From competition to collaboration

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“We could have handled that — why did it even go to the GP?” 

If I had a pound for every time I’ve heard that from a pharmacist, I’d be running my own Pharmacy First pilot. And let’s be honest: GPs probably feel the same way in reverse.

That mutual frustration tells us something. Pharmacy First has enormous potential – to reduce pressure on general practice, improve patient access and help the NHS stretch its increasingly tight budget. But implementation? Let’s just say we are not there yet. 

Patchy uptake. Confused pathways. Underspent budgets. This isn’t a failure of clinical skill or willingness. It’s a behavioural problem. So how do we fix it? 

The usual suspects (e.g. more guidance, more funding) would certainly help but they don’t change behaviour. And behaviour is the crux of the issue because until GPs and pharmacists are working together easily, naturally and often, the system will keep defaulting to the old ways.

Enter behavioural economics. We don’t need another protocol – we need nudges. Small shifts in how we present choices, measure outcomes and reinforce actions can make a big difference. 

One of the most powerful tools we have in this behavioural toolkit? Feedback loops. Positive and corrective feedback loops drawn from behavioural economics could be the breakthrough that is so urgently needed.

The power of positive feedback

Imagine receiving this weekly update in your pharmacy inbox: “You handled 18 minor illness cases this week, saving four GP hours.” That’s a nudge and a reward in one. It reinforces value, builds intrinsic motivation and combats the sense of invisibility many pharmacists feel in the NHS ecosystem. That one simple line delivers three critical things:
• A sense of achievement
• A reminder of impact
• A subtle motivator to do more.

This is the ‘progress principle’ in action. People are most motivated when they can see that what they are doing matters. For pharmacists, this kind of feedback affirms their value.

For GPs, a similar dashboard might read: “You saved 14 clinical hours this month by referring to Pharmacy First.” Micro-reinforcements like these build momentum and make the value of collaboration visible.

Course correction, not blame

Strategic, structured negative feedback isn’t about finger-pointing. It’s about learning.

Say around one-third of a pharmacy’s referrals are returning to the GP within 48 hours – that’s important data. Or if a GP is consistently under- referring common minor conditions, they need to see that.

Examples like: “This condition has a 40 per cent return-to-GP rate – let’s review referral suitability” or “your practice referred 6 per cent of eligible minor cases; the local average is 17 per cent” allow for self-correction and quality improvement, not confrontation.

It doesn’t have to be adversarial

Now let’s address the elephant in the consultation room: it can feel like a turf war out there. The funding picture doesn’t help:
• Community pharmacy receives 2.3 per cent of the NHS budget
• General practice gets around 10 per cent
• Wait times? Near zero for pharmacy; seven to 15 days for GPs
• Daily contact volume? 1.6 million visits (pharmacy) vs 1.08 million (GPs)
• Average consultation cost? £15 in pharmacy vs £39 in general practice.

It’s not exactly balanced but it doesn’t have to be adversarial.

More than a service

Why? Because Pharmacy First isn’t just a scheme. It is a shift in mindset, a culture change, a transition of professional identity. It challenges legacy roles and demands new ways of working, as well as changes in the ways different parts of the NHS relate to each other. 

For that to work, behaviour has to shift. And for behaviour to shift, feedback loops are essential. They build trust. They reward good habits. They show people the value they’re creating – in real time.

Behavioural economics shows us that lasting change doesn’t always require big policy moves. Sometimes, all it takes is a feedback loop, helping people to see the impact of their actions, adjust behaviours and build habits that stick.

If you are a pharmacist, LPC lead or NHS change-maker thinking about how to take Pharmacy First to the next level, try to connect because this isn’t just about referrals. It is about rethinking how pharmacy, general practice and the wider NHS collaborate across boundaries that should have been blurred long ago.

Let’s stop talking about pharmacy’s potential and start unlocking it – one referral, one nudge, one feedback loop at a time. Unlocking pharmacy’s potential isn’t just about funding or frameworks – it’s about behaviour. And behaviour starts with feedback. Embrace it and give it.

• Trevor Gore is founder of Maestro Consulting, a Self Care Forum trustee and associate director at the Institute for Collaborative Working (ICW).