Pharmacy First was launched in England on January 31 this year, but in some cases, more urgent medical attention is needed that pharmacies are not equipped to deal with.

A short but enlightening discussion on a “Pharmacy UK” Reddit forum has seen users share some of the “weird and wonderful tales we all have from our pharmacy first referrals”, with one of them even sharing “Pharmacy First is the horror story!”.

Sepsis

One user shared about two cases of “suspected sepsis in 2 days” when Pharmacy First was initially rolled out.

They said an older teenager with a temperature of 40 degrees Celsius and systolic blood pressure of around 85 had “severe tonsillitis that had progressed onto the start of sepsis”.

Read more: Rahul Sharda: A contractor’s views on Pharmacy First

“Alarm bells were ringing even before I did the measurements because this was an older teenager slumped against their mother like a ragdoll,” they added.

After a 999 phone call an “apologetic paramedic” said there were no ambulances so the teenager’s mother drove him to A&E herself.

Another case saw “a younger kid with a sore throat who had no energy, temp of 39+” go straight to A&E after calling 111 as the child’s parents “hadn’t seen them go to the toilet in about a day” as they weren’t sure “about lack of urine production”.

Whooping coughs and pregnancy complications

Another user had a 111 referral for a 2-year-old who had symptoms of a “high fever with cough / cold symptoms for over 7 days, bouts of uncontrolled coughing fits, particularly at night, that cause vomiting, child struggling to breath” which happened around ten to fifteen times a day. 

The pharmacist rang the parents “immediately because it raised an instinctual red flag” and “sure enough the poor kid was whooping in the background of my call to the parent”.

Read more: Pharmacy First thresholds slashed until March

“Boggles my mind that the CKS symptoms for whooping cough were listed verbatim in the referral and it still got to me,” they said.

After sending them to A&E, the pharmacist checked two weeks later and a “lab tested positive for whooping cough”, adding that “were it not for the service and community pharmacy's position she, and her sister with a congenital heart defect, might have died”.

The same user shared another story that was “arguably the worst as well” that seemed like a potential complication with a pregnancy, revealing that they saw a “patient suffering from lower abdominal pains, cramping, vaginal discharge” and was “less than 16 weeks pregnant”.

Pharmacy First updates

Earlier this week (October 14), NHS England revealed the minimum number of Pharmacy First consultations pharmacies must complete to qualify for a monthly payment has been reduced until March next year.

This month, the threshold had been set to climb from 20 to 30 – meaning that pharmacies delivering the service would have to complete a minimum of 20 consultations in order to qualify for a fixed monthly payment of £1,000.

But now pharmacies must deliver a minimum of 20 consultations in November and December 2024, rising to 25 in January and February 2025, and then 30 in March 2025 to qualify for the monthly payment.

Read more: Top pharmacies suspended from Pharmacy First scheme

At a panel about Pharmacy First across the devolved nations at The Pharmacy Show in Birmingham earlier this week (October 13), Community Pharmacy England’s director of NHS services Alastair Buxton said “we're still at the start of implementing it” and “it will probably take us perhaps a couple of years before we can fully implement the service”.

In August, NHS Business Service Authority data revealed that it would claw back over a million in Pharmacy First cash.

£2,000 in upfront Pharmacy First funding is set to be recovered from a total of 555 contractors who will not deliver five clinical pathways consultations by March 31, 2024.

Read more: Pharmacist swaps store sign to promote Pharmacy First

And C+D revealed in September that four pharmacies that have provided some of the highest numbers of Pharmacy First consultations have been suspended from the scheme, according to NHS England in London.