# Pharmacy First Consultations in OpenSAFELY-TPP

#### 12 January, 2026

This OpenSAFELY report presents real-time analyses of the Pharmacy First service using data from OpenSAFELY-TPP. It is designed to support policymakers and clinicians in making timely, data-driven decisions to enable targeted improvements in service delivery. The analysis is based on approximately 26 million individuals registered with general practices using TPP SystmOne software. This report will be updated monthly to incorporate new data when available.

The code for this report can be found in the OpenSAFELY Pharmacy First GitHub repository. For a more detailed description of the underlying data sources, methods, and results, please refer to the accompanying manuscript.

# Background

The COVID-19 pandemic has had a significant impact on the access to and provision of NHS healthcare services. In response to this, NHS England announced a recovery plan to “make it easier and quicker for patients to get the help they need from primary care”.

A key element of the recovery plan is the Pharmacy First programme, which launched on 31st January 2024, and supports community pharmacists to follow specified clinical pathways to assess for and manage seven common conditions (sinusitis, acute pharyngitis, acute otitis media, infected insect bites, impetigo, herpes zoster, and uncomplicated urinary tract infections in women) and supply medications, including prescription-only medications, where appropriate.

As part of efforts to improve and simplify information sharing between general practice (GP) and community pharmacy, GP Connect: Update Record has been created, allowing registered community pharmacy professionals to send summaries in a structured format from Pharmacy First consultations, using pre-specified SNOMED CT codes, directly into general practice workflow. However, the roll out of Update Record has been gradual due to the involvement of multiple community pharmacy and GP system suppliers, with each being ready at different stages.

The aims of this report are to:

1. Describe the trends in Pharmacy First service use over time, including variation by demographic and regional subgroups
2. Describe the completeness of recorded Pharmacy First consultations (clinical conditions and medications)
3. Describe the clinical conditions and medications being treated/supplied under Pharmacy First Clinical Pathways and recorded in GP records

# Results

## Monthly changes in Pharmacy First consultations in GP records

The monthly counts of patients with a recorded Pharmacy First consultation in OpenSAFELY-TPP broken down by individual Pharmacy First consultation codes are presented in Figure 1. All consultations were recorded either with the Pharmacy First service code or the Consultation Service for minor illness code. Only the Consultation Service for minor illness code (see purple triangles in Figure 1) is referenced in the service specification.

Figure 1. Monthly count of patients with a Pharmacy First consultation code in their GP records in OpenSAFELY-TPP, broken down by individual Pharmacy First consultation codes. The dashed vertical line indicates the launch of Pharmacy First on 31st January 2024. CP = Community Pharmacy.

### Demographic breakdowns

These charts show how the number of Pharmacy First consultations changed over time across key demographic groups. Counts are broken down by sex, age, IMD quintile, region, and ethnicity to highlight patterns in service use across the population.

#### Sex

Figure 2. Monthly count of patients with a Pharmacy First consultation code in OpenSAFELY-TPP broken down by sex.

#### Age

Figure 3. Monthly count of patients with a Pharmacy First consultation code in OpenSAFELY-TPP broken down by age bands.

#### Index of Multiple Deprivation (IMD)

Figure 4. Monthly count of patients with a Pharmacy First consultation code in OpenSAFELY-TPP broken down by IMD.

#### Region

Figure 5. Monthly count of patients with a Pharmacy First consultation code in OpenSAFELY-TPP broken down by region.

#### Ethnicity (5 Groups)

Figure 6. Monthly count of patients with a Pharmacy First consultation code in OpenSAFELY-TPP broken down by ethnicity.

## Completeness of recorded Pharmacy First consultations in GP records

Completeness of Pharmacy First consultations is summarised here by showing the proportion of consultations with a recorded medication, clinical condition, or both. This gives an indication of how complete consultations are captured in GP records over time.

Figure 7. Monthly breakdown of all Pharmacy First consultation codes with either a recorded Pharmacy First medication, clinical condition, or both in OpenSAFELY-TPP.

## Summary of clinical conditions recorded in Pharmacy First consultations

Pharmacy First consultations involving a clinical condition, as specified by NHS England, are shown here. This highlights which pathways were most commonly used between 2024-01-31 and 2025-12-31.

Figure 8. Monthly count of patients with a Pharmacy First consultation code in OpenSAFELY-TPP broken down by clinical condition.

## Summary of medications recorded in Pharmacy First consultations

This table presents the most commonly recorded medications recorded in Pharmacy First consultations, grouped by whether they were included in the Pharmacy First medications codelists or not.

