Pharmacy First: Returning Referrals
To support consistency across the system and alignment with national guidance, we are reminding contractors of the correct process when a Pharmacy First referral cannot be managed under the service.
Where a patient is not suitable for management under a Pharmacy First clinical pathway, the outcome should be recorded and communicated as a returned referral (not a rejected referral).
When returning a referral, contractors should ensure:
1. Clinical assessment is completed where appropriate
Patients should be clinically assessed in line with the relevant pathway before determining whether the service can be provided.
2. Clear clinical rationale is documented
The reason for returning the referral should be recorded concisely and may include:
- Patient does not meet clinical pathway inclusion criteria
- Identification of red flags requiring escalation
- Clinical judgement that presentation is not suitable for community pharmacy management under the service
- Inability to complete consultation after reasonable attempts
3. Appropriate onward direction is provided
Where applicable, patients and/or referrers should be supported with:
- Clear escalation route (GP, urgent care, NHS 111, emergency care where indicated)
- Self-care advice and safety-netting
- Relevant clinical observations where appropriate
4. Accurate record keeping is completed
The consultation outcome should be clearly documented within the pharmacy clinical system to ensure an auditable record of the clinical decision-making process.
