Referring minor illness patients to a community pharmacist: new referral pathway for primary care networks

This briefing note explains how the GP referral pathway works and how to implement it in PCNs and practices. It has been produced in partnership with Royal College of General Practitioners, Royal Pharmaceutical Society, Pharmaceutical Services Negotiating Committee, Primary Care Pharmacy Association and us.


Content


What is the NHS Community Pharmacist Consultation Service?

  1. The NHS Community Pharmacist Consultation Service (CPCS) offers patients same day minor illness consultations with a community pharmacist. Working in conjunction with the RCGP and BMA the service was developed to allow practice teams to refer low acuity patients for convenient, same-day consultations with clinical advice and, where indicated, the purchase of any over-the-counter medicine the patient may need.
  2. This new service can support general practice to ensure patients are seen by the right healthcare professional, in the right place, at the right time and will help make more GP appointments available for those with higher acuity needs.
  3. Currently 94% of all community pharmacies are signed up to provide the service, with those pharmacists having access to clinical skills continuing professional development training run by the RPS and RCGP.
  4. The benefit of the service for patients is that they are triaged on the same day and given the clinical advice and support they need. There is good evidence that advice provided by community pharmacists about minor illness results in the same outcome as if the patient went to see their GP or attended an emergency department.
  5. The benefit of the service for practices is the effective management of low acuity patients in alternative settings, supporting workload pressures in General Practice. The availability of this referral pathway now for all practice teams should be a fundamental part of restoring and increasing access to primary care services following wave two of the COVID-19 pandemic.

How does the service work?

  1. When a patient with minor illness symptoms contacts their GP practice requesting an appointment the care navigator or receptionist will ask them a series of questions using a standard appropriate symptom checklist. If their symptoms are appropriate, the GP practice can refer them for a same-day consultation with a community pharmacist. With the patient’s consent, the practice team can send an electronic referral message to the pharmacy the patient has chosen, to support safe follow up and audit.
  2. Following the referral, the pharmacist will contact the patient the same day by phone and either carry out the consultation by telephone, or arrange for the patient to attend the pharmacy, if appropriate. Some patients may be offered a video consultation by the pharmacist.
  3. 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 product if appropriate and they agree.
  4. Pharmacists are trained to recognise ‘red flag’ symptoms suggestive of more serious illness and after initial triage, where 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 escalate to an urgent care setting such as the emergency department, if needed.
  5. The pharmacist will make a record of the outcome of the consultation and send it to the patient’s GP by secure digital message.

How to get started

  1. Practices can start referring straight away into the new service as soon as the secure electronic referral process has been agreed with local community pharmacies (e.g. NHS mail, electronic interoperable messages between IT systems, or as part of a local shared record appointment system), ensuring integration with existing digital triage and assessment systems.
  2. Practices are already using the pathway with the support of NHS England and NHS Improvement regional teams. An implementation toolkit available on the dedicated GP CPCS page on Future NHS provides resources and templates to support practice staff and PCNs to implement the service.
  3. For more information visit the Future NHS page to see how to contact your local implementation lead.

The Pharmaceutical Services Negotiating Committee has produced an animation to explain how GP practices can refer into service.

Evaluation

  1. 340,000 patients have already been safely referred to the Community Pharmacist Consultation Service from NHS 111 for a minor illness consultation since October 2019. NHSE&I’s evaluation of the early adopters of the GP referral pathway showed the process to be safe, with a significant reduction in the number of GP in-hours appointments and high patient satisfaction scores. Significantly, 86% of patients chose to have a consultation with the pharmacist when one was offered, and 9 out of 10 people referred to the pharmacist were successfully treated or advised without onwards referral.
  2. Research commissioned for NHSE&I shows that almost nine in ten (89%) members of the public say they trust community pharmacists a great deal or a fair amount and 83% say they would be comfortable being referred to a community pharmacist by a GP receptionist, saying that it would allow GPs to spend more time with people who have serious health conditions and provide the convenience of being seen on the same day.

Case studies

Dr James Case, GP, Concord Medical Centre, Bristol: 

  1. “We see constant requests throughout the week from patients wanting to see their GP, many with minor illnesses, which are more suitably addressed by a community pharmacist. We estimated between 5-10% of those patients would be better going to a community pharmacy for help instead.
  2. “With training, our reception team was able to pick up on the sorts of illnesses that can more suitably be dealt with by a community pharmacist. We have a good process in place for referring patients to see the pharmacist and 70-80% of the issues are resolved by them. If during the consultation, the pharmacist identifies that the patient has a more complex problem, we will arrange to see them at the practice.”

Ann Neville, Practice Manager Lead at Darwen Primary Care Network:

  1. “The practices in Darwen were already familiar with care navigation and we were keen to see how implementing CPCS could help us to extend it. Our care navigators found the new process slightly more time consuming initially – as with any new way of working – but quickly picked up speed and the practices started to see the benefits of CPCS, in terms of better use of practice appointments for complex care and referral on to the pharmacists appropriately, particularly during the winter months.
  2. “GP referral to CPCS has allowed us to build our working relationships with our community pharmacy colleagues and patient feedback has been excellent.”

Bruce Prentice, Project Lead and Clinical Advisor to NHS England and NHS Improvement North West Region:

  1. “The aim in the North West is to create a sustainable and resilient long-term model for GP referral to CPCS delivering care within the practice framework. Following the successful introduction of the service, we are now seeking to expand it into 30% of our primary care networks across the whole of the North West by Autumn 2021.”