Table of Contents
Introduction _______________________________________________________ 2
Background to “Pharmacy First” the Minor Ailments scheme ___________________ 2
Outline of the scheme ____________________________________________________ 2
Objectives of the scheme _________________________________________________ 2
Access to the scheme ____________________________________________________ 3
Eligibility for the scheme _________________________________________________ 3
Conditions covered in the scheme _________________________________________ 3
Treatments available on the scheme ________________________________________ 3
Accessing Pharmacy First __________________________________________ 4
Role and responsibility of practice staff _____________________________ 5
Role and responsibility of the pharmacist ____________________________ 6
Role of Pharmacy Assistants ______________________________________________ 7
Processing Vouchers at the end of the month ________________________ 8
Managing Risks ____________________________________________________ 9
Appendix
Appendix A _______________________________________________________ 10
Contact Details of Prescribing Team _______________________________________ 10
Appendix B _______________________________________________________ 11
Contact Details of GPs __________________________________________________ 11
Appendix C _______________________________________________________ 14
Flow chart _____________________________________________________________ 14
Appendix D _______________________________________________________ 15
Registration Voucher ____________________________________________________ 15
Appendix E _______________________________________________________ 16
Pharmacy Advice Voucher _______________________________________________ 16
Appendix F _______________________________________________________ 17
Ethnicity Codes ________________________________________________________17
Attachment 1_____________________________Service Level Agreement
Attachment 2_________________________________Treatment protocols
Attachment 3_____________________________________Ethnicity Codes
Introduction
Background to “Pharmacy First” the Minor Ailments scheme
It has been estimated that a significant proportion of all GP consultations (up to
40%) is spent dealing with patients with minor ailments.¹ There is evidence
from our pilot scheme that was carried out over a two-year period that many
GP consultations for minor ailments can be dealt with satisfactorily by
pharmacists.
A minor scheme is important if GP practices are to meet the various targets in
the new GMS contract and to cope with the increasing pressure of more and
more people being treated in the community. Pharmacy First provides benefits
to patients in terms of increasing access and choice in primary care.
Pharmacy First was launched tPCT wide on the 7th June 2004 after excellent
evaluation results of the minor ailments scheme pilot conducted in the South
East patch of the PCT between June 2002 and June 2004.
So far the scheme has been a great success with 46 pharmacies participating
and together saving over 2,500 GP consultations a month. With the
introduction of the new Pharmaceutical Services (nPhS) Contract, Pharmacy
First is now an enhanced service.
Outline of the scheme
Patients with common self-limiting conditions are offered a consultation with a
community pharmacist instead of a GP. The pharmacists are able to prescribe
a treatment from an agreed treatment protocol so that patients, who would
have normally received their medicines on prescription from the GP, would
now receive their treatment from the pharmacist. Patients who are exempt
from prescription charges will be able to receive treatment free of charge from
the pharmacist.
Objectives of the scheme
1. Reduction in the time between onset and treatment of symptoms i.e.
faster treatment for patients.
2. Reduction in GP consultations for minor ailments - freeing up time in the
surgery.
3. Better utilisation of expertise and skills of pharmacists.
4. Increasing patient’s options on where and when they can obtain
treatment for minor ailments.
5. Supporting the Priorities & Planning Framework (2003-06) access target
which states that: 'by December 2004, 100% of patients who wish to do
so can see a primary healthcare professional within one working day
and a GP within 2 working days’. 1
1. GPs recommend OTC medicines for 40% of minor ailment consultations. PharmLife news Jul
2002 Available at www.pharmlife.co.uk
Pharmacy First - Guide for Pharmacists. 2nd Edition Feb 2006
2
Access to the scheme
On first presentation, patients contacting the GP surgery with one of the listed
conditions are offered the option of going to their community pharmacy. If the
patient accepts the pharmacy option, then the patient is given a pharmacy
registration voucher. Thereafter, the patient will register with one particular
pharmacy, and would not have to contact the practice before any future
consultations for Pharmacy First.
Eligibility for the scheme
Pharmacy First is open to all patients who have a full (permanent) NHS
registration with a GP in Hackney and some parts of the City.
Conditions covered in the scheme
The tPCT, GPs and pharmacists have agreed the list of Conditions, for each of
which there is an agreed Treatment Protocol. Pharmacists will have the
opportunity to rapidly refer patients back to the surgery if there are any
concerns.
Over the last year there have been requests from patients, pharmacists and
GPs for more conditions to be included in the scheme. The following
conditions have now been agreed as appropriate for inclusion in the scheme
and will be available from February 2006.
