This webpage explains how the Pharmacy First GP referral pathway works and how to implement it in primary care networks (PCNs) and general practices.

• What is the NHS Pharmacy First service?
• How does the service work?
• How to implement a referral pathway from General Practice into Pharmacy First services

What is the NHS Pharmacy First service?

The Pharmacy First service was launched in January 2024 – developed from and superseding the Community Pharmacy Consultation Service (CPCS).

There are 3 parts to the Pharmacy First service:

• Low acuity/minor illness management (legacy CPCS)
• Clinical pathways consultations
• Urgent repeat medication supplies – for NHS 111/urgent and emergency care (UEC) settings only (legacy CPCS)

Low acuity/minor illness management

A wide range of minor illnesses and common conditions are suitable to be referred into the Pharmacy First service: (this list is not exhaustive)

Clinical pathway consultations

The clinical pathways have been developed with input from a diverse group of experts including practising clinicians, antimicrobial resistance specialists, and representatives from national organisations, to create a service that benefits as many patients as possible.

Decisions made by this group were consensus-driven and grounded in the latest evidence and national guidelines.

The pathways have been designed with embedded measures to identify red flags and mitigate antimicrobial resistance, assisting pharmacists in effectively managing patients with common conditions.

The seven commonly occurring infections and age ranges included in the Pharmacy First Service are below:

* Distance selling pharmacies will not complete consultations for acute otitis media.

The service enables community pharmacies to manage minor illness and common conditions by offering patients self-care and safety-netting advice, and – where appropriate – supplying over the counter (OTC) and prescription only medicines (POM) via Clinical Protocol and Patient Group Directions (PGDs).

It supports general practice to ensure patients are seen by the right healthcare professional in the right place at the right time, helping free up GP appointments for those with higher acuity needs and increasing access to primary care services.

How does the service work?

Access

When a patient with relevant symptoms contacts their GP practice (which could be through an online consultation tool), and has been clinically triaged, the care navigator or receptionist can refer the patient for a consultation with a community pharmacy of the patient’s choice.

With the patient’s consent, the practice team can quickly and easily use integrated referral functionality within their GP IT system to send an electronic referral message to the pharmacy, supporting safe follow up and audit.

As part of the referral, the practice will advise the patient to contact the pharmacy and provide contact details.

The pharmacist may carry out the consultation remotely (including video consultation), if appropriate, or arrange for the patient to attend the pharmacy.

Pharmacies can access patient clinical information to inform the consultation via NCRS or the Summary Care Record.

For more information on how patient medical information is made available to appropriate clinicians please visit GP Connect Access Record.

Consultation

The pharmacist will take the patient’s clinical history and ask about symptoms and any current medication.

Following the consultation, the pharmacist will offer clinical advice and may sell the patient an over the counter (OTC) product or supply a prescription only medicine (POM) under the terms of a PGD, if appropriate.

For supplies made under a PGD, normal NHS prescription charge exemptions still apply.

Pharmacists are trained to recognise ‘red flag’ symptoms suggestive of more serious illness.

After initial triage, if symptoms do suggest something more serious, the pharmacist will help the patient to arrange an urgent GP appointment using the practice’s dedicated professional number or, if needed, escalate to an urgent care setting such as the emergency department.

Record keeping

The pharmacist will record the outcome of the consultation and send it to the patient’s GP.

GP practices who have enabled Update Record will receive a secure digital message on the practice system.

Otherwise, pharmacies will send the outcome of the consultation to the practice via secure email.

Information for general practices on GP Connect Update Record can be found here: GP Connect: Update Record – NHS England Digital

Implementing a referral pathway from general practice to Pharmacy First services

Community Pharmacy England have produced a web page Pharmacy First – Information for GP practice teams – Community Pharmacy England which has  a number of resources to support the introduction of Pharmacy First, including an animation and a toolkit to support reception teams and care navigators identify those suitable to be referred into the Pharmacy First service.

Making electronic referrals

99% of GP foundation systems have integrated, digital capability to be able to make Pharmacy First referrals. These referral solutions can be used for both minor illness and clinical pathways referrals.

In the exceptional cases where a GP system is being used that does not have integrated referral capability to Pharmacy First – referrals must be sent to Community Pharmacy via the dedicated GP email for pharmacy communications.

GP system suppliers have created guidance for their users on how to set up and use the integrated referral capability. Staff within general practice should refer to this for system specific support.

Collaboration within primary care networks

The Pharmacy First referral pathway from general practice works especially well when collaborative working relationships are built between care providers.

Implementation resources are available on the dedicated primary care network (PCN) page on NHS Futures (login required) to support practice staff and PCNs to implement the referral pathway.

This page includes a list of regional contacts who can help with practice and PCN queries about local pathway implementation

For more information on Pharmacy First, please visit NHS England » Pharmacy First.