Pharmacy First: To reject or not to reject?

LPCs across Cheshire and Merseyside have been reviewing Pharmacy First data and have identified several referrals from GP practices where a pharmacy has rejected a referral where a Minor illness consultation could have been completed and claimed.

The data also showed examples of where the rejection message showed that a consultation had taken place, but the referral had been rejected instead of completing a clinical record on the Pharmacy First IT system. This therefore meant the pharmacy owner was not eligible for a consultation fee.

The LPCs have kindly shared their analysis to allow us to highlight these examples of inappropriate rejections to help spread learning amongst pharmacy teams to ensure patients are seen when appropriate and to maximise the opportunities for pharmacies to provide the service and claim payment.

Pharmacy teams are reminded that GP practices can refer patients for two strands of the service:

  1. Minor illness consultations (as was the case in the previous Community Pharmacist Consultation Service (CPCS); and
  2. Clinical pathway consultations.

GP practices cannot refer patients for the Urgent supply of medicines/appliances strand of the service.

Key learnings

There is not an exhaustive list of minor illnesses included in the service

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.

Patients who are referred for the Clinical pathway strand of the service but do not meet the eligibility criteria should not be rejected; they can instead be seen under the Minor illness strand of the service

If a patient is referred for a Clinical pathway condition but does not meet the eligibility criteria, they can instead be 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.

Patients with symptoms indicative of a more serious illness/red flags should not be rejected

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.

Patients who are not contactable should not be rejected

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.

There are implications of rejecting appropriate referrals

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.

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