 Infective conjunctivitis.
 Cold sores. (Herpes Simplex)
 Nappy rash.
 Warts & Verrucae.
 Primary Dysmenorrhoea. (Period Pain)
 Haemorrhoids. (Piles)
Treatments available on the scheme
The scheme covers a limited range of drug treatments. These have been
agreed by all of the tPCT, GPs and pharmacists in this area. The scheme is
for the treatment of acute, short-term conditions only. Under the scheme
patients will be limited to a reasonable number of consultations depending on
the condition being treated, after which they would be referred to their GP for
re-assessment or continuing treatment.
Pharmacy First - Guide for Pharmacists. 2nd Edition Feb 2006
3
Accessing Pharmacy First
(See Flow chart appendix C.)
Patients can access the scheme in 2 ways
1. By telephoning the surgery requesting for a GP appointment.
2. Walking into a GP surgery requesting a GP appointment.
 The receptionists are trained to ask patients if a pharmacist can
manage their condition.
 Patients with minor ailments would then be provided with information
about the scheme both verbally and by providing patient information
leaflets to those who are in the surgery.
 It is important to note that patients are not obliged to go to a pharmacist
instead of having a GP appointment. The scheme should be offered as
an option not as an alternative.
 Patients who wish to use the scheme would be provided with a
registration voucher (appendix D), completed with details of the patient
to take to the pharmacy.
 Patients who have contacted the surgery by telephoning will still have to
pick up a completed registration voucher (appendix D) from their
surgery before going to the pharmacy.
 Patients who do not wish to use Pharmacy First should be offered a GP
appointment in the usual way.
 Once a patient has registered with a pharmacy, they can access the
scheme directly without contacting the surgery beforehand.
Pharmacy First - Guide for Pharmacists. 2nd Edition Feb 2006
4
Role and responsibility of practice staff
 Ensure that receptionist and other staff undertake appropriate training.
 Refer only eligible patients into the scheme.
 Ensure that frontline staff does not discourage patients from getting an
appointment with the GP if that is what they wish. Pharmacy First
should only be offered as an option.
 Fill in the registration voucher (appendix D) with details of the NHS
Number, the name and address of the person for whom voucher is
being issued.
 Hand the top copy (pink) of the voucher to the patient and file the
bottom copy in the appropriate locked place. These should be kept by
the practice for reference/audit purposes. When the pads of vouchers
are not in use they should be stored in a locked, secure place.
 Ensure the patient is aware that the pharmacist will need to ask them
some questions to satisfy their professional obligations regarding the
selection of an appropriate treatment. They will need to show evidence
of their exemption from prescription charges at the pharmacy as they do
for NHS prescriptions.
 Only issue one voucher per person. The registration voucher is to be
used only for the first visit to the pharmacy. Thereafter, the patient can
register with a particular pharmacist and receive further advice &
treatment under the scheme from the pharmacist without having to visit
the surgery first.
 In exceptional circumstances where a patient wishes to re-register with
another pharmacy, it is acceptable to issue another registration voucher
to the patient. The Prescribing Team at CH tPCT must be informed of
such changes within 48 hours.
 Maintain details of registration with Pharmacy First in patient’s notes.
 If GPs require copies of minor ailment consultations, ensure this is
officially communicated to the lead pharmacist.
 Treat communication from pharmacists with the right level of
importance.
Pharmacy First - Guide for Pharmacists. 2nd Edition Feb 2006
5
Role and responsibility of the pharmacist
 All patients presenting a pink registration voucher must be seen by the
pharmacist. After the first consultation with the pharmacist, the patient
must register with that particular pharmacy in order to receive future
advice & treatment as part of the scheme. On each occasion the
pharmacist must see the patient.
 During the consultation with the patient, complete the conditions (and/or
code) reported section on the advice voucher (appendix E). After an
agreement has been reached about the treatment for the patient,
complete the next section on the voucher.
 If you feel that the patient’s symptoms warrant urgent referral back to
the GP, fill the second section of the form giving reasons. Make sure to
let the practice know that you have seen the patient. Contact details for
all practices have been provided (Appendix B). The third copy of the
voucher can be used to notify the practice that you have seen the
patient.
 If a medicine is to be supplied via the voucher, complete the next
section detailing its name, quantity or code (refer to the Formulary if in
doubt as these are the only medicines that will be reimbursed).
 Ask the patient to sign the declaration on the back of the voucher.
