Pharmacy’s clinical role has grown faster than the way our counters are set up to deliver it. Community pharmacist Stephen Toland asks whether the first point of contact deserves the same structure as everything that follows it.
Stephen Toland
Community Pharmacist and Independent Prescriber, Derry
It is a Tuesday afternoon. A mum comes to the counter and asks about a rash on her daughter’s arm. The member of staff who greets her has been with you a few months. She is warm, capable and keen to help. She asks the questions she has heard colleagues ask, picks a cream from the shelf, and says to come back if it isn’t better in a few days.
It was probably fine. Most of the time it is.
But it is worth pausing on a few questions. Who decided which questions she asked? Would the colleague on the next shift have asked the same ones? If one detail had pointed to something more serious, would it have come up at all? And if it had, would she have recognised it?
The counter has changed, even if it looks the same
For most of our careers, the counter was where the prescription journey ended. Increasingly, it is where care begins. Pharmacy First in England continues to grow, with Scotland and Northern Ireland having their own successful
Pharmacy First services, Wales its Common Ailments Service, and the Republic of Ireland now recently introducing the Common Conditions Service.
Independent prescribing is moving into community pharmacy, and private PGD services are now a normal part of many pharmacies’ offer.
The result is simple. More patients now walk in with symptoms, not just prescriptions. Across the UK and Ireland, well over two million consultations take place in community pharmacies every week with patients who simply walk in. For many of them, the pharmacy is now the front door to the health service.
We have invested heavily in what happens behind that door: consultation rooms, clinical pathways, PGDs, prescribing qualifications. Yet the first conversation, usually with a counter assistant rather than a pharmacist, is often the least structured part of the whole journey. It relies on memory, on a questioning model learned during induction, and on how confident that person happens to feel that day.
That isn’t a criticism of our teams. We ask them to handle hundreds of conditions and symptoms, often with a queue behind the patient and the phone ringing, without a consistent, repeatable way to gather the key information and act on it.
The quiet cost of an unstructured start
The dramatic risk is the missed red flag. Thankfully it is rare, though the consequences can be serious. The everyday costs are quieter, and I suspect most owners will recognise them.
There’s the patient who would have been eligible for Pharmacy First but left with a product from the shelf. There’s the private service you have trained for and invested in, which is never mentioned because nobody thought to ask the question that would have led to it. There’s the referral to the GP for something your pharmacy could have treated. There’s the product recommendation made out of habit rather than evidence.
And there’s the pharmacist called to the counter, again, for something the team could have handled with a little more confidence. Every time that happens, tim
is taken from checking, prescribing and the services that sustain the business
Training doesn’t fully solve this, however good it is. Courses get completed and certificates get filed. But knowledge gaps rarely show up during a training session. They show up at three o’clock on a Saturday, with a patient describing a symptom your team member hasn’t come across since induction. That is the moment support matters most, and it is usually the moment it isn’t there.
Most owners also know a harder truth. We don’t really know what is said at our counters when we aren’t standing beside them.
What other sectors worked out long ago
Pilots use checklists. NHS 111 uses structured triage, and so do GP practices. None of this is because the people involved aren’t capable. It is because structure makes good people consistent, protects them when they are under pressure, and lets their skills show up the same way every time.
The first point of contact in community pharmacy has rarely been given that kind of support, even though it is now one of the busiest clinical front doors in the health service.
Why we built something
Neil Sharpe and I founded ConsultTed, and we are both practising pharmacists. We didn’t set out to build a technology company. We set out to fix something we were living with on our own counters every day.
ConsultTed is the result. It is a structured consultation template for the first point of contact. On a tablet at the counter, it guides staff through the key questions for each ailment. It helps them recognise red flag symptoms, and it points them to the right outcome: an OTC recommendation, a Pharmacy First or PGD service, a pharmacist or prescriber, signposting, or onward referral.
Patients can also enter their owninformation before they reach the counter, so the conversation starts from a better place.
Alongside this sits the Staff e-Learning Tool, built for the moment a knowledge
gap appears. A team member who is unsure about a condition, symptom or treatment can look it up in seconds. More than 200 conditions are covered, with red flags, OTC options, self care and aftercare advice in one place. Managers can see which staff have studied which ailments, so learning gaps become visible rather than guessed at. It isn’t designed to replace the training teams already do, but to support it in the moments that matter.
Michael Cunningham of Abbey Pharmacy in Bangor put it better than I could.
A few questions worth asking
I’d simply invite you to consider your own pharmacy.
- If two members of your team were asked about the same symptom, would they ask the same questions?
- Do you know which conditions your team feels least confident with?
- How many patients last week might have been eligible for a clinical service but left with a product instead?
- When your most experienced counter assistant is on holiday, what happens to the standard of those first conversations?
If some of those answers are uncomfortable, you are far from alone. They were uncomfortable for us too. That discomfort doesn’t reflect badly on our teams. It reflects a sector whose clinical ambitions have moved faster than the tools on its counters.
Our profession has worked hard to become the front door to healthcare. The next step is making sure what happens in those first thirty seconds matches everything we now offer behind it.
Stephen Toland is a community pharmacist and independent prescriber in Derry, Northern Ireland, and founded ConsultTed with Neil Sharpe.
