Recording of Pharmacy First consultations in general practice records in England: an observational study of the service’s first year using OpenSAFELY

Recording of Pharmacy First consultations in general practice records in England: an observational study of the service’s first year using OpenSAFELY | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var 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View ORCID Profile Amelia Green , View ORCID Profile Louis Fisher , View ORCID Profile Colm D Andrews , David Evans , Amir Mehrkar , Sebastian Bacon , View ORCID Profile Ben Goldacre , View ORCID Profile Amelia C Taylor , View ORCID Profile Diane Ashiru-Oredope , View ORCID Profile Kimberley Sonnex , Thomas Allen , View ORCID Profile Hannah Higgins , View ORCID Profile Tracey Thornley , View ORCID Profile Nicholas Mays , View ORCID Profile Rebecca E Glover , View ORCID Profile Rachel A Elliott , View ORCID Profile Anthony J Avery , View ORCID Profile Brian MacKenna doi: https://doi.org/10.1101/2025.09.30.25336964 Viveck J Kingsley 1 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford , OX2 6GG, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Viveck J Kingsley Milan Wiedemann 1 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford , OX2 6GG, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Milan Wiedemann Christopher Wood 1 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford , OX2 6GG, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Helen J Curtis 1 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford , OX2 6GG, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Helen J Curtis Amelia Green 1 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford , OX2 6GG, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Amelia Green Louis Fisher 1 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford , OX2 6GG, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Louis Fisher Colm D Andrews 1 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford , OX2 6GG, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Colm D Andrews David Evans 1 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford , OX2 6GG, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Amir Mehrkar 1 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford , OX2 6GG, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Sebastian Bacon 1 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford , OX2 6GG, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Ben Goldacre 1 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford , OX2 6GG, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Ben Goldacre Amelia C Taylor 4 Centre for Academic Primary Care, School of Medicine, University of Nottingham , Nottingham, NG7 2RD 5 NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester , Manchester, M13 9PL Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Amelia C Taylor Diane Ashiru-Oredope 3 UK Health Security Agency , London NW9 5EQ, UK 6 School of Pharmacy, University of Nottingham , Nottingham, NG7 2RD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Diane Ashiru-Oredope Kimberley Sonnex 6 School of Pharmacy, University of Nottingham , Nottingham, NG7 2RD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Kimberley Sonnex Thomas Allen 7 Manchester Centre for Health Economics, University of Manchester , Manchester, M13 9PL Find this author on Google Scholar Find this author on PubMed Search for this author on this site Hannah Higgins 3 UK Health Security Agency , London NW9 5EQ, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Hannah Higgins Tracey Thornley 3 UK Health Security Agency , London NW9 5EQ, UK 6 School of Pharmacy, University of Nottingham , Nottingham, NG7 2RD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Tracey Thornley Nicholas Mays 2 London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy , 15-17 Tavistock Place, WC1H 9SH, London, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Nicholas Mays Rebecca E Glover 2 London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy , 15-17 Tavistock Place, WC1H 9SH, London, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Rebecca E Glover Rachel A Elliott 5 NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester , Manchester, M13 9PL 7 Manchester Centre for Health Economics, University of Manchester , Manchester, M13 9PL Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Rachel A Elliott Anthony J Avery 4 Centre for Academic Primary Care, School of Medicine, University of Nottingham , Nottingham, NG7 2RD 5 NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester , Manchester, M13 9PL Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Anthony J Avery Brian MacKenna 1 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford , OX2 6GG, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Brian MacKenna For correspondence: brian.mackenna{at}phc.ox.ac.uk Abstract Full Text Info/History Metrics Supplementary material Data/Code Preview PDF Abstract Background Pharmacy First, a national community pharmacy service, launched in January 2024 to improve access to primary care for patients with minor conditions facing backlogs caused by the COVID-19 pandemic. Pharmacies are required to share details about their consultations with general practices. We aimed to describe how and what clinical activity was recorded in general practice during the first year of the service. Methods With the approval of NHS England, we conducted a retrospective cohort study using OpenSAFELY-TPP including Pharmacy First consultations between 31 January 2024 and 30 January 2025. We described patient demographics, consultation trends, and the clinical conditions and medications coded with Pharmacy First consultations. Results