Introduction
At least 100 community pharmacy minor ailments schemes have been implemented by local Primary Care Trusts (PCT) across the UK.1 However, only a small number of these schemes had been evaluated qualitatively.2-4 Results from these evaluations have demonstrated that most of the stakeholders (patients, pharmacists and GPs) thought the schemes benefited patients and health care professionals. The Pharmacy First Minor Ailments scheme was introduced by Nottingham City PCT in December, 2003. As part of our evaluation of the scheme we investigated barriers to the use of the scheme from stakeholders' perspective.

Method
A qualitative approach using semi-structured interviews was adopted. Forty stakeholders, 26 community pharmacists, 7 GPs and 7 relevant commissioners, took part in face-to-face interviews, which were conducted between November 2004 and March 2005. Each interview was tape-recorded with the participant's consent. The interviews were transcribed verbatim and analysed for emerging themes using the principles of constant comparison and deviant case analysis.

Key findings
Although the attitudes of the stakeholders toward the scheme varied widely, the majority were positive about benefits of the Pharmacy First Minor Ailments scheme to both patients and health care professionals. Three-quarters of the stakeholders felt that the formulary was too limited, and the most commonly suggested medicines to add were chloramphenicol and antihistamines (for hay fever). Most of the GPs and pharmacists felt that the publicity for the scheme had not been widespread, and therefore people did not know much about the scheme. Pharmacists highlighted a number of problems related to operating the scheme, for example, the large amount of paperwork involved, the lack of privacy on some pharmacy premises, general practice staffs' misunderstanding about the scheme, and the difficulty in providing services for some ailments. Several suggestions were made by interviewees about how the service could be improved and developed, such as, reducing the amount of paperwork, extending the formulary, increasing the publicity in order to raise public awareness, computerising the scheme, and providing training programmes for pharmacists.

Discussion
Most of the stakeholders were positive about benefits of the scheme to both patients and health care professionals, despite raising some problems. This has also been the case with the other minor ailments schemes and the most common suggestions for improving the schemes were to extend the formulary and reduce paperwork. 2-5 Nottingham City PCT has taken steps to resolve many of the issues raised in that they have extended the formulary, increased the publicity for the scheme and raised the consultation fee paid to pharmacists. Moreover, the administration process and paperwork involved are currently being revised and a computerised system is being piloted. However, there are still some issues outstanding that need to be addressed particularly the lack of privacy in some pharmacies.