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NHS Pharmacy First Service

This navigation tool is to facilitate Pharmacy First referrals generated by GP practice reception/ triage teams for a consultation with community pharmacies. The navigation tool is also available as a 2-page visual summary in table format.

  • Referrals should be generated by EMIS Local Services (or PharmRefer for Vision practices) Pharmacy First triage assessment tool.
  • When sending a referral EMIS Local Service or PharmRefer automatically lists pharmacies that currently offer the Pharmacy First Service.
  • Referrals should preferably be made to the patient’s nominated pharmacy but always ask the patient which pharmacy they prefer.
  • The patient may transfer between Clinical Pathways and Minor Illness service, depending on the symptoms presented at the community pharmacy.
  • NHS Pharmacy First service consists of three core elements:
    • Urgent repeat medicine supply
    • NHS referrals for minor illness consultation (previously commissioned as the GP CPCS).
    • Clinical pathways (new element)

Urgent Repeat Medicine Supply

  • Referral from Urgent and Emergency Care settings only.
  • Patients can be signposted to NHS 111 if a general practice is unable to furnish a prescription for a repeat medicine e.g. evenings/weekends.
  • Usual prescription charges/exemption rules apply

Minor Illness Consultation

  • Practice referral only via EMIS Local Services or PharmRefer
  • Do not refer patients aged under the age of 1.
  • Self care and safety netting advice will be provided in addition to any over the counter medication recommendation (if required) for the patient to purchase. 
  • The list of minor illness symptoms groups identified for referral to a community pharmacist can be found in Annex D of the service specification.

This list is not exhaustive:

  • Acne, spots, and pimples
  • Allergic reaction
  • Ankle or foot pain or swelling
  • Athlete’s foot
  • Bites or stings, insect or spider
  • Blisters
  • Constipation
  • Cough
  • Cold and flu
  • Diarrhoea
  • Ear discharge or ear wax
  • Earache
  • Eye, red or irritable
  • Eye, sticky or watery
  • Eyelid problems
  • Hair loss
  • Headache
  • Hearing problems or blocked ear
  • Knee or lower leg pain
  • Lower back pain
  • Lower limb pain or swelling
  • Mouth ulcers
  • Nasal congestion
  • Pain and/or frequency passing urine
  • Rectal pain
  • Scabies
  • Scratches and grazes
  • Sinusitis
  • Shoulder pain
  • Skin, blisters or rash
  • Sleep difficulties
  • Sore throat
  • Teething
  • Tiredness
  • Toe pain or swelling
  • Vaginal discharge
  • Vaginal itch or soreness
  • Vomiting
  • Wrist, hand, finger pain or swelling

Clinical Pathways Consultation

  • Practice referral via EMIS Local Service/PharmRefer and walk-in.
  • The new service will enable the management of seven conditions across various age ranges: 
    • Uncomplicated Urinary Tract Infections:  Women aged between 16 and 64 years
    • Shingles: 18 years and over
    • Impetigo: 1 year and over
    • Infected Insect Bites: 1 year and over
    • Sinusitis: 12 years and over
    • Sore Throat: 5 years and over
    • Acute Otitis Media:1 to 17 years 
  • Self care and safety netting advice provided.
  • If appropriate specific Prescription Only Medication supplied via a PGD.
  • Usual prescription charges/exemption rules apply.

Uncomplicated Urinary Tract Infection (UTI)

Signs and symptoms a patient may say

  • Burning pain when passing urine.
  • Needing to pass urine in the night.
  • Cloudy urine
Do refer:
  • Age 16 to 64 years.
  • Female.
  • Signs and symptoms of lower UTI
Do not refer
  • Under 16 years or over 64 years.
  • Male.
  • Pregnant.
  • Breastfeeding.
  • Recurrent UTI (2 in the last 6 months or 3 in the last 12 months).
  • Patient is using a urinary catheter device.
  • Temperature above 37.9°C

Shingles: Infection that causes a painful rash

Signs and symptoms a patient may say: Initially:

  • tingling or painful feeling in an area of skin.
  • headache or feeling generally unwell.

