Moving from Signposting to Digital Referral for additional NHS 111 referrals to Pharmacy First
From Wednesday 10 December 2025, NHS 111 telephone service is now electronically referring patients to a community pharmacy of their choice for additional Pharmacy First minor illness clinical condition groups. This will replace signposting for those conditions and will allow pharmacy teams to see these referrals directly in clinical systems.
These changes will introduce system efficiencies and support an improved patient journey. Based on reports it is estimated that this change will convert approximately 75,000 signposts per year to community pharmacy into digital referrals. Online electronic referrals will be following in March 2026.
What’s Changing?
- The NHS Pathways algorithms that underpin NHS 111 triage and clinical assessment generate two pharmacy specific disposition codes, (Dx28 (Contact Pharmacist within 24 hours) and Dx29 (Contact Pharmacist next working day)) that are now enabled for digital referral by utilising the Pharmacy First (PF) profiles in DoS
- Only pharmacies registered to deliver the Pharmacy First Service will receive digital referrals for Dx28/Dx29
- Pharmacies not registered for Pharmacy First will no longer appear on the list of pharmacies offered to the patient; however, patients directed to community pharmacy via informal signposts must continue to be treated and supported as part of community pharmacy Essential Service delivery – this has not changed.
Who Can Send Digital Referrals?
For pharmacies signed up to deliver Pharmacy First, digital referrals can come from:
- NHS 111 Telephony (all appropriate journeys)
- General Practice (for Clinical Pathways and Minor Illness)
- NHS provider urgent care Streaming and Redirection (please note: Streaming and Redirection is an NHS Pathways product is a digital ‘kiosk’ type product used in some areas of the country at Urgent and Emergency Care settings. It is based on NHS Pathways Clinical Decision Support System and is used to allow patients to self-assess their symptoms and direct them to the most appropriate place for their care. This could be offsite to locations such as pharmacy)
Action for Community Pharmacy contractors and pharmacy teams
- Community pharmacies will start to receive digital referrals in December 2025 for patients with minor ailments who have received a Dx28 or Dx29 outcome within NHS 111 as part of their usual referral case mix
- These referrals will flow directly into the community pharmacy IT clinical system
- These referrals should be processed in the same way as other Pharmacy First referrals, i.e. as a minor illness referral, unless the gateway criteria for a clinical pathway is met
- Community pharmacies will receive a digital referral for NHS111 Online patients from 1 March 2026
- Patients must be offered a clinical assessment in line with the Pharmacy First service specification, with onward referral if required
- Contractors are reminded that pharmacists and their teams must be aware of all local escalation routes including professional helplines and local GP contact details for any escalations
- Patients must not be immediately turned away or looped back to NHS 111 following an electronic referral. All patients must receive safety netting advice and support appropriate to their clinical need particularly at busy times when patients may have to be advised about availability of the pharmacist for attending in-person consultations to ensure they are clinically assessed by the pharmacist according to need
- All community pharmacy IT system suppliers have confirmed that the development to receive these additional Dx28/Dx29 codes is in place, so Pharmacies will automatically start to receive these into their Pharmacy First IT system once switched on.