Reimbursement of the pharmacist for the cost of the product will be
based on the assumption that there is a signed and completed voucher
with any relevant declarations.
 The point of dispensing check on exemption should be completed as it
is for all other NHS prescription forms. If evidence cannot be shown for
exemption, the medicine should still be provided free of charge. Mark
one of the boxes on the bottom right hand side of the voucher to declare
whether evidence of exemption has been seen.
 In case a prescription charge applies, you can take the money or
alternatively sell the medicine to the patient if it is cheaper. Mark the
‘paid box’ if medication has been sold. The indication that the patient
bought medication should be selected while filling out the voucher.
 Complete the lower parts of the voucher by adding your name,
signature, pharmacy stamp and date of supply.
 The pharmacist should see all patients presenting a voucher. Handle
the voucher in the same way that you would a prescription for the
purposes of dispensing and counselling the patient.
Pharmacy First - Guide for Pharmacists. 2nd Edition Feb 2006
6
 The pharmacist will ensure correct and timely entry of consultation
vouchers onto the Webstar software. Data will be submitted to Webstar
across the modem at the end of each calendar month.
 The pharmacist will ensure that all vouchers are kept for at least 2
years.
Role of Pharmacy Assistants
 To alert the pharmacist that a patient is requesting a consultation for
Pharmacy First since it can only be dealt with by the pharmacist.
Pharmacy First - Guide for Pharmacists. 2nd Edition Feb 2006
7
Processing Vouchers at the end of the month
 Consultation vouchers will be input into the minor ailment software by
pharmacy personnel. Staff should to ensure accurate data entry in a
timely manner for consistency of payments.
 Submission of data to Webstar Health will be made by the 5 th day of the
following calendar month via a modem.
 No vouchers should be sent to the tPCT for processing. Processed
vouchers are to be retained at the pharmacy for at least 2 years.
 Payment for vouchers will be calculated based on the agreement stated
in the Service Level Agreement.
 Payments will be made by BACS within a month of data submission
 Webstar health on behalf of the pharmacy department will provide
pharmacies with a break down of payments, stating separately the
consultation and prescription costs.
Pharmacy First - Guide for Pharmacists. 2nd Edition Feb 2006
8
Managing Risks
In order to understand, monitor and minimise any risks to patients and staff
and to learn from mistakes, near miss and incident reporting, systems must be
utilised.
In the event of any ‘adverse incident’ or “near miss”, the pharmacist will
complete the Incident and Near Miss Report (IR1) Form and send a copy to
the Prescribing Adviser at the tPCT. A copy of the completed form will remain
at the Pharmacy.
Any complaints about any aspect of the scheme should also be documented
and sent via the same route.
Pharmacy First - Guide for Pharmacists. 2nd Edition Feb 2006
9
Appendix A
Contact Details of Prescribing Team
All clinical correspondence regarding the scheme should be directed to
Barbara Brese
Prescribing Adviser
Ground Floor, E Block
St Leonard’s
Nuttall Street
London
N1 5LZ
Email: Barbara.brese@chpct.nhs.uk
Tel No: 020 7683 4462
Fax:
020 7683 4464
For Administrative and technical support, contact
Veera Vanapalli
Prescribing Support Technician
Ground Floor, E Block
St Leonard’s
Nuttall Street
London
N1 5LZ
Email: Veera.vanapalli@chpct.nhs.uk
