Pharmacy First and AMS

The NHS Pharmacy First service in England enables community pharmacists to manage common conditions, including infections, without the need for a GP visit. This initiative aligns with AMS goals by reducing unnecessary antibiotic prescriptions and encouraging self-care where appropriate.

Under Pharmacy First, pharmacists can:

• Offer consultations and NHS-funded treatment for conditions such as sore throat, acute sinusitis and urinary tract infections
• Use clinical decision-making frameworks like CHESTSSS to understand patient beliefs about antibiotics and address misconceptions
• Provide advice on the typical durations of self-limiting infections to manage patient expectations.

By integrating AMS principles into Pharmacy First consultations, community pharmacists can play a critical role in reducing AMR while improving patient outcomes.

Progress to date

Some data on rates of antibiotic supply via Pharmacy First is based on a recent analysis by the Company Chemists’ Association of over 150,000 anonymised patient consultation records from more than 3,000 CCA member pharmacies for August and September 2024.

Around 117,000 people attended or were referred to these pharmacies for treatment of six of the Pharmacy First conditions (shingles was excluded as it is not treated with antibiotics).

On average, two-thirds of patients who attended a pharmacy for the Pharmacy First service received antibiotic treatment, ranging from 35 per cent for ear infections to 79 per cent for uncomplicated UTIs in women aged 16-64 years.

The Gateway Point for eligibility for any of the Pharmacy First clinical pathway consultations was not reached by substantial numbers of patients. Reasons included their symptoms not matching the criteria for the service, symptom duration not being long enough, or not meeting age or gender criteria.

These patients may have received advice from a pharmacist but the consultation is not recorded, so rates of antibiotic provision are likely to appear higher (thecca.org.uk/wp-content/uploads/2024/12/Pharmacy-first-AMR-compressed-1.pdf).

The analysis found that pharmacists are closely adhering to the pathways set out in the patient group directions (PGDs) and only supplying antibiotics when appropriate. The authors concluded that the provision of antibiotics in community pharmacy is largely in line with, or lower than, other parts of primary care. Around 94 per cent of patients received a complete episode of care and antibiotics were one of the treatment options patients received.

The NHS Business Services Authority is producing a Pharmacy First dashboard for antimicrobial stewardship that includes a range of comparators relating to service activity, including consultation outcome, consultation type and medicines supplied for each of the seven common infections with a comparator reporting consultation activity as a population rate.

An additional report on the uncomplicated urinary tract infection clinical pathway presents both Pharmacy First supply and general practice prescribing of nitrofurantoin modified-release 100mg capsules for women aged 16-64 years (nhsbsa.nhs.uk/epact2-antimicrobial-stewardship-pharmacy-first-dashboard).

Finally, the National Institute of Health and Social Care Research has commissioned a mixed-method impact and implementation evaluation of the Pharmacy First service for managing common conditions (fundingawards.nihr.ac.uk/award/NIHR160217).