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GP digital referral service pilot needs ‘tinkering’, say pharmacists

Greater Manchester LPC: While the referral numbers are low, the system is starting to work
Greater Manchester LPC: While the referral numbers are low, the system is starting to work

Two pharmacists receiving digital referrals from GPs as part of NHS England’s DMIRS pilot have identified issues that need “tinkering with”.

Pharmacies in the Cheshire and Greater Manchester areas are among the first to trial the next stage of the Digital Minor Illness Referral Service (DMIRS), which sees GPs in pilot areas refer patients with low acuity conditions – such as rashes, constipation and vaginal discharge – directly to community pharmacies via online triage systems.

Laura Mullan, pharmacy manager at Asda in Halton Lea, Runcorn, told C+D that her pharmacy has received seven referrals since going live with the service in June.

She attributes the low number of patients being referred to her pharmacy to the fact that only two GP surgeries are currently piloting the service in her area, with patients being referred to “three pharmacies on the same street”.

However, it would have been “a nightmare” if they had had a few referrals every day, as “it can take ages” for a pharmacist to attend to each patient’s needs, she claimed.

Depending on the patient, “you could spend a good half an hour or 40 minutes” conducting the consultation, she said, and even longer if the pharmacy then needs to refer the patient back to the GP.

At the moment, “it's just extra paperwork and extra workload to do a job we're already doing”, Ms Mullan added.

Pharmacies and GPs need an audit trail

Helen Murphy, joint CEO of Halton, St Helens and Knowsley local pharmaceutical committee (LPC) – who has worked closely with GP practices and pharmacies in the Runcorn area – told C+D that just as GPs are asked to make a record of their consultations, that “shouldn’t be any different in a community pharmacy”.

Pharmacies are now “getting paid for a consultation with a patient that follows National Institute for health and Care Excellence guidance. It’s a direct referral from the GP practice, so you would expect [to have] an audit trail”.

The GP DMIRS pilot is “a great opportunity for community pharmacy to demonstrate what they can do with treating minor illnesses and supporting GP practices out of hours”, Ms Murphy added.

“We didn't want to overwhelm our community pharmacies with a massive volume of referrals. However, going forward, we're going to be looking to increase the volume.”

Issues with IT system setup

A pharmacist in the Greater Manchester area, who has asked to remain anonymous, told C+D that their pharmacy has also received seven referrals since the beginning of July and attributes this to issues “coordinating IT systems” with the GP surgery they were paired to for the delivery of the service.

“The receptionist at the GP [practice] will have to go through several steps to be able to refer one single patient. I think NHS England is looking to make it a one-step process in future,” they said.

“It is still in the pilot stage and it needs a lot of tinkering around the edges, but once it is developed further, it might be easier to do,” the pharmacist added.

“Lack of interoperability”

Fin McCaul, workforce lead at Greater Manchester LPC, told C+D the LPC is “aware of the [IT] problems” and it is potentially due to a lack of interoperability between the GP practice’s software and the one used to refer patients to a pharmacist.

“We are working hard to resolve [the issues],” he said. “If the system is difficult to use, then it will not benefit GPs or the wider NHS.

“It is still very early days in the project and while the referral numbers are low, the system is starting to work. The benefit of running a pilot in certain areas is to learn from the systems and processes.”

Pharmacies in seven regions are trialling the GP DMIRS referral scheme until March 31, 2020, and, following an evaluation, it may be commissioned as the Community Pharmacist Consultation Service (CPCS) under the national pharmacy contract in England.

Success of similar service

Tony Schofield, superintendent pharmacist at Flagg Court Pharmacy, South Shields, told C+D that he has been piloting a service similar to NHS England’s DMIRS since January, with a “small number” of GP practices referring to pharmacies in his area.

Under the GP2Pharmacy pilot, patients are triaged by their GP practice and offered fixed-time appointments with a pharmacist at one of 30 participating pharmacies.

Mr Schofield said he spends on average 10 minutes with each patient and while it has increased the workload, “it takes you out of the dispensing [role], which is what we should be aiming to do”.

Is your pharmacy taking part in the GP DMIRS pilot?

Reeyah H, Community pharmacist

How about we get paid for every patient we see? Like Drs? Regardless of self referral or DMIR. Oh no of course that won’t happen, we are pharmacists. We do things for free or accept pennies.  

Reeyah H, Community pharmacist

The real solution to this whole mess was to pay us properly in the first place and we would do minor ailments normally as part of our workload!! We have done it for since day dot. A lot of patients make the pharmacy the first port of call anyway! Please stop this stupid scheme before it’s across the whole country. 

C A, Community pharmacist

"just as GPs are asked to make a record of their consultations, that shouldn’t be any different in a community pharmacy”

Time for community pharmacy to learn how to do notes GP style -

Mr Smith - Rash - hydrocortisone 1% - patient to make another appointment if doesn't improve

Mr Jones - ED - sildenafil 50mg 

Mrs Irvine - Dermatitis - emollient and mild steroid

Ms Wilson - Contraceptive needs discussed - BP 120/80 - Loestrin 20 

Mr Bloggs - Back Pain - Co-codamol 30/500


Granted they aren't all that bad, but it is highly variable depending on the skill/workload/GP.

N O, Pharmaceutical Adviser

"""just as GPs are asked to make a record of their consultations, that “shouldn’t be any different in a community pharmacy”""


"" “getting paid for a consultation with a patient"""


Please also compare HOW MUCH --- time a Pharmacist has to spend with a patient + paper work + follow up = Pay.

Are we anywhere near what GPs get paid? or atleast worth of what we save to the NHS who don't provide any support by way of taking the establishment payment away??



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