Clinical pathway consultations 

The service enables pharmacists to provide advice and NHS-funded treatment, where clinically appropriate, for seven common conditions including via patient group directions (PGDs). 

Clinical pathways should be used for patients presenting with symptoms associated with any of the following conditions: 

• Sinusitis 
• Sore throat 
• Acute otitis media 
• Infected insect bite 
• Impetigo 
• Shingles 
• Uncomplicated urinary tract infections in women. 

A clinical pathways consultation can only be accessed when a gateway point in one of the clinical pathways is crossed. Pharmacists must confirm allergy status and identify any concurrent medication or medical conditions that may affect the treatment of the patient. 

Outcomes

The outcome of a consultation may include: 

• Self-care advice and sale of an OTC medicine if appropriate 
• Any of the clinical pathway outcomes, including: 

• • supply of a medicine under a PGD 
  • no supply of a medicine as it is not clinically appropriate 
• Referral to a separately commissioned service delivered in the pharmacy 
• Referral to the patient’s GP or relevant out-of-hours service for an urgent appointment 
• Routine referral to other appropriate services (including other health professionals). 

(The seven clinical pathways and associated PGDs are available on the NHS England website.) 

For urgent medicines supply, a referral is completed when either: 

• The pharmacist has a consultation with the patient and confirms no supply is 
• required 
• The patient is given advice, purchases a product, or an emergency supply is made 
• The patient is referred on to another healthcare provider 
• An EPS prescription is downloaded and dispensed 
• An item is not available and the patient is referred to a second pharmacy. 

For minor illness, a referral is completed when either: 

• The pharmacist has a consultation with the patient and the patient is given self-care advice and purchases an OTC item if appropriate 
• The patient is referred to a minor ailments scheme locally (where one exists) 
• The patient is referred to an appropriate prescriber 
• The pharmacist decides to refer the patient onwards to higher acuity services 
• The patient is contacted but refuses a consultation.

(A reminder that the seven clinical pathways and associated PGDs are available at NHS England Pharmacy First Service specification)