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Pharmacy First: pressure mounts on pharmacists as threshold approaches

Some PDA members in England are reporting increasing pressure from their management around the performance of the Pharmacy First Service as the minimum activity thresholds increase.

Thu 11th April 2024 The PDA

There is increasing concern about the pressure on pharmacists to ensure that the minimum activity threshold of clinical pathway consultations is reached. PDA members are reporting that this is manifesting in the introduction of daily or weekly targets and comparisons with other pharmacies through ‘league tables’ at some employers.

An ongoing PDA survey on the Pharmacy First Service showed that 35% of respondents have said they have had targets placed upon them, yet 94% of respondents say that no additional staff have been provided to manage the increase in workload.

In PDA surveys and discussions, many pharmacists agree that the introduction of the Pharmacy First service in England is welcome, being good for patients by increasing access, and potentially benefitting their own professional development. However, many recall the days of the Medicines Use Review (MUR) service and the push by some employers to set unachievable targets based on commercial objectives rather than patient needs. Some pharmacists believe that this is beginning to be mirrored in some cases regarding the Pharmacy First Service. At the height of MURs, the PDA helped hundreds of its members to deal with unreasonable pressure from managers to perform the service.

As the Pharmacy First Service becomes more embedded, the minimum activity thresholds relating to funding increases. The number of clinical pathway consultations required is set to double between April 2024, where a minimum of 5 consultations is required during the month, and May 2024 when 10 consultations will be needed for contractors to claim the block payment. This will increase over time to 30 consultations per month from October 2024 onwards.

In addition to concerns about targets, those delivering the service report issues with inappropriate NHS referrals and walk-in patients who attend the pharmacy believing that they are eligible for a service, only for many to find that they do not meet the gateway criteria for one of the seven clinical pathways. Such consultations do not contribute towards the minimum activity threshold.

It is pharmacists that must deal with any frustration expressed by those patients and the gap between patient expectation and the actual service adds significantly to the pharmacy workload.

The PDA remind all pharmacists that safeguards are in place through employment legislation and company policies which can give significant protection from bullying in the workplace. The PDA encourages any members experiencing unreasonable pressure to meet targets around any service provision or workplace bullying to get in touch with the PDA Member Support Centre to discuss how union representation and support can be provided.

Initial advice for PDA members

  • Agreeing objectives and targets should be a two-way process, they must be realistic and achievable within the resources available.
  • Pharmacy services must be based on patient needs and the service specification criteria being met and not employers’ commercial targets.
  • Document challenges around meeting any set targets to support communications with your employer and use your professional judgement around the provision of services if patient safety is at risk of being compromised.
  • If you experience bullying in the workplace, have been set unrealistic targets, or are pressured to meet commercial goals which fall outside of the interests of the patient, please contact the PDA Member Support Centre as soon as possible for advice and support.

Get involved

  • The PDA would like to keep this dialogue going and hear from pharmacists working in community pharmacy in England about their experiences of delivering the service, how effective the service implementation has been, how patients are responding, and how the new service is contributing to their workloads. Complete the survey here.

Learn more

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