Understanding the Factors Involved in the Development and Early Implementation of “Pharmacy First” Services for the Management of Common Conditions in England

Document Type : Original Article

Authors

1 Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK

2 School of Medicine, University of Nottingham, Nottingham, UK

3 School of Pharmacy, University of Nottingham, Nottingham, UK

4 Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK

Abstract

Background 
Amidst growing pressures on primary care services in England, the Pharmacy First (PF) scheme was introduced in 2024 to enable community pharmacists (CPs) to manage seven common conditions, including supplying antibiotics, where appropriate, according to patient group directions (PGDs). PF aims to increase timely access to care, reduce general practitioner (GP) workloads, and address health inequalities in terms of access to primary healthcare. This paper, part of a wider evaluation of PF, aims to describe and explain the factors affecting its development and early implementation.
 
Methods 
Semi-structured (n = 31) qualitative interviews were conducted with policy-makers, representatives of national community pharmacy and general practice bodies and frontline CPs and GPs in England. Analysis was guided by a framework combining Walt and Gilson’s “Policy Triangle” and the Consolidated Framework for Implementation Research (CFIR).
 
Results 
The study identified a range of factors shaping PF development and implementation. These included policy design complexity, stakeholder engagement, political priorities, and contextual pressures such as funding constraints and workforce shortages. Pharmacists welcomed the clinical upskilling opportunity, while GPs voiced concerns about patient safety and duplication of work. A lack of public awareness, inadequate training access (particularly for independent pharmacies and locum CPs), and poor interoperability between community pharmacy and general practice information systems further hindered rollout. Policy “layering,” with limited consideration of the implications for existing community pharmacy clinical services and the absence of a phased implementation strategy caused confusion among GPs and patients.
 
Conclusion 
PF illustrates both the potential and challenges of expanding clinical roles in community pharmacy through national policy. Despite political backing and sector-wide engagement, its implementation faced structural, financial, and communication barriers. Realising its full potential requires workforce and integrated information infrastructure, sustainable funding, and clear inter-professional communication and information sharing between general practice and community pharmacy.