A total of 402,165 Pharmacy First consultations were recorded for 340,710 patients from a general population of 26,142,380 registered patients in OpenSAFELY-TPP. Acute pharyngitis (28.9%) and uncomplicated urinary tract infection (28%) were the most frequently recorded conditions. By January 2025, 36.3% of recorded Pharmacy First consultations had a clinical condition, medication, or both. Females, younger adults and those living in more deprived areas were observed more often in Pharmacy First records compared to the general population. Conclusion Increasing recording of the Pharmacy First community pharmacy service was observed in general practice records during its first year, particularly among younger and more deprived populations. However, variation in structured recording of consultation details may limit evaluation. Background The COVID-19 pandemic placed sustained pressure on the National Health Service (NHS) in England, with persistent backlogs and longer waiting times for general practice (GP) appointments ( 1 , 2 ). As a result, community pharmacies have increasingly adopted clinical functions ( 3 ). As part of the NHS COVID-19 recovery plan ( 4 ), NHS England launched the Pharmacy First service on 31st January 2024, enabling community pharmacists to assess for and manage seven common conditions, and supply prescription-only medications, where appropriate ( 5 , 6 ). Pharmacy First requires sharing of clinical information between GPs and community pharmacies. NHS England mandated use of GP Connect: Update Record, which enables registered pharmacies to send summaries of Pharmacy First consultations directly into GP records ( 7 ) using pre-specified Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) codes ( 8 ). This structured transfer aims to ensure consistency, accuracy and speed of recording Pharmacy First consultations in GP records to support GP clinical decision-making when there is escalation back to GPs ( 9 ). However, its rollout has been gradual, with community pharmacy and GP software systems being ready at different timepoints ( 10 ). This study forms part of the National Institute for Health and Care Research (NIHR)-commissioned review of the implementation and impact of Pharmacy First ( 11 ), using the OpenSAFELY platform for near real-time access to pseudonymised GP records ( 12 , 13 ). We aimed to describe how Pharmacy First Clinical Pathway activity was recorded in OpenSAFELY-TPP during its first year. We report monthly activity compared to publicly reported figures, assess the information on clinical conditions and medications transferred to GP records, and describe Pharmacy First users’ demographics. Methods Study design and population We conducted a retrospective cohort study, using routinely collected electronic health record (EHR) data in OpenSAFELY-TPP between 31st January 2024 and 30th January 2025, the first year of Pharmacy First. We included all individuals who were alive and registered at a TPP practice during the study period, male or female and aged 0-120 years. We did not apply eligibility criteria defined for Pharmacy First pathways as we sought to describe all consultations as they appeared in GP records ( 5 ). Data sources OpenSAFELY-TPP All data were stored and analysed securely using the OpenSAFELY platform ( https://www.opensafely.org/ ), as part of the NHS England OpenSAFELY COVID-19 service. Data include pseudonymised data such as coded diagnoses, medications and physiological parameters. No free text data are included. No GP data from patients who have registered a Type-1 Opt out with their GP surgery were included in this study. NHS Business Services Authority (BSA) data For comparison we used the publicly available Pharmacy and appliance contractor dispensing dataset which captures all monthly Pharmacy First consultations reimbursed in England ( 14 ). Identification of clinical events and medications We extracted Pharmacy First consultations together with associated clinical conditions and medications ( Box 1 ). Box 1. Code written to identify clinical conditions and medications of Pharmacy First consultations in OpenSAFELY. Using Electronic Health Records Query Language (ehrQL) ( https://docs.opensafely.org/ehrql/ ) we identified all Pharmacy first consultations through consultation identifiers then extracted all clinical event codes (i.e. conditions) and medications associated with the consultation. Download figure Open in new tab Pharmacy First consultations We used SNOMED CT codes specified by NHS England in the GP Connect: Update Record documentation: Community Pharmacist Consultation Service for minor illness (1577041000000109) ( 8 ). Using OpenCodelists ( https://www.opencodelists.org/ ), we identified two further SNOMED CT codes: Pharmacy First Service (983341000000102) and Community Pharmacy Pharmacy First Service (2129921000000100) (supplementary Table A1). Pharmacy First clinical conditions Pharmacy First provides clinical pathways for seven conditions: acute otitis media, impetigo, infected insect bites, herpes zoster, acute sinusitis, acute pharyngitis, and uncomplicated urinary tract infection ( 5 ). These were identified using SNOMED CT codelists published by NHS England (supplementary Table A1). Pharmacy First medications We developed medication codelists, using the dictionary of medicines and devices (dm+d) terminology for each clinical condition, to specify the exact drug, formulations and strengths that may be supplied ( 6 ) (supplementary Table A1). Data analyses Patient population using Pharmacy First We report demographic (10-year age bands, sex, ethnicity in 16 categories) and regional (Indices of Multiple Deprivation quintiles, region) breakdowns for service users compared to the total registered