Recording of Pharmacy First consultations in general practice records in England: an observational study of the service's first year using OpenSAFELY

Viveck J Kingsley; Milan Wiedemann; Christopher Wood; Helen J Curtis; Amelia Green; Louis Fisher; Colm D Andrews; David Evans; Amir Mehrkar; Sebastian CJ. Bacon; Ben Goldacre; Amelia C Taylor; Diane Ashiru-Oredope; Kimberley Sonnex; Thomas Allen; Hannah Higgins; Tracey Thornley; Nicholas Mays; Rebecca E Glover; Rachel Elliott; Anthony J. Avery; Brian MacKenna

doi:10.3399/BJGP.2025.0678

Published eLetters

eLetter submission guidelines

Submit a Response to This Article

Compose eLetter

Title *

Author Information

Contributors

First Name and Middle Initial *

First or given name, e.g. 'Peter'.

Last Name *

Your last, or family, name, e.g. 'MacMoody'.

Email Address *

Your email address, e.g. higgs-boson{at}gmail.com. PLEASE NOTE: your email address will be published.

Occupation *

Your role and/or occupation, e.g. 'Orthopedic Surgeon'.

Affiliation *

Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

Please describe the competing interests

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Jump to comment:

Pharmacy First: when does a pharmacy consultation become primary care?
Kinan Mokbel

Published on: 08 August 2026

Published on: (8 August 2026)
Page navigation anchor for Pharmacy First: when does a pharmacy consultation become primary care?
Pharmacy First: when does a pharmacy consultation become primary care?
Kinan Mokbel, Honorary Professor at Brunel University London, Senior Lecturer (Clinical Pharmacy, Advanced Clinical Practice, Pharmacology), University of Exeter
Kingsley and colleagues have identified more than a recording problem. By January 2025, only 36.3% of recorded Pharmacy First consultations contained a structured clinical condition, medication or both¹. This raises a more fundamental question: what does it mean to “complete an episode of care” if the clinical story does not reliably travel with the patient?

As pharmacists take on greater clinical responsibility, should this be matched by an equally ambitious approach to continuity? Is sending a consultation message to general practice enough, or should the next clinician be able to see clearly what was assessed, supplied and safety-netted?

This matters because Pharmacy First is not simply a signposting service. Acute pharyngitis and uncomplicated UTI were the two most frequently recorded conditions, while phenoxymethylpenicillin and nitrofurantoin were the most frequently recorded medicines¹. If a patient returns with persistent symptoms or requires another antibiotic shortly afterwards, can the next clinician fully see what happened in pharmacy, or are we asking patients themselves to reconnect the clinical story? Incomplete information transfer therefore becomes a question not only of data quality, but of continuity and antimicrobial stewardship.

International experience makes this harder to ignore; US pharmacy leaders have called for bidirectional electronic health record access as pharmacists assume greater clinical...
Show More

Kingsley and colleagues have identified more than a recording problem. By January 2025, only 36.3% of recorded Pharmacy First consultations contained a structured clinical condition, medication or both¹. This raises a more fundamental question: what does it mean to “complete an episode of care” if the clinical story does not reliably travel with the patient?

As pharmacists take on greater clinical responsibility, should this be matched by an equally ambitious approach to continuity? Is sending a consultation message to general practice enough, or should the next clinician be able to see clearly what was assessed, supplied and safety-netted?

This matters because Pharmacy First is not simply a signposting service. Acute pharyngitis and uncomplicated UTI were the two most frequently recorded conditions, while phenoxymethylpenicillin and nitrofurantoin were the most frequently recorded medicines¹. If a patient returns with persistent symptoms or requires another antibiotic shortly afterwards, can the next clinician fully see what happened in pharmacy, or are we asking patients themselves to reconnect the clinical story? Incomplete information transfer therefore becomes a question not only of data quality, but of continuity and antimicrobial stewardship.

International experience makes this harder to ignore; US pharmacy leaders have called for bidirectional electronic health record access as pharmacists assume greater clinical responsibility². Australia’s My Health Record offers a more shared model of access to medicines and other clinical information³, while Canadian experience with pharmacist prescribing highlights both improved access and the importance of integration⁴, Yet, New Zealand provides a useful counterpoint: its minor-conditions pharmacy pilot improved access, but did not show strong evidence of reducing pressure elsewhere in the health system⁵.

Perhaps the next evaluation of Pharmacy First should therefore ask more than whether the consultation was recorded. Did it prevent duplication? Was follow-up visible? Did it support antimicrobial stewardship? And did workload genuinely disappear from general practice, or simply return later in another form?

In my view, Pharmacy First should not create pharmacy care running parallel to primary care. Success should mean that patients experience one connected system, regardless of which door they enter.

References
1. Kingsley, V.J., Wiedemann, M., Wood, C, et al. Recording of Pharmacy First consultations in general practice records in England: an observational study of the service's first year using OpenSAFELY. Br J Gen Pract. 2026. doi:10.3399/BJGP.2025.0678.
2. Ross, L.A., Dumont, Z., Herbert, S.M, et al. Framework and recommendations to support bidirectional information sharing between community pharmacies and other health care settings. J Am Coll Clin Pharm. 2025; 8(5): 406-412. doi:10.1002/jac5.70027.
3. Australian Digital Health Agency. My Health Record: Information for healthcare providers. Australia; 2026. Available from: www.digitalhealth.gov.au/healthcare-providers.
4. Nakhla, N., Leung, V. and Schwartz, K.L. Expansion of pharmacist prescribing could help improve health care access and quality. Can Fam Physician. 2024;70(7-8):441-443. doi:10.46747/cfp.700708441.
5. Health New Zealand. Minor Health Conditions Service Pilot Evaluation. 2024. Available from: www.healthnz.govt.nz/publications/minor-health-conditions-service-pilot-evaluation.

Show Less

Competing Interests: None declared.