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Referrals and red flag symptom training: Your CPCS queries answered

Mr Yeung answered pharmacists' questions about the CPCS in a live Q&A last night
Mr Yeung answered pharmacists' questions about the CPCS in a live Q&A last night

How many referrals pharmacies should expect and whether call handlers are trained to spot red flag symptoms were just two topics discussed during C+D's live Q&A on the CPCS.

C+D sat down with Andre Yeung, one of the architects behind the pilot that inspired the Community Pharmacist Consultation Service (CPCS), to answer pharmacists' questions on the service in a live webinar last night (December 10). 

The interview featured questions submitted by C+D readers on various topics, including the service basics, what types of referrals pharmacists will receive, and how to manage the workload.

Watch the full interview in the video below. (Skip to 8.45 minutes for the start of​ the Q&A)

Number of patients coming through the CPCS

In response to a question about the number of NHS 111 referrals to expect via the service, Mr Yeung said it is “really difficult” to put an exact figure on it, as it is dependent on many variables.

However, “patients that are calling 111 are usually calling when a GP practice has closed”, he explained.

This “spike” in calls means pharmacies open after GP surgeries have typically closed, or at the weekend, are likely to receive more patient referrals via the CPCS, Mr Yeung said.

Call handler training

Mr Yeung also addressed pharmacists’ concerns at receiving referrals for patients with “obvious red flags”, who questioned whether the NHS 111 call handlers had had appropriate training on who to refer patients to in these cases.

“That is something that pharmacists have to bear in mind,” Mr Yeung said. “You've got a non-healthcare professional answering the phone, not being able to see the person that they're talking to, so it is very difficult already to get a steer on that.

“What [call handlers] are doing is following an algorithm and basing entirely what happens with that patient off the back of what that patient tells them,” he explained.

“When the patient attends the pharmacy, it's for the pharmacist to carry out the clinical assessment. They're the first healthcare professional that's been involved in assessing that patient, and it's the pharmacist that then decides what's appropriate and what's not.”

Mr Yeung urged pharmacists not to get “frustrated” if a patient is referred to them with red flag symptoms, as “that is part of what we are expecting pharmacists to do as part of the [service]”.

Watch the full video to hear Mr Yeung's advice on:

  • Whether independent prescribers can treat a patient privately if they are referred by NHS 111
  • How to ensure that locums receive support to provide the CPCS
  • How and when pharmacists should handle requests for quantities of controlled drugs schedule 4 and 5
Have you received many referrals from NHS 111 as part of the CPCS?

Jack Daniels, Community pharmacist

I've either been very unlucky or the referrals I've had have been a waste of time and I dare say money to the NHS. I locum for a supermarket pharmacy & have seen several of these. One was for a immunocompromised patient who had just finished a course of antibiotics for a chest infection which hadn't cleared but 111 sent him over here anyway! No one asked him if he this was an infection already under treatment and neither was he asked about the medication he was on to suppress his immune system. So after coughing and spluttering over me in the room did I discover that he was on antiviral medication. He refused to go back to 111 so that ended well! The next was for a schedule 2 controlled drug then there was another minor illness for a 2 year old child whose father wasn't very happy when I included advice on OTC analgesia in the telephone consultation- " I already have all that" he snapped " I wanted antibiotics for my very sick child as he's unwell with high temp and lethargic with sputum, why can't you give them to me?" So I explained our limitations in three service so he wasn't happy that he was fobbed off on to us as he put it. He wanted an appointment with a doctor and not to see a pharmacist. Since then I've had another 2 controlled drugs referrals- 1 of which was for nitrazepam liquid like anyone is going to have that at half nine on a Saturday evening - when I spoke to the child's mother she said she told 111 that her local pharmacy did have it but couldn't give it as an emergency as they needed a script so she rang 111 and they referred her to us rather than doing a script! In a lot of these cases they're ending up doing the same work twice and pharmacies are claiming the £14 without making a real significant contribution to the patients treatment. Anyway that's just my humble opinion

Joan Richardson, Locum pharmacist

The balance may be slightly redressed at some point in the future as there are supposed to be referrals from GP surgeries to the pharmacy but don't hold your breath!

Reeyah H, Community pharmacist

So he has spoken to many many pharmacists. Go back and speak to them again perhaps.This service has resulted in the most ridiculous referrals resulting in delayed treatment for patients. 

N O, Pharmaceutical Adviser

"""pharmacies open after GP surgeries have typically closed, or at the weekend, are likely to receive more patient referrals via the CPCS,"""

So any Pharmacy that is not open when the surgery is closed have to suffer?? Is this what is a fair negotiation by PSNC to replace the MURs?? And we are to prove ourselves that we can offer clinical services to get more services!!! How can we do that please explain.

How can you negotiate a service that is not fairly distributed amongst all the Pharmacies and benefits only a few? Rediculous.

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