising the IP skillset and advanced clinical training. This offering would sit ‘on top’ of the Pharmacy First service, and in time will negate the need for any PGDs. There is a lot to be worked out between now and then, but we start by supporting those on the funded course just now to be able to use their new qualification as soon after they have it as possible.

I am struggling to fill vacancies at the moment – how will we be able to deliver this service?

We firmly believe that over the next few years, developments like Pharmacy First, changes to CMS/M:CR and our IP strategy along with specific work on recruitment and retention will all help towards making community pharmacy a more attractive career prospect.