The study is the first to evaluate data collected over the initial six months of NHS England's Acute Sore Throat Pharmacy First service
Patients with a sore throat are more than twice as likely to be given antibiotics by a pharmacist through England's Pharmacy First Scheme compared with a similar scheme in Wales, according to an initial analysis published in the Journal of Antimicrobial Chemotherapy.
The study, led by researchers from the London School of Hygiene & Tropical Medicine (LSHTM) and Cardiff University, compared antibiotics supplied through NHS England's Acute Sore Throat Pharmacy First scheme and Wales's Sore Throat Test and Treat service, using electronic data recorded by participating pharmacies.
Both schemes allow participating pharmacies to supply prescription-only medicines for acute sore throat after consultation with a community pharmacist. They are intended to enable patients to seek treatment directly from a pharmacy without a GP appointment, to free-up these up for those who may have complex illness. Patients can access both services directly or through a referral from a healthcare professional.
From February to July 2024, a total of 317,864 consultations for acute sore throat were recorded across participating pharmacies in England. In Wales, a total of 27,684 consultations were recorded across participating pharmacies. Following a consultation, patients were more than twice as likely to be supplied with antibiotics in England (72.7%) compared to in Wales (29.9%).
Dr Ayodeji Matuluko, Research Fellow at the London School of Hygiene & Tropical Medicine and joint first author for the study, said: "Our study highlights significant differences in antibiotic supply rates for sore throat between England and Wales.
"We need to collectively consider ways to ensure the appropriate use of antibiotics, to stem the potential public health threat posed by bacterial resistance.
"It's important that we now consider what factors may be influencing this disparity, such as variation in the service provided to patients or whether there may be differences in the demographics of those who attend pharmacies with sore throats, such as age and overall health."
Pharmacy First was launched in England in January 2024 under the previous UK Government's NHS Primary Care Recovery Plan. The Sore Throat Test and Treat service in Wales launched as a pilot in 2018, as an extension to the Common Ailments Service.
While the schemes in England and Wales are similar, Wales's Sore Throat Test and Treat requires pharmacists to confirm the presence of suspected Group A Streptococcus, the most common cause of bacterial sore throat, through a swab test before an antibiotic is supplied.
Antibiotics are ineffective against viruses, which are known to cause the majority of acute cough or upper respiratory tract infections in the community. The overuse and misuse of antibiotics contributes to antimicrobial resistance (AMR), one of the world's top threats to public health.
As swab tests were not completed in England, it's unclear what proportion of patients had a bacterial throat infection that did require antibiotics to treat. This early analysis suggests that introducing swab testing for acute sore throat in participating pharmacies across England may reduce the supply of unnecessary antibiotics.
The researchers stress, however, that NHS England's Pharmacy First scheme is in its infancy, having only launched at the beginning of 2024, in comparison to the Wales scheme which launched in 2018. The promotion of any new service is likely to attract a high volume of patients in the initial months after it is launched and patient numbers are likely to fall over time as it becomes part of standard practice.
The study period also did not account for seasonal illnesses that are known to impact antibiotic use in either England or Wales, or for demographic and socioeconomic differences between communities in Wales and England such as age, overall health and service accessibility.
The findings provide an opportunity to learn from data collected across the past decade in Wales and suggest that further resources should be invested to ensure pharmacists are supported with up-to-date training and the public are educated on the proper use of antibiotics.
Dr Rebecca Glover, Assistant Professor in Antimicrobial Resistance at LSHTM and senior author for the study, said: "We believe that one possible reason for the difference seen in antibiotic supply rates may be the presence of a diagnostic test for patients in Wales but this does not mean it's the answer for pharmacies across England. Diagnostic tests can add additional expense to an already-burdened healthcare system and the tests themselves often vary in quality.
"While these services in England and Wales are similar, they are not direct comparisons, since the data are captured differently across the two nations. IT systems, scale, pace of program uptake and training processes are also quite different.
"Our next steps will be to investigate the uptake, antibiotic use, safety and impact of the English Pharmacy First service as a whole in much greater detail, as part of a three-year evaluation commissioned by the National Institute for Health and Care Research."
Dr Glover and team at LSHTM were awarded £2.4m by the National Institute for Health and Care Research (NIHR) in 2024 and will separately be evaluating Pharmacy First's impact on England's GPs, the wider NHS, pharmacy services and patients.