population. To reduce disclosure risks, counts ≤7 are redacted, then all counts rounded to the nearest 5. Monthly Pharmacy First consultations Monthly counts of patients with at least one recorded Pharmacy First consultation in GP records are reported, split by Pharmacy First code. We compared monthly Pharmacy First consultation counts in OpenSAFELY-TPP (covering 40% of England’s GP-registered population) with publicly available figures derived from reimbursement claims (100% coverage) ( 14 ). We also break down by clinical condition. Pharmacy First consultation information in GP records Pharmacy First consultations were categorised as: (i) having a recorded Pharmacy First clinical condition; (ii) having a Pharmacy First medication prescribed; or (iii) both; the remainder having neither recorded. Monthly proportions were calculated. We included all three Pharmacy First consultation codes described above, and separately limited to the recommended code, to examine variation in recording practices. Clinical conditions recorded in Pharmacy First consultations For all Pharmacy First consultations we extracted all SNOMED CT codes recorded which matched the seven NHS England-defined clinical conditions. For each clinical condition, counts were broken down by sex and Index of Multiple Deprivation (IMD). We also compare the percentage of Pharmacy First consultations attributed to each of the seven clinical conditions between OpenSAFELY-TPP and NHS BSA data. Medications recorded in Pharmacy First consultations Medications issued during Pharmacy First consultations were identified using dm+d codes recorded within the same consultation. We report the ten most frequently recorded generic products (Virtual Medicinal Product [VMP] dm+d level). We describe the percentage of consultations with and without an NHS England-specified medication for each condition. Software and reproducibility Data management was performed using Python v3.9.1 and R v4.0.5. Code for data management and analysis, as well as codelists, are available for review and reuse under MIT open license at https://github.com/opensafely/pharmacy-first/ . Detailed pseudonymised patient data is potentially re-identifiable and therefore not shared. Patient and public involvement OpenSAFELY has involved patients and the public in various ways ( https://opensafely.org ), including two citizen juries exploring public trust; co-developed explainer video ( https://www.opensafely.org/about/ ); patient representation on our OpenSAFELY Oversight Board; partnership with Understanding Patient Data to produce lay explainers; various online public engagement events; and more. The wider Pharmacy First evaluation will involve PPIE and qualitative interviews with patients. Results Patient population using Pharmacy First Between 31 January 2024 and 30 January 2025, we identified 402,165 Pharmacy First consultations for 340,710 patients from 26,142,380 registered patients in OpenSAFELY-TPP ( Table 1 ). Pharmacy First users were predominantly female (67.3%) and over half were aged under 40 (59.3%). Most patients were of White British ethnicity (71.3%), and uptake was highest among those in the most deprived quintile (25.4%). Yorkshire and the Humber was the most represented, accounting for 23.7% of Pharmacy First users compared to 14.5% of the registered population. View this table: View inline View popup Download powerpoint Table 1. Description of patient population with at least one Pharmacy First consultation code (n = 340,710) and total registered population in OpenSAFELY-TPP (N = 26,142,380). Monthly Pharmacy First consultations in GP records Of the 402,165 Pharmacy First consultations, 209,900 (52.2%) were recorded using the SNOMED CT code for Pharmacy First Service , and 192,265 (47.8%) using the recommended code, Community Pharmacist Consultation Service for minor illness ( Figure 1 ). The code for Community Pharmacy First Service was not used. Use of the recommended code increased from around 5,000 per month to 37,565 in December 2024. Use of the Pharmacy First Service code remained comparatively stable. Download figure Open in new tab Figure 1. Monthly count of consultations with a Pharmacy First consultation code in their GP records in OpenSAFELY-TPP, broken down by individual Pharmacy First consultation codes. CP = Community Pharmacy. *Recommended Pharmacy First consultation code. Comparison with NHS BSA data The number of Pharmacy First consultations recorded in OpenSAFELY-TPP was substantially lower than expected based on its approximate 40% population coverage. OpenSAFELY-TPP captured between 11.3% and 23.7% of the total consultations reported per month in NHS BSA data ( Figure 2 ). Both datasets showed broadly similar overall trends. Download figure Open in new tab Figure 2. Monthly counts of Pharmacy First consultations in OpenSAFELY-TPP, which represents approximately 40% of the population, and NHS BSA data which represents 100% of reimbursement claims. Labels indicate the percentage of OpenSAFELY-TPP consultations of the BSA total. Pharmacy First consultation information In February 2024, only 4.5% of Pharmacy First consultations in OpenSAFELY-TPP contained a clinical condition code and 0.7% a medication, with both recorded in <0.1% ( Figure 3a ). By January 2025, 13.5% included a condition, 0.8% a medication, and 22.0% both - totalling 36.3% of consultations with a recorded condition and/or medication. When restricted to consultations recorded using the recommended code ( Figure 3b ), the overall pattern was similar, but by January 2025, 53.7% had a recorded condition and/or medication (17.8% condition, 0.2% medication, 35.7% both). Download figure Open in new tab Figure 3. Monthly breakdown of all Pharmacy First consultation codes