Pharmacy First myth busting: To reject or not to reject?
This article tackles some of the misconceptions around rejecting Pharmacy First referrals and aims to bust myths to increase understanding of the service.
We have previously published a series of articles on myth busting covering a variety of aspects of Pharmacy First. All of these myths can be viewed on our Pharmacy First service – myth busting page.
Myth: GP practices can refer patients for all three strands of the Pharmacy First service.
Wrong! GP practices can refer patients for two strands of the service:
- Minor illness consultations (as was the case in the previous Community Pharmacist Consultation Service (CPCS); and
- Clinical pathway consultations.
GP practices cannot refer patients for the Urgent supply of medicines/appliances strand of the service.
Myth: In the Pharmacy First service specification there is a list of all the minor illnesses that are included in the service.
Wrong! While the service specification does include a list of minor illness symptom groups identified for referral to a community pharmacist for the Minor illness strand of the service; it is important to note that this list is not exhaustive.
Therefore, if a referral is received for a minor illness that is not included in the list, for example, a verruca or chickenpox, this is not a reason to reject the referral and these patients can be seen under the Minor illness strand of the service.
Myth: Patients who are referred for the Clinical pathway strand of the service but do not meet the eligibility criteria should always be rejected.
Wrong! If a patient is referred for a Clinical pathway condition but does not meet the eligibility criteria, they may be able to be instead seen under the Minor illness strand of the service.
For example, if a patient is referred for earache but is an adult, they would not be eligible for the Acute Otitis Media clinical pathway, but the pharmacist could provide the Minor illness strand of the service for this patient.
Myth: Patients with symptoms indicative of a more serious illness/red flags should be rejected.
Wrong! If having spoken to the patient, you suspect the patient does not have a minor illness but instead has a more serious condition/red flags are identified, this is still classed as a Minor illness consultation and should be treated as such, instead of being rejected.
Appropriate action should be agreed with the patient such as the pharmacist arranging an urgent appointment with the patient’s GP, GP out of hours provider or a referral to the emergency department/999.
Myth: Patients who are not contactable should be rejected.
Wrong! If a patient is not contactable, then you are not able to claim for a consultation. However, the referral should be closed on the Pharmacy First IT system, noting the reason for this, rather than the referral being rejected.
Myth: There are no implications from rejecting referrals.
Wrong! There will be times when it is appropriate to reject a referral, for example, if a GP practice has referred a patient for a medication review, which is not part of the service. However, there are implications of rejecting appropriate referrals, for example:
- GP practices may not review rejection messages on the same day. Therefore there is a risk that a patient with a serious condition may be missed or even those with minor illnesses are left not being able to see another healthcare professional.
- If you are rejecting referrals which are appropriate for the Pharmacy First service, this may affect the GP practice team’s willingness/confidence in future to make referrals for the service.
- You will not be paid for the consultation.
Therefore, it is important to carefully consider whether rejection is the appropriate action to take when you receive a referral.
Pharmacy owners are reminded that we have published a resource ‘The Pharmacy First Service – when can you claim?’ which provides a range of scenarios for the service and highlights when a payment claim can be made.
