Purpose
The purpose of the SOP describes the process for formally referring patients from the Severnside IUC advice queue in the out-of-hours period to a community pharmacy as part of Pharmacy First (formally NHS Community Pharmacy Consultation Service).
Pharmacy First was launched by NHS England to facilitate same or next day appointments with community pharmacists for minor illness or for an urgent supply of regular medicine. More information can be found here.
Pharmacy First referrals are already being used in BNSSG by care navigators in General Practice, receptionists at Minor Injuries Units /Urgent Treatment Centres and from the Emergency Departments.
During periods of high demand, when Severnside is experiencing long patient waits and increased clinical risk, this process can formally direct patients of low acuity to the most appropriate place for their care. This in turn may contribute to reducing the number of patients in the advice queue, reduce patient waits (for those referred and those remaining), and as a consequence reduce the level of clinical risk.
See flow chart of whole process – Appendix Three.
Pharmacy First Criteria
- BNSSG criteria for antibiotic treatment – PRN00936_ii_Pharmacy-First-Clinical-Pathways-v.1.6.pdf
- National Criteria for NHS Community Pharmacist Consultation Service (CPCS) for patients aged over 1 year – nhs-conditions.pdf (icb.nhs.uk)
- 12/24 hours cases
- Pharmacy referral must be able to be managed within the NHS111 timeframe
- Patient must be able to travel to a pharmacy
- Cases from NHS111 and not from HCPs
- Patient consent to a pharmacy referral
The Standard Operating Procedure
Case selection
Appropriate cases for Pharmacy First referral will be identified by the Clinical Navigator (CN) using the criteria above. Once identified, the CN will add a Pharmacy First tag to the case.
Referral to Pharmacy First
All cases with a Pharmacy First tag will be managed by the Operational Team. The nominated operational team member will call the patient to advise their case has been identified as appropriate for Pharmacy First using the below script and:
- check if the patient is in agreement, and
- advise the patient they will be called back by the pharmacist, assuring the patient if there is any issue the pharmacist can refer them directly back to us without the patient going back through NHS111
- do not give an estimated time of call back from the pharmacy
Call script
“I’m a call handler from Severnside Urgent Care service calling following your contact with NHS111. One of our clinicians has reviewed your case and thinks it would be appropriate to pass your case to a community pharmacist to call you back. This means we will electronically send your details to the pharmacist, and they will call you back within the time frame recommended when you called 111. It is likely your case with be dealt with more quickly that way. If the pharmacist has any problems in sorting things out for you, they can refer straight back to us. Is that OK with you?
If anything changes or worsens between now and when the pharmacist calls, please call back via 111”
Using Pharmacy First Software
If the patient agrees to the community pharmacy referral the operational team member will:
- Check all the demographics particularly telephone numbers are correct with the patient
- Following the call with the patient send the referral to the pharmacy via PharmRefer (see Appendix Four)
- In Adastra:
- Add a note to the case in the OLC screen using the prepopulated drop-down text “Patient has agreed to be passed to a community pharmacist. Pharmacy referral made to XXXXX pharmacy” ensuring the correct pharmacy is added to the notes
- Add a short (three word) description of the presenting complaint in the OLC screen
- Finish and close the case using the informational outcome ‘ADMIN – Pharmacy First Severnside referral’
Patients who decline Pharmacy First
If the patient does not agree to the referral the operational team member will add a note using the ‘Comfort Call’ function and remove the ‘Pharmacy First’ tag and reinstating any previous tag.
Pharmacy First Considerations
Pharmacy First Time frames
Pharmacies will call all patients referred on the Pharmacy First system. Most referrals will be consulted over the phone and some patients depending on symptoms may be offered a face-to-face appointment.
The call-back to the patient will be the same day for morning referrals, and same day or next morning for referrals made during the afternoon.
Patient escalation
If during the consultation the Pharmacist feels the patient needs to be managed by a GP, Urgent Care or Hospital, this will then be escalated appropriately by the Pharmacist. In the instance of requiring Out of Hours GP care, the referral will be made to SevernSide by calling the Professional Line 0117 92448293 as per usual process.
