By Asif Mukhtar, Founder & CEO, PharmBot AI (Consultant Pharmacist)

Pharmacy First has been welcomed as one of the most significant developments in community pharmacy practice in over a decade. It represents a bold shift: recognising pharmacists as first-contact clinicians and expanding access to care for millions of patients.

But behind the headlines and the positive sentiment lies a quiet, unspoken truth — one that frontline pharmacists understand intimately:

Pharmacy First is clinically valuable, but operationally overwhelming.

And unless this hidden burden is acknowledged and addressed, the sustainability of the service will be challenged.

Let’s talk about the part no one wants to say out loud.

1. Pharmacy First is a clinical service –  without clinical infrastructure

Pharmacists are being asked to deliver clinical consultations with the same expectations as primary care:

  • focused history taking
  • red flag identification
  • risk stratification
  • PGD eligibility checks
  • clinical reasoning
  • safety-netting
  • documentation
  • audit readiness

But unlike GPs, advanced practitioners, or urgent care clinicians…

Pharmacies have been given zero clinical workflow tools.

  • No standardised assessment pathways.
  • No digital templates.
  • No decision support.
  • No documentation guidance beyond “record the consultation”.

It’s clinical work delivered with non-clinical tools.

2. Documentation is the silent pressure point

Every pharmacist already knows this:

The admin is heavier than the consultation.

To be compliant, a Pharmacy First consultation needs:

  • subjective history
  • objective findings (where applicable)
  • red flags assessed
  • differential thinking
  • PGD eligibility
  • rationale for decisions
  • supply vs refer justification
  • safety-netting
  • follow-up advice
  • record of any override
  • claim information

Some pharmacists free-type.  Some scribble notes and record them later. Some rely on memory. Some use templates.

None of this is scalable, safe, or sustainable.

We would never accept this level of inconsistency in general practice or urgent care –  but pharmacy is expected to manage with patchwork systems.

3. Variation in clinical assessment is real – and risky

Every pharmacist assesses slightly differently. That’s normal in medicine.

But in a high-throughput environment like community pharmacy, variation can become:

  • inconsistent identification of red flags
  • variable PGD use
  • differences in antibiotic supply
  • inconsistent safety-netting
  • incomplete documentation
  • over-referral or under-referral decisions

Pharmacy First is designed to improve patient access.

But inconsistent practice can ultimately undermine trust in the service.

4. Pharmacy staff are under pressure to deliver quick, efficient consultations

Let’s be honest.

A sore throat assessment under Pharmacy First should take at least 7–12 minutes if done properly:

  • focused history
  • Centor scoring
  • red flag screening
  • medication review
  • allergy check
  • decision based on PGD
  • advice + safety-netting
  • documentation

But in the real world?

  • Workload.
  • Staffing challenges.
  • Queues.
  • Phones.
  • Dispensing pressures.Clinical consultations running back-to-back.

This creates a tension between quality and speed that pharmacists are forced to navigate alone.

5. Pharmacy First will only succeed with proper clinical workflow support

Pharmacy First is not a “minor ailments” service.  It is clinical triage, clinical decision-making, and clinical accountability.

To deliver this safely and consistently, pharmacies need:

✔ structured assessment workflows

✔ deterministic red-flag logic

✔ automatic PGD eligibility checks

✔ standardised decision-making support

✔ instant, clinical-quality documentation

✔ audit-ready records

✔ consistency across staff and sites

This is not “nice to have”.

This is clinical safety infrastructure – the same infrastructure every other clinical setting takes for granted.

6. Community pharmacies are stepping up – but they shouldn’t have to do it alone

Pharmacists are embracing Pharmacy First with professionalism and enthusiasm.

But they are doing so with:

  • no clinical templates
  • no structured flows
  • no triage support
  • no documentation tools
  • no audit system
  • no risk-stratification aids

It’s a testament to the profession’s resilience.

But resilience is not a long-term strategy.

7. The future is structured, digital-first clinical pathways

  • Pharmacy First will expand.
  • More conditions will be added.
  • The service will become more integrated with primary care.
  • Clinical expectations will rise further.

The only sustainable path forward is:

Digital clinical workflow automation for community pharmacy.

  • Structured.
  • Repeatable.
  • Safe.
  • Auditable.
  • Efficient.

Supporting pharmacists, not replacing them.

8. A new generation of pharmacy technology is coming

At PharmBot AI, we believe pharmacists deserve:

  • clinical-grade digital tools
  • structured assessment flows
  • instant documentation
  • PGD-driven logic
  • consistent clinical reasoning
  • reduced administrative burden
  • technology built by pharmacists, for pharmacists

We’re actively working on this vision – and more will be shared soon.

But for now, what matters is recognising the reality:

Pharmacy First is a clinical service without clinical infrastructure – and that must change.

  • The profession deserves better tools.
  • Patients deserve consistent, safe care.
  • And the future of pharmacy deserves proper investment in digital clinical capability.

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