Tel No: 020 7683 4699
Fax:
020 7683 4464
Pharmacy First - Guide for Pharmacists. 2nd Edition Feb 2006
10
Appendix B
Contact Details of GPs
Practices in the NE patch
Practice
Address
HEALY MEDICAL
CENTRE
FOUNTAYNE ROAD
HEALTH CTR
200 UPPER CLAPTON ROAD
E5 9DH
1A FOUNTAYNE ROAD
N16 7EA
154 UPPER CLAPTON ROAD
E5 9JZ
19-21 OLDHILL STREET
N16 6LD
1A FOUNTAYNE ROAD
N16 7EA
2 EGERTON ROAD
N16 6UA
21 ATHERDEN ROAD
E5 0QP
10 KENNINGHALL ROAD
E5 8BY
148 UPPER CLAPTON ROAD
E5 9JZ
1A FOUNTAYNE ROAD
N16 7EA
62 CRANWICH ROAD
N16 5JF
THE SURGERY
OLDHILL MEDICAL
CENTRE
THE ELM PRACTICE
STAMFORD HILL
GROUP PRACT
ATHENA MEDICAL
CENTRE
NIGHTINGALE
PRACTICE
THE CLAPTON
SURGERY
FOUNTAYNE ROAD
HEALTH CTR
THE SURGERY
Lead GP
Telephone
Fax
Dr DUGGAL
8806-1550
8806 9027
Dr GADHVI
7683-4854
8806 6362
Dr GOEL
8806-1928
8806 8823
Dr GUPTA
8806-6993
8807 8823
Dr KIERNAN
7683-4839
8808 8823
Dr MARKS
8800-1000
8880 2402
Dr OKOREAFFIA
8985-6675
8533 7775
Dr PAYNE
8985-8388
8986 6004
DR SHARIFF
8806-7735
8806 2991
Dr SHARIFF
7683-4847
8442 9843
Dr SPITZER
8802-2002
8880 2112
Pharmacy First - Guide for Pharmacists. 2nd Edition Feb 2006
11
Practices in the NW patch
Practice
Address
BARTON HOUSE HEALTH
CTR
233 ALBION ROAD
N16 9JT
JOHN SCOTT HEALTH
CENTREN4 2NU
JOHN SCOTT HEALTH
CENTRE N4 2NU
STATHAM GROVE
N16 9DP
6 BARRETTS GROVE
N16 8AR
34A ALLERTON ROAD
N16 5UF
SOMERFORD GROVE
N16 7UA
JOHN SCOTT HEALTH
CENTRE
N4 2NU
100A STOKE NEWINGTON
CHURCH STREET
N16 0AP
JOHN SCOTT HEALTH
CENTRE
N4 2NU
40 BROOKE ROAD
N16 7LR
2 DEFOE ROAD
N16 0EP
THE SANCTUARY
CEDAR PRACTICE
THE STATHAM GROVE
SURGERY
THE SURGERY
THE SURGERY
SOMERFORD GROVE
HLTH.CTR.
THE HERON PRACTICE
THE SURGERY
DR PATEL’S PRACTICE
DR SN PRASAD
ABNEY HOUSE MED
CENTRE
Lead GP
Telephone Fax
Dr BENCH
7249-5511/6
7254 8985
Dr BURNETT
8210-3724
8210 3769
Dr CARVER
7690-1151
8809 6900
Dr ENGLAND
7254-4327
7241 4098
Dr GANGOLA
7254-1661
7275 8777
Dr M WETZLER
8802-2882
8802 7438
Dr KEENE
7241-9700
7275 7198
Dr
KRISHNAMURTHY
7690-1172/4
8809 0999
LOCUM
7254-3807
7923 9260
Dr V PATEL
7690-1193
8210 3763
Dr S N PRASAD
7254-5652
7275 8455
Dr SALIH
7254-6820
7241 0265
Practices in the SE Patch
Practice
Address
KINGSMEAD MEDICAL
CENTRE
ELSDALE STREET
SURGERY
4 KINGSMEAD WAY
E9 5QG
28 ELSDALE STREET
E9 6QY
186 Homerton High Street
E9 6AG
52B WELL STREET
E9 7PX
36 LOWER CLAPTON ROAD
E5 0PD
200 WICK ROAD
E9 5AN
4 HOMERTON TERRACE
E9 6RT
74 BROOKSBYS WALK
E9 6DA
3 MANDEVILLE STREET
E5 0DH
THE LEA SURGERY
WELL ST SURGERY
LOWER CLAPTON
HEALTH CTR.
THE WICK HEALTH
CENTRE
LATIMER HEALTH
CENTRE
THE SURGERY
THE SORSBY HEALTH
CENTRE
Lead GP
Telephone Fax
Dr ADIREDDI
Dr CHARLES
8985-1930
0844 477
8763
8533 3951
0844 477
8764
Dr A GOEL
8986-3106
8985 1909
Dr JULIAN
8985-2050
8985 5780
Dr LYLE
8986-7111
8986 8140
Dr OSEN
8985 2664
8986 6341
Dr HG PATEL
8985-2249
8985 7333
LOCUM
Dr RAMA
MOHANA RAO
8985-2797
8985 0999
8986-5613
8986 8072
Pharmacy First - Guide for Pharmacists. 2nd Edition Feb 2006
12
Practices in the SW patch
Practice
Address
LONDON FIELDS
MEDICAL CTR
BEECHWOOD MEDICAL
CTR
KINGSLAND MEDICAL
CTR
38-44 BROADWAY MARKET
E8 4QJ
86A DALSTON LANE
E8 3AH
414 KINGSLAND ROAD
E8 4AA
12 RUSHTON STREET
N1 5DR
85 NUTTALL STREET
N1 5HZ
8 ENGLEFIELD ROAD
N1 4LN
1B MADINAH ROAD
E8 1PG
1A MADINAH ROAD
E8 1PG
10 RUSTON STREET
N1 5DR
24 HOLLY STREET
E8 3XP
167 KINGSLAND ROAD
E2 8AL
ST LEONARD’S Nuttall Street
E2 8AN
136 Richmond Rd
E8 3HN
15 Half Moon Court
EC1A 7HF
THE HOXTON SURGERY
THE LAWSON PRACTICE
ENGLEFIELD ROAD
SURGERY
THE DALSTON
PRACTICE
SANDRINGHAM
PRACTICE
SHOREDITCH PARK
SURGERY
QUEENSBRIDGE GROUP
PRACT.
