Referrals
Referrals
Referrals for the Pharmacy First service can be made in different ways. The referring organisation will provide the phone number of the selected pharmacy to the patient and advise them to either call the pharmacist or attend in person at the pharmacy.
An electronic referral will be sent to the selected pharmacy’s IT system and/or to the pharmacy NHSmail shared mailbox, both of which should be checked regularly.
Where a contractor has received a referral but has not been contacted by the patient within 30 minutes, the pharmacist should use clinical judgement in deciding whether to contact the patient. If the patient has not made contact before the next working day, then the referral can be closed.
Types of referrals
Referrals can be made from all the referring organisations apart from general practice. If a prescription is available for the item the patient is requesting, this should be used to fulfil the urgent supply.
For the emergency supply to be made, the pharmacist must have interviewed the person requesting the item and satisfied themselves that:
- There is an immediate need for it to be supplied
- It is impracticable for the patient to obtain a prescription without undue delay
- An emergency supply is legal.
If the medicine is not in stock at the selected pharmacy, the pharmacist will identify another pharmacy that provides the service and forward the electronic referral (in this instance, both pharmacies are eligible for the service completion fee).
If it is not possible to make an emergency supply (due to legal or other patient factors), the pharmacist will ensure the patient is able to speak to another appropriate healthcare professional by either:
- Referring the patient to their own general practice
- Contacting a local out-of-hours provider.
Pharmacists must not refer a patient back to NHS 111 or the IUC CAS by asking the patient to call back directly.
The pharmacist should ensure that any relevant red flags – symptoms associated with sepsis, meningitis or cancer – are recognised and responded to.
Any concurrent medication or medical conditions should be identified.
The outcome of the referral may include:
- Self-care advice and sale of an OTC medicine if appropriate
- Any of the clinical pathway outcomes for the seven conditions
- 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.
If a patient has used the service more than twice within a month, with the same symptoms and there is no indication for urgent referral, the pharmacist should consider referring the patient to their GP.
If pharmacists require additional advice or need to escalate the patient to a higher acuity care location, they should use their clinical judgement to decide the urgency, route and need for referral, and choose one of the options below:
- Option A – Refer the patient for an urgent in-hours appointment with their own GP and contact the practice to secure an appointment
- Option B – Call NHS 111 service if the patient’s own GP is not available, using the healthcare professionals’ line for access to a clinician, to seek advice
- Option C – If the patient presents with severe symptoms indicating the need for an immediate medical consultation, the pharmacist should tell the patient to attend A&E immediately or call an ambulance on their behalf.