Keywords

References

  1. Paddison C. How long are patients waiting for a GP appointment in England? 2023; https://www.nuffieldtrust.org.uk/news-item/how-long-are-patients-waiting-for-a-gp-appointment-in-england. Accessed December 16, 2025.
  2. Delivery Plan for Recovering Access to Primary Care. NHS England 2023. https://www.england.nhs.uk/publication/delivery-plan-for-recovering-access-to-primary-care/.
  3. Pharmacy First: what you need to know. 2024; https://healthmedia.blog.gov.uk/2024/02/01/pharmacy-first-what-you-need-to-know/. Accessed May 20, 2025.
  4. Murray R. Community pharmacy clinical services review 2016. https://www.england.nhs.uk/primary-care/pharmacy/independent-review-cpcs/.
  5. Seston EM, Schafheutle EI, Willis SC, et al. Preparing pharmacists for the Community Pharmacist Consultation Service: a questionnaire survey. Int J Pharm Pract. 2023;31(1):32-37. doi:10.1093/ijpp/riac076
  6. Moriarty S, Bradford M, Stockwell S, et al. A qualitative evaluation of clinical services under the Community Pharmacy Contractual Framework. RAND Europe; 2025. https://www.researchgate.net/profile/Stephanie-Stockwell/publication/393663547_A_qualitative_evaluation_of_clinical_services_under_the_Community_Pharmacy_Contractual_Framework/links/687511140d8ed26a9d5ae4e2/A-qualitative-evaluation-of-clinical-services-under-the-Community-Pharmacy-Contractual-Framework.pdf.
  7. Wu JH, Khalid F, Langford BJ, et al. Community pharmacist prescribing of antimicrobials: A systematic review from an antimicrobial stewardship perspective. Can Pharm J (Ott). 2021;154(3):179-192. doi:10.1177/1715163521999417
  8. Spinks JM, Lau ET, Glass BD, Nissen LM. Evaluating the management of urinary tract infections by community pharmacists in Queensland, Australia. Pharmacy Practice. 2024;22(4):1-10.
  9. Mantzourani E, Deslandes R, Hodson K, et al. Community pharmacists' views on the early stages of implementation of a national pilot independent prescribing service in Wales: a qualitative study. Integr Pharm Res Pract. 2023;12:11-23. doi:10.2147/iprp.S395322
  10. Stewart F, Caldwell G, Cassells K, Burton J, Watson A. Building capacity in primary care: the implementation of a novel ‘Pharmacy First’ scheme for the management of UTI, impetigo and COPD exacerbation. Prim Health Care Res Dev. 2018;19(6):531-541.
  11. Hansard: Pharmacy First. Volume 744: debated on Wednesday 31 January 2024. UK Parliament; 2024. https://hansard.parliament.uk/Commons/2024-01-31/debates/06F77B89-F311-4381-A2FD-C9220CEB5EDD/PharmacyFirst.
  12. Walt G, Gilson L. Reforming the health sector in developing countries: the central role of policy analysis. Health Policy Plan. 1994;9(4):353-370. doi:10.1093/heapol/9.4.353
  13. Damschroder LJ, Aron DC, Keith RE, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50. doi:10.1186/1748-5908-4-50
  14. Damschroder LJ, Reardon CM, Opra Widerquist MA, Lowery J. Conceptualizing outcomes for use with the Consolidated Framework for Implementation Research (CFIR): the CFIR Outcomes Addendum. Implement Sci. 2022;17(1):7. doi:10.1186/s13012-021-01181-5
  15. Sabatier PA. The need for better theories. In: Theories of the Policy Process, Second Edition. Routledge; 2019:3-17.
  16. Latif A, Waring J, Watmough D, et al. Examination of England's New Medicine Service (NMS) of complex health care interventions in community pharmacy. Res Social Adm Pharm. 2016;12(6):966-989. doi:10.1016/j.sapharm.2015.12.007
  17. Mustafa M, Hatah E, Makmor-Bakry M. Perspectives of pharmacists on medication reviews - Exploring implementation research in service establishment in community settings. Res Social Adm Pharm. 2023;19(4):673-680. doi:10.1016/j.sapharm.2022.12.005
  18. Glover RE, Lalani M, Sonnex K, et al. A mixed methods protocol for an impact and implementation evaluation of the Pharmacy First Services for management of common conditions in England. Int J Pharm Pract. 2025;33(2):152-161. doi:10.1093/ijpp/riaf004
  19. Green J, Thorogood N. Qualitative Methods for Health Research. SAGE Publications Ltd; 2018.
  20. Chu J, Maharajan MK, Rajiah K. Perspectives of community pharmacists on extended pharmacy services and value-added services in Malaysia: a cross-sectional survey. Int J Pharm Pract. 2023;32(2):146-155. doi:10.1093/ijpp/riad087