with either a recorded Pharmacy First medication, clinical condition, or both in OpenSAFELY-TPP, for: (a) all consultations with any Pharmacy First consultation code; (b) only consultations with the recommended Pharmacy First code - Community Pharmacist Consultation Service for minor illness (1577041000000109). Clinical conditions recorded in Pharmacy First consultations Among consultations with recorded clinical conditions, acute pharyngitis (28.9%) and uncomplicated UTI (28%) were most frequently recorded ( Table 2 ), followed by acute otitis media (16.2%), sinusitis (13.6%), infected insect bites (7.5%), impetigo (2.9%) and herpes zoster (2.8%). All conditions were more commonly recorded among female patients, notably 55 male cases were recorded under the female UTI pathway. These findings closely matched NHS BSA data, with differences ranging from 0.1% (herpes zoster), to 4.5% (acute pharyngitis), see supplementary Table A3. View this table: View inline View popup Download powerpoint Table 2. Patients with recorded Pharmacy First clinical conditions in OpenSAFELY-TPP during the first 12 months following the services’ launch date on 31 January 2024, grouped by sex. View this table: View inline View popup Download powerpoint Table 3. Top ten medication counts and percentage recorded in Pharmacy First consultations during the first 12 months following the services’ launch date on 31 January 2024. Medications recorded in Pharmacy First consultations Among consultations with a recorded medication, the most frequently issued were phenoxymethylpenicillin 250mg tablets (32.1%) and nitrofurantoin 100mg modified-release capsules (31%). Other medications each made up <6% of the total. The top 10 accounted for 86.2% of all medications recorded in Pharmacy First consultations. Discussion Summary Pharmacy First was introduced on 31st Jan 2024 following the COVID-19 pandemic. Among 26,142,380 registered patients in OpenSAFELY-TPP, we observed 402,165 Pharmacy first consultations in GP records in its first year, from around 25,000 per month to 56,495 by January 2025. This represented 23.7% of total Pharmacy First consultations reimbursed. Where present, the most frequently recorded clinical conditions were acute pharyngitis and uncomplicated UTI. By January 2025, 36.3% of Pharmacy First consultations had a recorded clinical condition, medication, or both (53.7% of those with the recommended Pharmacy First code). Findings in context This study provides the first large-scale assessment of recording of Pharmacy First activity in GP records. While published figures report the total monthly Pharmacy First service use with condition/medication breakdowns, the OpenSAFELY platform allows more detailed studies on the patient populations using these services and the potential impacts on patient flows. Here we establish general data quality and patterns of Pharmacy First service use as transferred to practices. Consultation counts in NHS BSA data were higher, as expected given its complete coverage of reimbursed consultations compared with OpenSAFELY-TPP’s 40% population coverage, but further discrepancies are also present. Pharmacy First consultations are almost all attributed to an identifiable patient (98.94%, February-October 2024) ( 15 ) so transfer to their GP records is theoretically possible. Pharmacies may send consultation information by post/email if electronic systems fail, which may not be coded by the receiving practice. Discrepancies may therefore partly reflect known issues with the GP Connect: Update Record functionality ( 16 ) and variation in subsequent coding. The increase in Pharmacy First consultations in OpenSAFELY-TPP between September 2024 and January 2025 likely reflects resolution of technical issues after August 2024 ( 17 ), alongside growing awareness and uptake of the Pharmacy First service. Some duplication of records within GP systems is also possible, as we observed fewer unique patients per consultation in OpenSAFELY-TPP (0.847; 340,710/402,165) compared with data from pharmacies (0.963; 2.25 million/2.35 million, April 2024-March 2025) ( 15 ). By January 2025, 36.3% of Pharmacy First consultations in OpenSAFELY-TPP included clinical information; this proportion was higher among consultations recorded using the recommended Pharmacy First code (53.7%), indicating lower levels of recorded clinical information among consultations recorded using non-recommended Pharmacy First codes. Recording a suspected/confirmed clinical condition in a Pharmacy First pathway is not mandatory, and may therefore be absent in GP records ( 6 ). However, national data indicate that a medication was issued for around three quarters of all Pharmacy First consultations ( 18 ), and by implication, a condition should be confirmed in these cases. The apparent incompleteness of information transferred to GP records may limit further analysis, but information available in a clinical setting may be different. Pharmacy First service users differed demographically from the overall OpenSAFELY-TPP population. Male patients were underrepresented (32.7% of all Pharmacy First consultations, and 38.1% among those with a recorded clinical condition excluding female urinary tract infection vs 50.2% in OpenSAFELY-TPP). This is consistent with national Pharmacy First data, which reports 36% male consultations (April 2024 - March 2025) ( 15 ), and with evidence that men are less likely to consult for common conditions ( 19 ). Younger age groups (0-39 years) accounted for the majority of consultations (59.3%). Patients from Yorkshire and the Humber were over-represented (23.7% vs 14.5% in OpenSAFELY-TPP). Patients from more deprived areas were also over-represented, and White British ethnicity also slightly