This report sets out an update to members on the community pharmacies in the borough and the implementation of Pharmacy First.

Appendix 1 - report from the North West London Integrated Care Board (ICB) – to follow.

At the Chair’s invitation, Hitesh Patel, the Chief Officer of the Local Pharmaceutical Committee, introduced the report and raised the following points:

1.    Explained that Pharmacy First was a new scheme which started at the end of January 2024 and provided a service for patients which meant they could access particular prescriptions directly from a pharmacy.

2.    It had been difficult to provide the scheme fully due to workforce issues. In Kensington, Chelsea, and Westminster, eight pharmacies had closed in the last 20 months, and this had impacted access and the social interaction pharmacies provided. The aim for Pharmacy First nationally was three million consultations but this would not be possible if pharmacies continued to close.

3.    There was nothing in the Pharmacy First programme to support economically disadvantaged patients who would not be able to afford medicine suggested to them by the pharmacist. Thus, they would end up going back to their GP, or in the worst case, urgent care, and would be unlikely to use the scheme again.

4.    The number of referrals by GPs was still quite low and there were other areas in North West London which were experiencing higher levels of referrals. There needed to be better IT integration for referrals and the NHS payment system which was a significant problem currently. Pharmacists were unable to access patients’ full GP records.

5.    Residents were facing problems with accessing prescriptions because of the shortage of a lot of medicines currently and the Government was not paying the correct fee to pharmacies to obtain medicines from the correct place.

Cheo Chalk, added that this feedback matched what Healthwatch had heard from residents. Residents supported pharmacy first but were concerned with the closure of pharmacies and the cost of medicines.

The Committee discussed the report and raised the following points:

1.   Queried whether GPs felt it was safer and quicker to do the work themselves and that was stopping them from referring to the scheme. The officer explained that it was related to the capacity of the GP surgery, if they had capacity to handle minor issues then they were likely to do it themselves. The scheme was intended to help GP surgeries who were overstretched. There were still things which people could walk into a pharmacy for and be treated for without a referral, but some things did need a referral.

2.  Noted that the monthly cap of referrals was 3,000 and asked how many were taking place per month currently. In response, the officer explained that the rate was increasing gradually and data from the NHS had a three to four month delay so they did not yet have any data on it. They did not think that the cap would ever be reached and shared that 30 consultations had to take place per month for the pharmacy to receive the minimum payment. In absence of GP referrals and walk-ins, the minimum target of 30 could even be too many to reach.

3.  Enquired what work had been done to evaluate confidence levels of the pharmacists to provide the service. The officer clarified that pharmacists did have access to patients’ summary care records, but they had to access it via a different system. There had been a huge amount of training provided but they were confident to provide the service and had been doing a clinical skills assessment to upskill.

4.  Questioned whether pharmacists worked collaboratively to review patients that were being consistently prescribed the same medicine. The officer explained that they were able to, and they used a service that does that. There were patient reviews when prescribing new medicines and certain medicines would only be prescribed at set levels. This work was usually done by pharmacists in GP practices.

5.  Asked about antibiotic resistance and what could be done. The officer confirmed that the pharmacies got paid for the consultation, not for the medicine, so there was no incentive to prescribe certain medicines. The Chair of the Local Pharmaceutical Committee added that the pharmacists were able to see the antibiotics a patient had been prescribed and ensure they were appropriate for the condition they were being treated for. There were situations where they were prescribed antibiotics when it was not the appropriate choice for the condition. There was set criteria and pathways to prescribing antibiotics. For example, if a patient came in with a urinary tract infection and they had had a previous infection in the last six to 12 months and had received antibiotics, they would be referred back to their GP. On their summary health records, pharmacists could see what medication they had been prescribed in the last 12-24 months.

6.  The Chair of the LPC informed the Committee that there was a very high financial burden in terms of rent in the area and asked if the Council could help to reduce business rates for pharmacies, that would help them to remain open and reinvest into their businesses.