Practices referring patients to Pharmacy First for lower acuity minor illnesses and clinical pathway consultations

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

What is the NHS Pharmacy First service?

In May 2023, NHS England and the Department of Health and Social Care (DHSC) published the Delivery plan for recovering access to primary care. The plan committed to expanding the role of community pharmacy by introducing a Pharmacy First service, enabling them to support the management of seven common conditions.

The Pharmacy First service incorporates and builds on elements (urgent medicines supply and minor illness) of the Community Pharmacist Consultation Service (CPCS). It enables community pharmacies to manage common infections 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).

Three parts of the Pharmacy First Service:

  • urgent repeat medication supplies for NHS 111/urgent and emergency care (UEC) settings only
  • low acuity/minor illness management
  • clinical pathways 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 mitigate antimicrobial resistance, assisting pharmacists in effectively managing patients with common conditions.

The seven commonly occurring infections included in the Pharmacy First Service:

  • uncomplicated urinary tract infection (women aged 16-64 years)
  • impetigo (adults and children aged 1 year and older)
  • infected insect bites (adults and children aged 1 year and older)
  • acute sore throat (adults and children aged 5 years and older)
  • acute sinusitis (adults and children aged 12 years and older)
  • shingles (adults aged 18 years and older)
  • acute otitis media (children aged 1 to 17 years)

The service 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.

Pharmacies can access National Care Record Service (NCRS) and data suggests that pharmacists are able to complete episodes of care for approximately 9 out of 10 patient consultations , rather than the patient seeing their GP or attending an Urgent and Emergency Care setting. For more information on how patient medical information is made available to appropriate clinicians please visit GP Connect Access Record.

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

How does the service work?

When a patient with relevant symptoms contacts their GP practice, the care navigator or receptionist can refer the patient for a consultation with a community pharmacist of the patient’s choice. With the patient’s consent, the practice team will 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 by telephone (for minor illness), or, if appropriate, arrange for the patient to attend the pharmacy. In some situations, the pharmacist may offer patients a video 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 OTC product or supply a POM 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.

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

How to get started

CPE has produced an animation to introduce the service to healthcare professionals.

GP clinical system may already have integrated referral functionality enabled. Practices can start referring as soon as they have set up a referral process to enable the electronic message to be sent to community pharmacies (e.g. NHS mail, electronic interoperable messages between IT suppliers, or as part of a local shared record appointment system). I.T. suppliers will be required to meet the Booking and Referral Standard (BaRS).

Implementation resources are available on the dedicated PCN page on Future NHS 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 services, visit the NHS England » Pharmacy service webpages.