The Kent, Surrey and Sussex working group discussions showed that pharmacists are often nervous about making a clinical decision when someone is acutely ill. Comments highlighted particular concerns about missing danger symptoms that could suggest something is seriously wrong.

This was particularly true for pharmacists from secondary care, who recognised that in their usual practice, they would offer advice to consultants and medical colleagues on the right action to take. When faced with advising on self care and minor ailments in their occasional community pharmacy practice, they felt that they were more likely to refer. In some cases, this tendency to refer related to a lack of familiarity with the therapies available to offer over the counter.

Regardless of why the pharmacist is reluctant to make the decision, the evidence shows that when people are unwell they want to get the appropriate care at their first visit. The uncertainty over who can or will do what is one of the reasons why people choose to go to emergency departments.