  21. Karia AM, Chen L, Norman R, et al. Barriers and facilitators affecting the implementation of community pharmacist–led professional services in Organisation for Economic Co-operation and Development member countries: a scoping review in the context of expanded scope. Int J Pharm Pract. 2025;riaf120. doi:10.1093/ijpp/riaf120
  22. Walk In Consultation Service (WICS). Community Pharmacy Cornwall; 2025. https://communitypharmacycornwall.org/2207-2/kernow-clinical-commissioning-group-kccg/walk-in-consultation-service-wics/.
  23. Feindt PH, Flynn A. Policy stretching and institutional layering: British food policy between security, safety, quality, health and climate change. Br Politics. 2009;4:386-414.
  24. Van der Heijden J. Institutional layering: A review of the use of the concept. Politics. 2011;31(1):9-18.
  25. Rudoler D, Peckham A, Grudniewicz A, Marchildon G. Coordinating primary care services: A case of policy layering. Health Policy. 2019;123(2):215-221. doi:10.1016/j.healthpol.2018.12.002
  26. Hutchison B, Abelson J, Lavis J. Primary care in Canada: so much innovation, so little change. Health Aff (Millwood). 2001;20(3):116-131.
  27. Stent J. Nearly a third of Scots use country’s Pharmacy First service, data reveals. https://www.chemistanddruggist.co.uk/CD138142/Nearly-a-third-of-Scots-use-countrys-Pharmacy-First-service-data-reveals/. Published April 29, 2024.
  28. Owen-Boukra E, Cai Z, Duddy C, et al. Collaborative and integrated working between general practice and community pharmacies: A realist review of what works, for whom, and in which contexts. J Health Serv Res Policy. 2025;30(2):136-148. doi:10.1177/13558196241290923
  29. Jones B, Anchors Z, Voss S, Walsh N. Challenges and enablers to implementation of the Additional Roles Reimbursement Scheme in primary care: a qualitative study. Br J Gen Pract. 2024;74(742):e315-e322.
  30. McKee M, Brayne C. Physician associates in the UK: some fundamental questions that need answers now. BMJ. 2024;384:q699. doi:10.1136/bmj.q699
  31. McCartney M. Why the fuss about physician associates? BMJ. 2024;385:q862. doi:10.1136/bmj.q862
  32. Skeen A. From physician associate to medical student. BMJ. 2024;386:q1585. doi:10.1136/bmj.q1585
  33. Barnard R, Spooner S, Hubmann M, Checkland K, Campbell J, Swinglehurst D. The hidden work of general practitioners: An ethnography. Soc Sci Med. 2024;350:116922. doi:10.1016/j.socscimed.2024.116922
  34. England CP. 2023 Community Pharmacy Workforce Survey Community Pharmacy England; 2023. https://cpe.org.uk/our-news/2023-workforce-survey-results-published/.
  35. Bramwell D, Hammond J, Warwick-Giles L, Bailey S, Checkland K. Implementing the additional roles reimbursement scheme in seven English primary care networks: a qualitative study. Br J Gen Pract. 2024;74(742):e323-e329.
  36. Care DoHaS. Proposal for the use of patient group directions by pharmacy technicians: United Kingdom Governement; 2024. https://www.gov.uk/government/consultations/proposal-for-the-use-of-patient-group-directions-by-pharmacy-technicians/proposal-for-the-use-of-patient-group-directions-by-pharmacy-technicians.
  37. Clews G. What will the latest proposals on pharmacy supervision mean for the profession? Pharm J. 2024;312(7981).
  38. Robertson J. Pharmacists spending time on unpaid Pharmacy First consultations, survey shows. 2024; https://www.thepharmacist.co.uk/pharmacy-first/pharmacists-spending-time-on-unpaid-pharmacy-first-consultations-survey-shows/#:~:text=The%20majority%20of%20respondents%20estimated,and%2021%25%20did%20not%20know. Accessed 2nd June, 2025.
  39. Price K. Pharmacy First budget ‘shockingly underspent’ in first half of financial year. Pharm J. 2025;314(7995). doi:10.1211/PJ.2025.1.349956
  40. Campeau Calfat A, Duval C, Laberge M, Savard A-M, Sirois C. Clinical services in community pharmacies: a scoping review of policy and social implications. Int J Pharm Pract. 2020;29(2):116-125. doi:10.1093/ijpp/riaa007
  41. Kirk MA, Kelley C, Yankey N, et al. A systematic review of the use of the Consolidated Framework for Implementation Research. Implement Sci. 2015;11:1-13.
  42. Zahidie A, Asif S, Iqbal M. Building on the health policy analysis triangle: Elucidation of the elements. Pak J Med Sci. 2023;39(6):1865.

Files

History

  • Received Date: 01 September 2025
  • Revised Date: 27 February 2026
  • Accepted Date: 22 May 2026
  • First Published Date: 23 May 2026
  • Published Date: 01 December 2026

Share

How to cite

Statistics