higher (71.3% vs 67.1%). Patterns in deprivation and ethnicity may reflect the greater availability of community pharmacies in deprived areas ( 20 ), which could help mitigate aspects of the inverse care law observed in general practice ( 21 , 22 ). However, variation will also reflect underlying clinical condition incidence, healthcare access patterns, and recording practices. Strengths and limitations The main strength of this study is the use of OpenSAFELY-TPP, a secure, population-scale platform covering 26 million patients across 2,540 general practices. This dataset is largely representative of the national population with regards to IMD, age, sex, and ethnicity, making the findings generalisable to England ( 23 ). Additionally, this study is the first to evaluate the recording of Pharmacy First consultations in GP records at scale, providing insight into service uptake, data quality, and integration into primary care systems. Limitations include the inclusive definition of a Pharmacy First consultation used in this study, which incorporates multiple SNOMED CT codes, and may capture some consultations outside the official service specification. London’s underrepresentation in OpenSAFELY-TPP may reduce applicability to urban populations. While OpenSAFELY has been used to deliver analysis across the full English GP population ( 24 , 25 ), access to OpenSAFELY-EMIS (covering the remaining GPs) is currently paused, whilst NHS England concludes formal commercial and data processing agreements with EMIS ( 26 ). Policy implications Presence of consultations and clinical details improved over the study period, likely reflecting technical refinements and growing familiarity with the system. Transfer of all Pharmacy First consultations was unlikely during the first year, given the real-world challenges of rapidly implementing national infrastructure. Future services should be supported by timely publication of technical documentation, including SNOMED CT codes to support transparency and independent evaluations. The temporary suspension of GP Connect: Update Record functionality during industrial action highlights the need for resilient and clinical safety-assured digital systems. Improved digital integration between community pharmacy and general practice will enhance service monitoring and evaluation, and support the integration of Pharmacy First within routine general practice workflows. To support ongoing evaluation of equitable access, we developed a public dashboard ( https://reports.opensafely.org/ ) presenting stratified, near real-time data on Pharmacy First consultations. This tool enables policymakers and clinicians to monitor detailed uptake and patterns of Pharmacy First activity over time, supporting oversight of the national roll-out. In October 2025, a large increase in Pharmacy First activity coincided with GP Connect becoming a contractual obligation for GPs ( 27 ) and addition of some gateway (reimbursement) criteria ( 17 , 27 ). Future research This analysis forms the foundation for a broader mixed methods programme exploring the wider impact of the Pharmacy First service on primary care service use and prescribing ( 11 ). This will explore whether Pharmacy First contributes to improving primary healthcare access, the quality of antimicrobial use, and potential scope for refinements to the service, providing robust evidence to inform better implementation and for policymakers to determine the future role of community pharmacy in England. Further investigation is needed to understand variation in the recording of Pharmacy First consultations, including the use of non-recommended codes, and whether this reflects technical constraints, data entry practices, or limited uptake of GP Connect: Update Record . Validation work should also test alignment with pathway inclusion criteria, such as male patients recorded under the UTI pathway or medications outside the service specification. Qualitative research with pharmacists, GPs, and patients is planned to explore these findings. OpenSAFELY’s tools and infrastructure are openly available, enabling further studies of Pharmacy First and near real-time monitoring of the service’s rollout. Conclusion This study provides the first large-scale analysis of Pharmacy First consultation recording in general practice records. Recorded uptake increased over time, particularly among younger and more deprived populations. Although detailed information was expected to transfer reliably into GP records, the total count of Pharmacy First consultations fell short of the expected total, and some lacked coded clinical information. Strengthening technical integration and ensuring consistent recording across systems will be essential to support robust evaluations of the service and its impact. We invite others to expand on our initial work using OpenSAFELY. Administrative Funding The OpenSAFELY platform is principally funded by grants from: NHS England [2023-2025]; The Wellcome Trust (222097/Z/20/Z) [2020-2024]; MRC (MR/V015737/1) [2020-2021]. Additional contributions to OpenSAFELY have been funded by grants from: MRC via the National Core Study programme, Longitudinal Health and Wellbeing strand (MC_PC_20030, MC_PC_20059) [2020-2022] and the Data and Connectivity strand (MC_PC_20058) [2021-2022]; NIHR and MRC via the CONVALESCENCE programme (COV-LT-0009, MC_PC_20051) [2021-2024]; NHS England via the Primary Care Medicines Analytics Unit [2021-2024]. This project was funded by a grant from the National Institute for Health and Care Research [NIHR160217]. Diane Ashiru-Oredope is funded by NIHR Senior Clinical and Practitioner Award (NIHR304553). The views expressed are those of the authors and not necessarily those of the NIHR, NHS England, UK