Failed contacts
Once the patient is passed to the community pharmacy the Pharmacist will try to call the patient. If this results in a failed contact of the patient, the Pharmacist will use their clinical judgement and follow their local policy for failed contacts.
Patient Notes following a Pharmacy First Consultation
Similar to IUC Post Event Messages, Pharmacy First will have their own process of electronically notifying the Patient’s own GP of the clinical consultation.
Pharmacy First Safety Netting
Pharmacy First will provide appropriate safety netting, and one possible scenario is for the patient to ring NHS111.
Training
All Clinical Navigators to receive an overview of process and step by step instructions on case selection. All Operational staff will receive training on the IT system and referral process.
Governance
The standard clinical governance processes such as learning events and complaints will be implemented for the process of Pharmacy First while patients are within our care.
The ICB will be reporting Pharmacy First data monthly which will initially be done via monthly meetings between the ICB and Clinical Lead and Operational Lead leading on Pharmacy First. In the longer term, the data will be scrutinised in SevernSide SDIP Group and Quality Group.
Appendicies
Appendix One – Pharmacy First Pharmacies
| Pharmacy Name | Pharmacy Address | Post code | Phone | Shared NHS mail address | Opening hours | Saturdays | Sundays | ||||
| Bristol | Asda (BEDMINSTER) | East Street | Bedminster | Bristol | BS3 4JY | 0117 300 4210 | pharmacy.fnw08@nhs.net | 9.00- 12.30, 13.00-16.30 and 17.00-21.00 | 9.00- 12.30, 13.00-16.30 and 17.00-21.00 | Sun 10.00- 16.00 | |
| Asda (Whitchurch) | Oastlands Avenue | Bristol | BS14 0ST | 01275 894610 | pharmacy.frd73@nhs.net | 9.00- 12.30, 13.00-16.30 and 17.00-21.00 | 9.00- 12.30, 13.00-16.30 and 17.00-21.00 | Sun 10.00- 16.00 | |||
| Boots UK Ltd – Broadmead | 59 Broadmead | Bristol | BS1 3ED | 0117 9293631 | pharmacy.flq56@nhs.net | 9.00-18.00 | 9.00-18.00 | Sun 11-17.00 | |||
| Boots Imperial | Imperial Park | Hartcliffe Way | Bristol | BS13 7TJ | 0117 9642197 | pharmacy.fnk97@nhs.net | 09.00–20.00 Sat 11.00-17.00 Sun | 9.00-19.00 | Sun 10.30-16.30 | ||
| Bristol Pharmacy Whitchurch | Whitchurch Health Centre | Armada Road, Whitchurch | Bristol | BS14 0SU | 01275 839865 | pharmacy.fnd81@nhs.net | 9.30-18.30 | 9.00-17.00 | Sun CLOSED | ||
| Easton Day and Night Chemist | 192 Stapleton Road | Easton | Bristol | BS5 0NY | 0117 3290672 | pharmacy.fg520@nhs.net | 9.00-21.00 | 9.00-21.00 | Sun 9- 22.00 | ||
| Hengrove Pharmacy | 9 The Parade | Hengrove | Bristol | BS14 9DB | 0117 3005446 | pharmacy.fpq26@nhs.net | 9.00-18.00 | 9.00-13.00 | Sun CLOSED | ||
| Tesco Instore Pharmacy – Eastville | The Eastgate Centre | Eastville | Bristol | BS5 6XU | 0117 9511156 | pharmacy.fg915@nhs.net | 8.00 – 20.00 | 8.00 – 20.00 | Sun 10.00- 16.00 | ||
| North Somerset | Boots Locking Castle | Unit 2 Castle D/Trict Ctr | Summer Lane | Weston Super Mare | BS24 7AY | 01934 525048 | pharmacy.frp15@nhs.net | 8.00 – 21.00 | 8.00 – 21.00 | Sun 10.00- 16.00 | |
