Claim Pharmacy First for any minor ailment GP referral, says CPE

Pharmacies can be paid for a Pharmacy First consultation for any minor illness that is referred from a GP surgery, even if this is not covered by the seven common conditions listed in the service specification, Community Pharmacy England (CPE) has clarified.

And they warned that rejecting GP referrals inappropriately ‘may affect the GP practice team’s willingness/confidence in future to make referrals for the service’, as well as carrying risks to the patient and leaving the pharmacy unpaid for the consultation.

CPE issued a notice on the issue following a review of Pharmacy First data across Cheshire and Merseyside – an area which according to recent analysis from Company Chemists’ Association (CCA) pharmacies had some of the highest levels of Pharmacy First consultations and GP referrals to the service in the country.

According to CPE, local pharmaceutical committees (LPCs) in Cheshire and Merseyside had ‘identified several referrals’ from GP practices to Pharmacy First that had been rejected by the pharmacy, but in fact could have been claimed under the minor illness part of the consultation.

The notice from CPE and the LPCs reminded pharmacies that GPs 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. Consultations that fit the criteria for the seven clinical pathways: earache in 1-17 year olds, impetigo, infected insect bites, shingles in adults, sinusitis in over 12s, sore throat in over 5s and uncomplicated UTIs in women aged 16-64.

And it reminded pharmacies that the seven clinical pathways were ‘not an exhaustive list of minor illnesses included in the service’.

‘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,’ the notice clarified.

And if referrals are received for the seven common conditions but do not meet the eligibility criteria – for instance, an adult with earache – they can still be seen under the minor illness strand of the Pharmacy First service, and the pharmacy can still claim and be paid for the consultation, the notice said.

Even consultations that identify a more serious issue should still be recorded as a minor illness consultation, the notice said, adding that pharmacies should also take ‘appropriate action’ to escalate the issue.

‘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,’ the LPCs said.

They added that consultations for patients who are not contactable ‘should not be rejected’, but instead ‘closed on the Pharmacy First IT system, noting the reason for this’ – and in this instance, the pharmacy would not be eligible to claim payment.

‘There are implications of rejecting appropriate referrals’, the LPCs warned, explaining that because GP practices ‘may not review rejection messages on the same day’, there was a risk that a patient with a serious condition may be missed or those with minor illnesses could be left unable able to see another healthcare professional.

Rejecting referrals inappropriately could also worsen relationships with GPs around the service, the LPCs warned, saying: ‘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.’

And they reiterated that pharmacies would not be paid for consultations carried out for rejected referrals.

However, they stated that ‘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’.

A recent survey of 266 independent pharmacy owners conducted by the Independent Pharmacies Association (IPA) found that for the majority of respondents, less than half of Pharmacy First consultations pass the gateway point for a service payment.

A major reason cited by respondents for low consultation numbers was inadequate or informal referrals from GPs.

Meanwhile, recent data from the Company Chemists' Association (CCA) suggested that 88% (81,627) of patients presenting to a CCA member pharmacy with one of the seven common conditions within the first month of the service had a consultation with a pharmacist that passed the gateway point.

Data collected by the CCA recently suggested that the integrated care systems (ICSs) delivering the most Pharmacy First consultations also had the highest number of electronic referrals from other parts of the NHS.

It added that three in 10 GP surgeries have referred a patient for a Pharmacy First consultation, but added that 69% of those referrals were from a very small minority (7%) of GP surgeries.

When the data was released, CCA chief executive Malcolm Harrison called for ‘targeted support’ for GP surgeries ‘to boost referrals and efforts to share best practice across and between ICSs.’