Table 1. Top ten medications recorded in Pharmacy First consultations between 2024-01-31 and 2025-12-31.

| Count | %
--- | --- | ---
Medication included in codelists
Phenoxymethylpenicillin 250mg tablets | 105,605 | 36.7%
Nitrofurantoin 100mg modified-release capsules | 50,200 | 17.5%
Phenazone 40mg/g / Lidocaine 10mg/g ear drops | 20,055 | 7.0%
Clarithromycin 500mg tablets | 14,890 | 5.2%
Flucloxacillin 500mg capsules | 14,260 | 5.0%
Phenoxymethylpenicillin 250mg/5ml oral solution | 11,830 | 4.1%
Mometasone 50micrograms/dose nasal spray | 11,690 | 4.1%
Fluticasone furoate 27.5micrograms/dose nasal spray | 10,490 | 3.6%
Amoxicillin 250mg/5ml oral suspension | 9,465 | 3.3%
Amoxicillin 250mg/5ml oral suspension sugar free | 6,095 | 2.1%

# Methods

## Data Sources

### OpenSAFELY-TPP

Data were accessed from OpenSAFELY-TPP, which covers approximately 40% of the English population, and includes pseudonymised, structured data. Individuals were included if they were aged between 0 and 120 years, had a Pharmacy First consultation, were registered at a TPP general practice each month, and had a recorded sex of male or female (assigned at birth). Data from individuals who opted out of NHS data sharing with their GP surgery (Type 1 Opt-out) were excluded and free-text data were also not included.

To reduce the risk of re-identification, all counts smaller or equal 7 were redacted, then all counts were rounded to the nearest 5.

## Identification of clinical events and medications

### Pharmacy First consultations

The identification of Pharmacy First consultations relied on the presence of relevant SNOMED CT codes recorded in GP records. Using the GP Connect: Update Record technical documentation we identified the Community Pharmacist Consultation Service for minor illness (1577041000000109) code. Using OpenCodelists (https://www.opencodelists.org/), we identified two further SNOMED CT codes associated with Pharmacy First consultations: Pharmacy First Service (983341000000102) and Community Pharmacy Pharmacy First Service (2129921000000100).

### Pharmacy First clinical conditions

As specified by NHS England, the Pharmacy First service includes the supply of medication for seven clinical conditions: acute otitis media, impetigo, infected insect bites, herpes zoster, acute sinusitis, acute pharyngitis, and uncomplicated urinary tract infection. To identify these clinical conditions within Pharmacy First consultations, we implemented the clinical conditions codelist issued by NHS England. This codelist included a single code for each condition as specified by NHS England. Each clinical condition has NHS England-defined inclusion and exclusion criteria, applied at the time of consultation to determine treatment eligibility. Our analysis included all consultations recorded with a Pharmacy First consultation code, regardless of eligibility.

### Pharmacy First medications

We developed codelists for medications for each of the seven clinical conditions using the corresponding Patient Group Directions which specify the exact drug, strengths, and formulations that may be supplied as part of the consultation. Relevant dictionaries of Medicines + Devices (dm+d) codes were identified directly from dm+d data by matching on drug name, strength and formulation.

## Data Analyses

### Monthly changes in Pharmacy First consultations in GP records

Patients with at least one recorded Pharmacy First consultation code each month were included in this report. We reported monthly consultation counts to capture the total activity in GP records.

### Completeness of recorded Pharmacy First consultations in GP records

Completeness was assessed to determine the extent to which key clinical information - specifically conditions and medications - is consistently recorded in Pharmacy First consultations. Consultations were categorised in three mutually exclusive groups: (i) those with a recorded clinical condition from one of the seven pre-specified clinical conditions; (ii) those with a prescribed Pharmacy first medication; and (iii) those with both a recorded Pharmacy first-specific clinical condition and medication. Monthly proportions were calculated to assess changes in recording patterns over time.

### Summary of clinical conditions recorded in Pharmacy First consultations

We identified Pharmacy First clinical conditions by extracting all SNOMED CT codes recorded during Pharmacy First consultations that matched the seven NHS England-defined clinical conditions. Monthly counts of consultations were summarised by clinical condition to illustrate changes in activity over time and variation between conditions.

### Summary of medications recorded in Pharmacy First consultations

Medications issued during the Pharmacy First consultations were identified using dm+d codes recorded within the same consultation, and summarised at the Virtual Medicinal Product (VMP) level. We restricted analysis to the ten most frequently recorded medications. We identified the percentage of Pharmacy First consultations with and without a prescription as specified by NHS England.

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