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Pharmacies in England assessing patients under the sore throat pathway of Pharmacy First are more than twice as likely to supply antibiotics than their counterparts in Wales, a new study has found. 

The study, published in the Journal of Antimicrobial Chemotherapy in March, compared the Acute Sore Throat Pharmacy First (ASTPF) scheme in England with the Sore Throat Test and Treat (STTT) service in Wales, looking at their respective antibiotic supply rates between February 1, 2024 and July 30, 2024. 

In England, the supply rate was 72.7 per cent based on 317,864 consultations, compared to a 20.9 per cent supply rate in Wales based on 27,684 consultations. 

The authors noted that Pharmacy First authorises antibiotic supply to patients with a FeverPAIN clinical score of 4 or 5, while in Wales pharmacists must confirm the presence of suspected group A Streptococcus (GAS) with point-of-care testing (POCT) before making a supply. 

In addition, Wales uses a lower FeverPAIN score threshold of 2 or 3 to decide if patients are eligible for POCT.  “The rationale behind the different FeverPAIN thresholds in England and Wales is not clear from published literature or policy documents,” the study authors note.

And even when the researchers looked only at Welsh patients who had a FeverPAIN score of 4 or higher, the prescribing rate of 59.7 per cent was still “significantly lower” than under ASTPF. 

In addition to the differing policy on the use of POCT, the authors cite the “gradual” introduction of the Welsh sore throat service versus the ‘at scale’ launch of Pharmacy First as a possible factor driving the disparity in supply rates. 

The paper’s authors were awarded a £2.4m research grant last February to assess the impact of Pharmacy First over its first three years, looking in particular at antimicrobial resistance issues. 

Research fellow Ayodeji Matuluko of the London School of Hygiene and Tropical Medicine, who was joint first author on the paper, commented: “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.” 

Rebecca Glover, assistant professor in antimicrobial resistance at LSHTM, 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 programme 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.”