Health Security Agency (UKHSA), the Department of Health and Social Care, or other funders. Funders had no role in the study design, collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Conflicts of interest statement All authors declare the following: AM has represented the RCGP in the health informatics group and the Profession Advisory Group that advises on access to GP Data for Pandemic Planning and Research (GDPPR); the latter was a paid role. AM is a former employee and interim Chief Medical Officer of NHS Digital. AM has consulted for health care vendors, the last time in 2022; the companies consulted in the last 3 years have no relationship to OpenSAFELY. SB has received research funding from the Bennett Foundation, NHS England, the NIHR Oxford Biomedical Research Centre, the Wellcome Trust, XTX Markets, Health Data Research UK; he also receives personal income from consulting on digital healthcare with Respiratory Matters Ltd, and Madalena Consulting LLC. BG has received research funding from the Bennett Foundation, the Laura and John Arnold Foundation, the NHS National Institute for Health Research (NIHR), the NIHR School of Primary Care Research, NHS England, the NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, the World Health Organisation, UKRI MRC, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme; he has previously been a Non-Executive Director at NHS Digital; he also receives personal income from speaking and writing for lay audiences on the misuse of science. BMK is employed by NHS England working on medicines policy and clinical lead for primary care medicines data. AJA is National Clinical Director for Prescribing for NHS England. Information governance and ethical approval NHS England is the data controller of the NHS England OpenSAFELY COVID-19 Service; TPP is the data processor; all study authors using OpenSAFELY have the approval of NHS England. [3] This implementation of OpenSAFELY is hosted within the TPP environment which is accredited to the ISO 27001 information security standard and is NHS IG Toolkit compliant; [4] Patient data has been pseudonymised for analysis and linkage using industry standard cryptographic hashing techniques; all pseudonymised datasets transmitted for linkage onto OpenSAFELY are encrypted; access to the NHS England OpenSAFELY COVID-19 service is via a virtual private network (VPN) connection; the researchers hold contracts with NHS England and only access the platform to initiate database queries and statistical models; all database activity is logged; only aggregate statistical outputs leave the platform environment following best practice for anonymisation of results such as statistical disclosure control for low cell counts. [5] The service adheres to the obligations of the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018. The service previously operated under notices initially issued in February 2020 by the the Secretary of State under Regulation 3( 4 ) of the Health Service (Control of Patient Information) Regulations 2002 (COPI Regulations), which required organisations to process confidential patient information for COVID-19 purposes; this set aside the requirement for patient consent. [6] As of 1 July 2023, the Secretary of State has requested that NHS England continue to operate the Service under the COVID-19 Directions 2020. [7] In some cases of data sharing, the common law duty of confidence is met using, for example, patient consent or support from the Health Research Authority Confidentiality Advisory Group. [8] Taken together, these provide the legal bases to link patient datasets using the service. GP practices, which provide access to the primary care data, are required to share relevant health information to support the public health response to the pandemic, and have been informed of how the service operates. This study was supported by Anne Joshua (Deputy Director of Pharmacy Commissioning & Head of Pharmacy Integration, NHS England) as senior sponsor, and approved by the Health Research Authority (REC reference 20/LO/0651). (NHS England service evaluations/audits are currently not required to have Ethics approval.) NHS Digital. The NHS England OpenSAFELY COVID-19 service - privacy notice [Internet]. 2023 [cited 2023 Jul 4]. Available from: https://digital.nhs.uk/coronavirus/coronavirus-covid-19-response-information-governance-hub/the-nhs-england-opensafely-covid-19-service-privacy-notice NHS Digital. Secretary of State for Health and Social Care - UK Government. COVID-19 Public Health Directions 2020: notification to NHS Digital [Internet]. 2023 [cited 2023 Jul 4]. Available from: https://web.archive.org/web/20250414105355/https://digital.nhs.uk/about-nhs-digital/corporate-information-and-documents/directions-and-data-provision-notices/data-provision-notices-dpns/opensafely-covid-19-service-data-provision-notice NHS Digital. ISB1523: Anonymisation Standard for Publishing Health and Social Care Data [Internet]. 2023 [cited 2023 Jul 4]. Available from: https://web.archive.org/web/20250430135246/standards.nhs.uk/published-standards/anonymisation-standard-for-publishing-health-and-social-care-data NHS Digital. Data Security and Protection Toolkit [Internet]. 2023 [cited 2023 Jul 4]. Available from: https://web.archive.org/web/20250405100349/https://digital.nhs.uk/services/data-security-and-protection-toolkit/data-security-and-protection-toolkit NHS Digital. Coronavirus (COVID-19): notice under regulation 3( 4 ) of the Health Service (Control of Patient Information) Regulations 2002 – general [Internet]. 2022 [cited 2023 Jul 5]. Available from: https://www.gov.uk/government/publications/coronavirus-covid-19-notification-of-data-controllers-to-share-information/coronavirus-covid-19-notice-under-regulation-34-of-the-health-service-control-of-patient-information-regulations-2002-general--2 Health Research Authority. Confidentiality Advisory Group [Internet]. 