Over the years, there has been a gradual rise in the role of the pharmacist in patient care in both the hospital and community setting and more recently in the primary care setting.

The government's 5YFV came into being in 2014 and highlighted the role that pharmacies can play in treating minor ailments. In 2015, the Department of Health and Social care set out its plans to introduce a pharmacy integration fund/programme to help transform the way in which pharmacists and community pharmacy would operate in the NHS, with the aim of creating a more effective NHS primary care patient pathway. In January 2019, NHS England published the NHS Long Term Plan, which noted the role that pharmacists would play in local primary care networks, with funding for PCNs being used to expand the number of clinical pharmacists who were considered a key part of the general practice team.

Fast forward six months to July 2019, and The Community Pharmacy Contractual Framework was unveiled. This five-year funding contract commenced in October 2019 and shifted the focus of the pharmacist's role from dispensing to clinical services, with the intention that pharmacists would become increasingly more involved in urgent care and would provide an increasing number of clinical services that would otherwise be dealt with by NHS 111, GPs, urgent care centres and A&E.

The intention under this framework, is that community pharmacies will be the first port of call for minor illness and health advice in England and will play a part in putting prevention at the heart of the NHS. With the use of the Pharmacy Integration Fund, a range of additional prevention and detection services will be piloted by 2024. These include hepatitis C testing, stop-smoking referral scheme from secondary care, point of care testing around minor ailments to tackle antimicrobial resistance, early detection service for cardiovascular conditions, routine monitoring of patients, early diagnosis of cancer, and tackling health inequalities.

The new pharmacy contract also saw the introduction of a new national NHS Community Pharmacist Consultation Service (CPCS), which replaced the NUMSAS service and local DMIRS pilots both of which came into being through the use of the Pharmacy Integration Fund announced in 2015. NUMSAS managed referrals from NHS 111 to community pharmacy when a patient needed urgent access to a previously prescribed medicine and DMIRS involved digital referrals from NHS 111 to community pharmacies when the patient complained of a certain group of symptoms.

The national CPCS was launched on 29 October 2019 to progress the integration of community pharmacy into local NHS urgent care services. CPCS takes referrals to community pharmacy from NHS 111, allowing patients a face-to-face appointment with a pharmacist following an initial assessment by an NHS 111 call handler.

In an extension to the CPCS, a new referral pathway has been agreed, which from this autumn will allow general practices across England to refer patients with minor illnesses for a same-day consultation with a community pharmacist. NHS England and NHS Improvement will commission the service from pharmacies across England from this November.

The introduction of this additional referral route into the CPCS follows a successful pilot, which was run by NHS England and NHS Improvement and which saw thousands of patients directed to a pharmacist. It is anticipated that these numbers will continue to grow under the new scheme and appropriate patients will be directed away from general practice.

Further planned extensions of the CPCS include referrals from urgent treatment centres and possibly A&E with the aim of the CPCS to relieve pressure on the primary and urgent care system and offer a swifter and more convenient service closer to patients' homes. While it is not clear what the potential for referrals will be, the GP Forward View suggested that around 20 million appointments in general practice alone do not require a GP.

Exposure to clinical negligence claims

Historically, clinical negligence claims against pharmacists have revolved around dispensing errors or failures to identify/warn of contraindications when dispensing medicines. As the pharmacist's role in the provision of clinical services increase and as the role further extends into the urgent care sphere, so too will the risk of becoming involved in a claim for clinical negligence. Failure to refer, missed red flags, and communication errors with primary/secondary care are some of the areas where pharmacists may see an increase in claims. Often an issue in clinical negligence claims is the breakdown of communication between service providers and the interaction between the GP practice and the pharmacy service will be key. It will be important to ensure that the pharmacists themselves do not become overwhelmed and that there is availability if a pharmacist considers a patient needs to be seen by a GP.

Good record keeping, a system for communicating with other healthcare professionals involved in the patient's care, knowledge of local protocols for appropriate referral of patients, and knowledge of and access to the NICE Clinical Knowledge Summaries are some of the essential pre-requisites to improving patient safety and reducing harm, and with that reducing the risk of a claim for clinical negligence.

Conversely, the support that the primary care sector will receive from pharmacists will help to alleviate the pressures on general practice and, it is reasonable to assume therefore, reduce those adverse events that are directly or indirectly related to an overburdened general practice. There will be swifter access for patients with minor ailments or long-term conditions to a healthcare professional and improved access to a GP for those patients with more serious conditions.

It may take some time to see the real impact that the increased role of the pharmacist will have on the primary care sector and whether the high numbers that were redirected away from general practice under the pilot will be replicated under the new scheme. Certainly, it is hoped that the pressures in general practice will be eased and patient access to healthcare improved.

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