The department's Primary Care Clinical Trials Unit has partnered with Boots to test whether community pharmacies can serve as effective sites for clinical trial recruitment, following the shift in patient pathways brought about by NHS Pharmacy First.
A Boots store in Durham Market Place is now recruiting women with urinary tract infection (UTI) symptoms to the DURATION trial, which investigates optimal antibiotic treatment durations to help tackle antimicrobial resistance. The store will invite customers presenting with UTI symptoms to take part in the research.
The pilot responds to a practical challenge created by NHS Pharmacy First, launched in England in 2024. The policy enables pharmacists to diagnose and treat seven common conditions, including UTIs – meaning patients who would previously have visited their GP now increasingly access treatment through community pharmacies instead. For trials that have traditionally recruited through general practice, this represents a significant change in where potential participants can be found.
Building on pandemic learning
The approach draws on experience gained during the COVID-19 pandemic, when the PRINCIPLE trial successfully recruited participants through community pharmacies. However, while pandemic recruitment was a temporary response to exceptional circumstances, Pharmacy First represents a permanent shift in how care is delivered – requiring a more systematic adaptation of research infrastructure.
Lucy Cureton, Senior Trial Manager at the Primary Care Clinical Trials Unit, said: "The introduction of the Pharmacy First pathway has been hugely beneficial for patients. However, it has fundamentally changed where patients present with UTI symptoms. This presents a challenge to primary care clinical trials, where GP surgeries are a key location for recruiting participants. We want to show that our research can pivot alongside the changing landscape of healthcare delivery."
Heather Elliot, Director of Life Sciences and Clinical Trials at Boots, said: "This partnership demonstrates how community pharmacies can contribute to nationally important research whilst delivering expanded clinical services. Our colleagues in Durham are proud to be part of this pilot and to play a role in this important work to address antimicrobial resistance through both evidence-based prescribing and active research participation."
Addressing a critical evidence gap
The DURATION trial addresses a significant gap in the evidence base for antibiotic prescribing. With over four million UTI prescriptions issued annually in the UK, there is surprisingly limited evidence on optimal treatment length. Current practice risks unnecessarily prolonged antibiotic courses – a key driver of resistance development.
The trial aims to recruit 1,650 women across primary and secondary care settings, randomising those with bladder infections (cystitis) to receive commonly prescribed antibiotics for varying durations, and those with kidney infections (pyelonephritis) to comparable treatments for different periods. Participants complete symptom diaries and provide urine samples to assess both clinical recovery and resistance development up to 42 days after treatment.
Testing a new model
The Durham pilot will assess whether recruitment rates and data quality from community pharmacy match those achieved through GP-based recruitment, while also addressing practical questions around workflow management, consent processes, and sample collection logistics. Boots' network of over 1,800 stores, combined with established clinical infrastructure and high levels of public trust, offers a significant opportunity to test this approach at scale.
Recruitment to DURATION continues across GP practices and secondary care settings until February 2026, with results expected by the end of the year. The findings will inform national and international prescribing guidelines for UTI treatment duration.