2023 [cited 2023 Jul 4]. Available from: https://web.archive.org/web/20250408154826/https://www.hra.nhs.uk/about-us/committees-and-services/confidentiality-advisory-group/ Data Availability All data were linked, stored, and analysed securely within the OpenSAFELY platform ( https://opensafely.org ). Data include pseudonymised information such as coded diagnoses, medications, and consultation details. No free-text data were included. Detailed pseudonymised patient data are potentially re-identifiable and cannot be shared. All analysis code is openly available for review and reuse under the MIT open licence at https://github.com/opensafely/pharmacy-first . This study also used publicly available data from the NHS Business Services Authority (NHS BSA) on dispensing contractors, available under the Open Government Licence at: https://www.nhsbsa.nhs.uk/prescription-data/dispensing-data/dispensing-contractors-data . https://www.nhsbsa.nhs.uk/prescription-data/dispensing-data/dispensing-contractors-data https://github.com/opensafely/pharmacy-first Acknowledgements We are very grateful for all the support received from the TPP Technical Operations team throughout this work, and for generous assistance from the information governance and database teams at NHS England and the NHS England Transformation Directorate. Footnotes Added Figure 3b, author affiliations updated, and word count reduced. References 1. ↵ NHS England . Appointments in General Practice . 2025 [cited 2025 Apr 15]. Appointments in General Practice. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/appointments-in-general-practice 2. ↵ British Medical Association . Pressures in general practice data analysis . 2025 [cited 2025 Apr 15]. Pressures in general practice data analysis. Available from: https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice-data-analysis 3. ↵ NHS England . Community Pharmacy Contractual Framework 2019-2024 [Internet] . 2024 [cited 2025 Apr 15]. Available from: https://www.england.nhs.uk/primary-care/pharmacy/community-pharmacy-contractual-framework/ 4. ↵ NHS England . Delivery plan for recovering access to primary care [Internet] . 2023 . Available from: https://www.england.nhs.uk/long-read/delivery-plan-for-recovering-access-to-primary-care-2/ 5. ↵ NHS England . Pharmacy services: Pharmacy First [Internet] . 2024 [cited 2025 Feb 26]. Available from: https://www.england.nhs.uk/primary-care/pharmacy/pharmacy-services/pharmacy-first/ 6. ↵ NHS England . Community Pharmacy advanced service specification: NHS Pharmacy First Service [Internet] . 2023 [cited 2025 Feb 26]. Available from: https://www.england.nhs.uk/publication/community-pharmacy-advanced-service-specification-nhs-pharmacy-first-service/ 7. ↵ NHS England . GP Connect Update Record [Internet] . 2023 [cited 2025 Feb 26]. Available from: https://digital.nhs.uk/developer/api-catalogue/gp-connect-update-record 8. ↵ NHS England . GP Connect: Update Record [Internet] . 2024 [cited 2025 Feb 26]. Available from: https://digital.nhs.uk/services/gp-connect/gp-connect-in-your-organisation/gp-connect-update-record 9. ↵ NHS England . GP Connect Update Record: FAQs [Internet] . 2025 [cited 2025 Mar 19]. Available from: https://www.england.nhs.uk/long-read/gp-connect-update-record-faqs/ 10. ↵ Community Pharmacy England. Reminder: GP Connect: Update Record rollout . 2024 [cited 2025 Feb 26]; Available from: https://web.archive.org/web/20240425094253/https://cpe.org.uk/our-news/gp-connect-update-record-rollout-and-flow-of-information/ 11. ↵ Glover RE , Lalani M , Sonnex K , Allen T , Anderson C , Ashiru-Oredope D , et al. A mixed methods protocol for an impact and implementation evaluation of the Pharmacy First Services for management of common conditions in England . Int J Pharm Pract . 2025 Mar 5; 12. ↵ Cunningham C , Fisher L , Wood C , Speed V , Brown AD , Curtis H , et al. Incidence and treatment of group A streptococcal infections during covid-19 pandemic and 2022 outbreak: retrospective cohort study in England using OpenSAFELY-TPP . BMJ Med [Internet] . 2024 May 24; 3 ( 1 ). Available from: https://bmjmedicine.bmj.com/content/3/1/e000791 13. ↵ Wood C , Speed V , Fisher L , Curtis HJ , Schaffer AL , Walker AJ , et al. The impact of COVID-19 on medication reviews in English primary care. An OpenSAFELY-TPP analysis of 20 million adult electronic health records . Br J Clin Pharmacol. 2024 July; 90 ( 7 ): 1600 – 14 . OpenUrl PubMed 14. ↵ NHS Business Service Authority . Dispensing contractors’ data [Internet] . 2025 [cited 2025 Feb 26]. Available from: https://www.nhsbsa.nhs.uk/prescription-data/dispensing-data/dispensing-contractors-data 15. ↵ UK Health Security Agency . English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) Report 2024-2025 [Internet] . [cited 2025 Dec 15]. Available from: https://assets.publishing.service.gov.uk/media/6936ac34b612700b2cb73607/ESPAUR-report-2024-to-2025.pdf 16. ↵ NHS England . NHS England » Collective action by GPs: supporting guidance [Internet] . [cited 2025 Dec 19]. Available from: https://www.england.nhs.uk/long-read/collective-action-by-gps-supporting-guidance/ 17. ↵ Department of Health & Social Care Pharmacy Team . Communication: Contractual Updates and Service Changes from October for Pharmacy First, Pharmacy Contraception Service and the New Medicine Service [Internet] . 