A few days later a rash appears in blotches on one side of the body only.

Do refer
  • Age 18 years and over.
  • Rash appears within the last 7 days.
  • Signs and symptoms of shingles.
Do not refer
  • Aged under 18.
  • Pregnant or suspected pregnancy.
  • Breastfeeding with shingle sores on the breasts.
  • Shingle rash onset over 7 days ago

Impetigo: A contagious skin infection

Signs and symptoms a patient may say:

  • Sores or blisters quickly burst and leave crusty, golden-brown patches.
  • Patches can:
    • look a bit like cornflakes stuck to the skin
    • get bigger
    • spread to other parts of the body
    • be itchy
    • sometimes be painful
Do refer
  • Age 1 year and over.
  • Signs and symptoms of impetigo.
Do not refer
  • Children under 1 year of age.
  • Recurrent impetigo (2 or more episodes in the same year). 
  • Pregnant or suspected pregnancy under 16 years. 
  • Bullous (fluid filled blisters) impetigo

Infected Insect Bites

Signs and symptoms a patient may say:

  • Redness/pain/tenderness/ swelling of the skin. 
  • Redness/swelling of the skin surrounding the bite/sting is spreading.
  • Skin surrounding the bite/sting feels hot to touch.
  • Pus leaking from site of bite/sting
Do refer
  • Age 1 year and over. 
  • Infection that is present or worsening at least 48 hours after the initial bite(s) or sting(s).
Do not refer
  • Children under 1 year of age.
  • Pregnant or suspected pregnancy under 16 years.
  • Human or animal bite.
  • Bite or sting occurred while travelling outside the UK.

Acute Sore Throat

Signs and symptoms a patient may say:

  • Throat is painful/dry/scratchy.
  • Redness in the back of the mouth.
  • Swollen tonsil(s).
  • Pus filled spots on tonsil(s).
  • High temperature.

Recurrent sore throat/tonsillitis:

  • 7 or more episodes in 12 months  
    • 5 or more episodes in each of the preceding 2 years
    • 3 or more episodes in each of the preceding 3 years
Do refer
  • Age 5 years and over. 
  • Signs and symptoms of acute sore throat
Do not refer:
  • Children under 5 years of age.
  • Pregnant or suspected pregnancy under 16 years.
  • Recurrent sore throat/tonsillitis:
    • 7 or more episodes in 12 months  
    • 5 or more episodes in each of the preceding 2 years
    • 3 or more episodes in each of the preceding 3 years

Acute Sinusitis: Infection of the sinuses (behind the forehead, cheeks and nose)

Signs and symptoms a patient may say:

  • Pain, swelling and tenderness around cheeks, eyes or forehead.
  • Blocked or runny nose.
  • Reduced sense of smell.
  • Green or yellow mucus from nose.
  • High temperature.
Do refer
  • Age12 years and over.
  • Signs and symptoms of acute sinusitis.
  • Symptom duration of 10 days of more.
Do not refer
  • Under 12 years of age.
  • Pregnancy or suspected pregnancy under 16 years of age. 
  • Symptom present less than 10 days.
  • Recurrent sinusitis (4 or more episodes in 12 months).
  • Chronic sinusitis (sinusitis symptoms that last for more than 12 weeks). 

Acute Otitis Media: A middle ear infection

Signs and symptoms a patient may say:

  • Earache.
  • High temperature.
  • Difficulty hearing.
  • Discharge running out of the ear.
  • Pressure inside the ear.
Do refer
  • Aged between 1 to 17 years.
  • Sign and symptoms of acute otitis media.
Do not refer
  • Under 1 year of age or over 18 years of age.
  • Pregnancy or suspected pregnancy under 16 years of age.
  • Temperature of over 39°C.
  • Recurrent acute otitis media:
    • 3 or more episodes in 6 months 
    • 4 or more episodes in 12 months with at least one episode in the last 6 months

Resources

References