Introduction & module overview

The past year has been another incredibly busy one as community pharmacy is increasingly seen as the first point of contact for many patients. While England still lags behind Wales and Scotland when it comes to utilising community pharmacy, this is changing and NHS England’s primary care delivery plan will see the expansion of pharmacy blood pressure and oral contraception services. 

In addition, England’s Pharmacy First service, which starts on January 31, 2024, is intended to increase access to POMs for seven common conditions (impetigo, infected insect bite, sinusitis, sore throat, earache, shingles and uncomplicated UTIs in women).

Meanwhile, community pharmacy has continued to play a key role in flu and Covid-19 vaccination services.

Clinical developments

NICE updates quality standards for UTIs in adults

Three new standards and two updated pieces of guidance on urinary tract infections (UTIs) were published during the year. The first new standard states that women under 65 years of age are diagnosed with a UTI if they have two or more key urinary symptoms and no other excluding causes or warning signs.

No single symptom or combination of symptoms are completely reliable in diagnosing a urinary tract infection. Other causes of urinary symptoms, such as vaginal and urethral problems, need to be excluded. For example, the presence of discharge or irritation reduces the probability of a UTI. It is also important to exclude vaginal infections and sexually transmitted diseases.

The second and third new standards cover short courses of antibiotics sufficient for treating uncomplicated lower UTIs:

• Non-pregnant women with an uncomplicated lower UTI should be prescribed a three-day course of antibiotics; men and pregnant women with an uncomplicated lower UTI should be prescribed a seven‐day course
• Men with a recurrent UTI, and women with a recurrent lower UTI where the cause is unknown, or a recurrent upper UTI, should be referred for specialist advice.

The two updated pieces of guidance are that men and non-pregnant women should not be prescribed antibiotics to treat asymptomatic bacteriuria; and adults with indwelling urinary catheters do not need to have dipstick testing to diagnose UTIs.