| Milton Pharmacy | 260 Milton Road | Weston-Super-Mare | BS22 8EN | 01934 413100 | pharmacy.fpr03@nhs.net | 8.00 -22.00 Mon – Thurs 8.00 -21.00 Fridays | 8.00-13.00 | Sun CLOSED | |||
| Morrisons WSM | Summerlane | Locking Castle | Worle | Weston-Super-Mare | BS24 7AY | 01934 521135 | pharmacy.fdm06@nhs.net | 9.00 -13.30pm 14.30-19.00 | 9.00-13.30 14.30-18.00 | Sun 10.00- 16.00 | |
| Smart Pharmacy | 111 Old Street | Clevedon | Bristol | BS21 6BP | 01275 876797 | nhspharmacy.fdl90@nhs.net | 08.45 – 18.30 | 09.00 -noon | Sun CLOSED | ||
| Tesco Clevedon | Kenn Road | Clevedon | North Somerset | BS21 6LH | 0117 2912057 | pharmacy.frm86@nhs.net | 8.30-13.00 14.00-20.00 | 8.30-13.00 14.00-20.00 | Sun 10.00- 16.00 | ||
| Tudor Lodge Pharmacy | Tudor Lodge Surgery | 3 Nithsdale Road | Weston-Super-Mare | BS23 4JP | 01934 615111 | pharmacy.fph80@nhs.net | 7.00 – 21.00 | 8.00-21.00 | Sun CLOSED | ||
| Yatton Pharmacy | 8 Pages Court | High Street | Yatton | Bristol | BS49 4EG | 01934 832236 | pharmacy.fna45@nhs.net | 9.00 – 18.00 | 9.00- 17.30 | Sun CLOSED | |
| South Gloucestershire | Boots Cribbs Causeway | The Mall | Patchway | Bristol | Bs34 %UP | 0117 9509744 | pharmacy.fd125@nhs.net | 10.00-19.00 | 10.00-16.00 | 11-15.00 | |
| Boots Longwell Green | Unit D Gallagher Shop Pk | Aldermoor Wy,Longwell Grn | Bristol | BS30 7ES | 0117 9678963 | pharmacy.fre69@nhs.net | 9.00 -21.00 | 9.00- 21.00 | 10.30-16.30 | ||
| Shaunaks Pharmacy | Courtside Surgery | Kennedy Way, Yate | Bristol | BS37 4DQ | 01454 322452 | pharmacy.ffq95@nhs.net | 8.30-19.00 | 9.00-13.00 | Sun CLOSED | ||
| Tesco Yate | 12 East Walk | Yate | Bristol | BS37 4AS | 01454 660187 | pharmacy.fw074@nhs.net | 9.00-21.00 | 9.00- 21.00 | Sun 10.00- 16.00 | ||
| Yate Family Pharmacy | Kennedy Way Surgery | Kennedy Way, Yate | Bristol | South Gloucestershire | BS37 4AA | 01454 323496 | pharmacy.fm704@nhs.net | 08.30 -213.00 13.30-18.45 | Sat Closed | Sun CLOSED |
Appendix Two – National Criteria
Appendix Three – Process flow chart
Appendix Four – Referring a patient on PharmRefer
Link to log into PharmRefer
- Log in using your username and password
- You will then be prompted for your six-digit security code
- Use the option to skip to referral details – your team don’t need to go through the triage questions as they will already have done this
- The screen for entering patient details should look similar to this (below). Search for the patient using their NHS number by selecting ‘Search for a patient in PDS’, then ‘NHS Number’.
- Confirm if this is the correct patient or proceed without PDS
- Complete the remaining fields, including adding a three-word symptom summary of the reported condition in the Additional Information
- Select confirmation text for a test message to be sent to the patient
- When all details are added select ‘Send Referral’.
Tables
| Version | Date | Author | Comments |
| Draft | Sep 2024 | LG/RS | Document created |
| 1 | 28.11.2024 | LG | Document published |