2025 [cited 2025 Dec 16]. Available from: https://www.nhsbsa.nhs.uk/sites/default/files/2025-09/Communication%20to%20Contractors%201%20September%202025%20PF%20PCS%20and%20NMS.pdf 18. ↵ NHS Pharmacy First Clinical Pathways Data | NHSBSA [Internet] . [cited 2025 Dec 15]. Available from: https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/dispensing-contractors-information/nhs-pharmacy-first-service-pfs/nhs-pharmacy-first-clinical-pathways-data 19. ↵ Wang Y , Hunt K , Nazareth I , Freemantle N , Petersen I . Do men consult less than women? An analysis of routinely collected UK general practice data . BMJ Open . 2013 Aug 1; 3 ( 8 ): e003320 . OpenUrl Abstract / FREE Full Text 20. ↵ Todd A , Thomson K , Kasim A , Bambra C . Cutting care clusters: the creation of an inverse pharmacy care law? An area-level analysis exploring the clustering of community pharmacies in England . BMJ Open . 2018 Oct 1; 8 ( 7 ): e022109 . OpenUrl Abstract / FREE Full Text 21. ↵ Gopfert A , Deeny SR , Fisher R , Stafford M . Primary care consultation length by deprivation and multimorbidity in England: an observational study using electronic patient records . Br J Gen Pract . 2021 Mar 1; 71 ( 704 ): e185 – 92 . OpenUrl Abstract / FREE Full Text 22. ↵ Fisher R , Allen L , Malhotra A , Alderwick H . Tackling the inverse care law: Analysis of policies to improve general practice in deprived areas since 1990 [Internet] . The Health Foundation ; 2022 Jan [cited 2025 Apr 17]. Available from: https://www.health.org.uk/publications/reports/tackling-the-inverse-care-law 23. ↵ Andrews C , Schultze A , Curtis H , Hulme W , Tazare J , Evans S , et al. OpenSAFELY: Representativeness of electronic health record platform OpenSAFELY-TPP data compared to the population of England . Wellcome Open Res . 2022 ; 7 : 191 . 24. ↵ Fisher L , Speed V , Curtis HJ , Rentsch CT , Wong AYS , Schultze A , et al. Potentially inappropriate prescribing of DOACs to people with mechanical heart valves: A federated analysis of 57.9 million patients’ primary care records in situ using OpenSAFELY . Thromb Res . 2022 Mar 1; 211 : 150 – 3 . OpenUrl CrossRef PubMed 25. ↵ Fisher L , Curtis HJ , Croker R , Wiedemann M , Speed V , Wood C , et al. Eleven key measures for monitoring general practice clinical activity during COVID-19: A retrospective cohort study using 48 million adults’ primary care records in England through OpenSAFELY . Malagón T , Franco EL , Shah A , editors. eLife . 2023 July 27 ; 12 : e84673 . OpenUrl PubMed 26. ↵ Bennett Institute for Applied Data Science . OpenSAFELY Update – July 2024 [Internet] . 2024 . Available from: https://www.opensafely.org/changelog/#2024-07-24 27. ↵ NHS England . Changes to the GP Contract in 2025/26 [Internet] . [cited 2025 Dec 15]. Available from: https://www.england.nhs.uk/long-read/changes-to-the-gp-contract-in-2025-26/ View the discussion thread. Back to top Previous Next Posted December 30, 2025. Download PDF Supplementary Material Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Recording of Pharmacy First consultations in general practice records in England: an observational study of the service’s first year using OpenSAFELY Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Share Recording of Pharmacy First consultations in general practice records in England: an observational study of the service’s first year using OpenSAFELY Viveck J Kingsley , Milan Wiedemann , Christopher Wood , Helen J Curtis , Amelia Green , Louis Fisher , Colm D Andrews , David Evans , Amir Mehrkar , Sebastian Bacon , Ben Goldacre , Amelia C Taylor , Diane Ashiru-Oredope , Kimberley Sonnex , Thomas Allen , Hannah Higgins , Tracey Thornley , Nicholas Mays , Rebecca E Glover , Rachel A Elliott , Anthony J Avery , Brian MacKenna medRxiv 2025.09.30.25336964; doi: https://doi.org/10.1101/2025.09.30.25336964 Share This Article: Copy Citation Tools Recording of Pharmacy First consultations in general practice records in England: an observational study of the service’s first year using OpenSAFELY Viveck J Kingsley , Milan Wiedemann , Christopher Wood , Helen J Curtis , Amelia Green , Louis Fisher , Colm D Andrews , David Evans , Amir Mehrkar , Sebastian Bacon , Ben Goldacre , Amelia C Taylor , Diane Ashiru-Oredope , Kimberley Sonnex , Thomas Allen , Hannah Higgins , Tracey Thornley , Nicholas Mays , Rebecca E Glover , Rachel A Elliott , Anthony J Avery , Brian MacKenna medRxiv 2025.09.30.25336964; doi: https://doi.org/10.1101/2025.09.30.25336964 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Primary Care Research Subject Areas All Articles Addiction Medicine (568) Allergy and Immunology (863) Anesthesia (300) Cardiovascular Medicine (4435) Dentistry and Oral Medicine (444) Dermatology (382) Emergency Medicine (608) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1509) Epidemiology (15227) Forensic Medicine (30) Gastroenterology (1124) Genetic and Genomic Medicine (6597) Geriatric Medicine (668) Health Economics (997) Health Informatics (4534) Health Policy (1368) Health Systems and Quality Improvement (1613) Hematology (540) HIV/AIDS (1264) Infectious Diseases (except HIV/AIDS) (15916) Intensive Care and Critical Care Medicine (1103) Medical Education (623) Medical Ethics (146) Nephrology (667) Neurology (6599) Nursing (346) Nutrition (998) Obstetrics and Gynecology (1144) Occupational and Environmental Health (957) Oncology (3332) Ophthalmology (974) Orthopedics (369) Otolaryngology (420) Pain Medicine (436) Palliative Medicine (130) Pathology (663) Pediatrics (1693) Pharmacology and Therapeutics (691) Primary Care Research (711) Psychiatry and Clinical Psychology (5447) Public and Global Health (9230) Radiology and Imaging (2198) Rehabilitation Medicine and Physical Therapy (1370) Respiratory Medicine (1196) Rheumatology (593) Sexual and Reproductive Health (712) Sports Medicine (530) Surgery (712) Toxicology (99) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a002f1317f19ad07',t:'MTc3OTUyNzU4MA=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();