THE SURGERY
WHISTON / SOUTHGATE
MC
RICHMOND RD MEDICAL
CTRE
NEAMAN PRACTICE
Lead GP
Telephone Fax
Dr CAHILL
7254-2883
7254 2066
Dr CHOUDARY
7254-2855
7923 0444
Dr DATTANI
7249-8732
7254 6878
Dr FORMAN
7729-4704
7729 3197
Dr FULLER
7739-9701
7739 3912
Dr MARLOWE
7254-1324
7923 9242
Dr KAWALE
7275-0077
7923 9209
Dr MDINGI
7275-0022
7923 2622
Dr O'ROURKE
7739-8525
7739 5352
Dr PILKINGTON
7254-1101
7923 1541
Dr RIZK
7739-3600
7613 5345
Dr SHIVNANI
7704 2233
7704 2299
Dr TIBREWAL
7254-2298
7923 9247
Dr CC CHOR
7600-9741
7606 0071
Pharmacy First - Guide for Pharmacists. 2nd Edition Feb 2006
13
Appendix C
Flow chart
PHARMACY FIRST
Scheme for the management of minor ailments in community pharmacies.
Patient rings GP
practice or goes
for an
appointment.
scheme
Future use of
scheme.
GP practice
Offer patient the option of seeing a
pharmacist in the scheme.
Refer urgent /
inappropriate
cases back to
practice.
Complete RED referral voucher.
MUST HAVE NHS NUMBER &
PRACTICE STAMP & give patient
top copy.
1 copy kept for practice records.
Participating pharmacy
1. Register the patient.
2. Advice & supply of medication where appropriate.
3. Patient signs voucher.
4. Vouchers are processed at the pharmacy.

Conditions to be treated according to agreed Treatment Protocol.

All treatments & quantities from agreed Formulary.
Pharmacy First - Guide for Pharmacists. 2nd Edition Feb 2006
14
Patient
must
register with
their usual
pharmacy
for ongoing.
use of the
scheme
Appendix D
Registration Voucher
Pharmacy First
Minor Ailments Scheme – Registration Voucher
Date
NHS number
Name
Address
GP Surgery (Stamp)
Pharmacy (Stamp)
* Pharmacist will not see patient without an NHS number.
* Please fill-in one registration voucher per person.
Pharmacy First - Guide for Pharmacists. 2nd Edition Feb 2006
15
Appendix E
Pharmacy Advice Voucher
Ethnicity Code
Pharmacy First - Guide for Pharmacists. 2nd Edition Feb 2006
16
Appendix F
Ethnicity Codes for Minor Ailments
Ethnic Origin Categories
Code
Asian
Bangladeshi
K
Chinese
R
Indian
Other Asian (please
specify)
Pakistani
H
L
Vietnamese
S3
J
Black
Ethnic Origin Categories
Code
Other Ethnic Groups
Arab/Middle Eastern
S1
Any other ethnic Group
(please specify)
Traveller
White
SX
British (English, Scottish,
Welsh, Northern Irish)
A
Eastern European
C3
Greek (including Greek
Cypriot)
C1
S4
African (except Somali)
N2
Irish
B
British
Caribbean
P1
M
Jewish
Kurdish
C6
S2
Other (please specify)
PX
Other White European
(please specify)
C4
Somali
N1
Orthodox Jewish
C5
Other white/mixed white
(please specify)
CX
Turkish (including Turkish
Cypriot)
C2
Mixed
White & Asian
F
White & Black Caribbean
D
White & Black African
G
Other (please specify)
E
Pharmacy First - Guide for Pharmacists. 2nd Edition Feb 2006
17