From 31 January 2024, patients in England with earache, sore throat, or a urinary tract infection can now get antibiotics directly from a community pharmacist without seeing a GP. This programme, called Pharmacy First, aims to relieve pressure on overstretched general practices by shifting care for seven common conditions to high-street pharmacies. But no one has yet systematically measured whether it actually works—or for whom. This 36-month evaluation will track how many people use the service, whether GP and A&E visits drop, and whether the scheme widens or narrows health inequalities. If the programme proves effective, the NHS could permanently expand pharmacists’ role in treating common illnesses, freeing GP appointments for more complex cases. The study also examines antibiotic prescribing patterns, which matters for tackling antimicrobial resistance. If Pharmacy First leads to overuse, the policy could backfire. The findings will give policymakers hard data on whether shifting minor illness care to pharmacies saves money, speeds up treatment, and reaches patients who currently struggle to see a GP.
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Mixed-method impact and implementation evaluation of Pharmacy First Services for management of common conditions Scientific abstract Research question: This mixed-method evaluation aims to answer the following questions: how is Pharmacy First (PF) being implemented across England; what explains this pattern; and what are its impacts on volume of prescribing, case mix of GP consultations, Accident & Emergency (A&E) and hospital use, equity of access and cost for different groups of patients in different contexts? Background: On 31st January 2024, the Government launched Pharmacy First (PF) across England, which enables community pharmacists to supply prescription-only medicines, including antibiotics, to treat seven common health conditions: earache, uncomplicated urinary tract infections in women, sore throat, sinusitis, impetigo, shingles and infected insect bites, after consultation with a community pharmacist. It is hoped that PF will enable faster care and reduce pressure on general practitioners (GPs). Aim: The aim is to evaluate the seven PF minor illness Patient Group Directives (PGD) implemented across England on volume of prescribing, case mix of GP consultations, A&E and hospital use, equity of access and cost for different groups of patients in different contexts, acceptability, and fidelity. Methods: This study is a 36 month, mixed-methods evaluation combining quantitative and qualitative data. Methods comprise evidence synthesis, semi-structured interviews, focus groups, interrupted time series analysis (ITSA) and an economic evaluation. Findings will be brought together and interpreted using an implementation science framework, the Consolidated Framework for Integration Research (CFIR), supplemented by Proctor’s implementation outcomes framework. Work package 1: Literature review, scoping and theory of change, designed to undertake initial orientation and scoping by (i) conducting a review of the published and grey literature on pre-existing PGD and Pharmacist Independent Prescriber (PIP) programmes within the UK; (ii) conducting interviews with English policy officials, national GP leaders and frontline pharmacists; (iii) conducting interviews with Scottish and Welsh policy advisers, GP leaders and frontline pharmacists; and thereby (iv) contributing to the development of other work packages. Work package 2: Development of data linkages, and analysis of uptake and impact on consultation patterns, workload and patient safety, including antimicrobial use, designed to (i) establish data access and linkage; (ii) describe the uptake of PF nationally, regionally and locally; (iii) evaluate how health care usage changes after the introduction of PF and the impact of PF on inequalities; (iv) evaluate how safety outcomes and antimicrobial use change following introduction of PF; and (v) describe the impact of PF on antimicrobial use and resistance (AMR) trends. Work package 3: An economic evaluation to assess the economic impact of PF. It will: (i) assess the national budget impact of PF from the NHS and personal social services (PSS) perspective; and (ii) estimate the impact of PF on patients’ health and costs from an NHS and PSS perspective to generate estimates of cost-effectiveness/net benefit. Work package 4: Interviews with pharmacists, GPs and policymakers and interviews and focus groups with service users to assess implementation and fidelity of the roll out, specifically (i) to understand how and why PF is and is not taken up including the fidelity of the scheme to the original specification; (ii) to evaluate the effects of PF on the access to, and acceptability of, community pharmacy services to populations historically marginalized in terms of primary health care access; and (iii) to assess pharmacists’ and GPs’ perceptions of the safety of the scheme. Work package 5: A mixed-methods analysis, consolidation of findings and identification of policy implications with two objectives: (i) to
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