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‘Slow but steady start’: one month into the NHS 111 referral service

LPC chief officer Hitesh Patel: Are patients ready for this service yet?
LPC chief officer Hitesh Patel: Are patients ready for this service yet?

It has been a “slow but steady” start to the CPCS, with just a small number of referrals since it went live last month, pharmacists have told C+D.

Over 10,000 pharmacies have signed up to the Community Pharmacist Consultation Service (CPCS), which sees pharmacies receive £14 for each consultation they complete following an NHS 111 referral for minor illnesses and urgent medicines supply, since it went live on October 29.

However, pharmacists have told C+D that they have only received a few referrals in the first month of the service, and in some cases, have not been able to complete the consultations, because of IT glitches or patients not turning up for their appointments.

Low number of referrals

Rob Severn, chair of the Nottinghamshire local pharmaceutical committee (LPC), said his LPC “is working with NHS 111 and other interested parties” to understand the reasons behind contractors in his area receiving so few referrals, with the aim of “increasing the uptake”.

Olivier Picard, who owns and manages Newdays Pharmacy in Reading, told C+D that his pharmacy has only received five referrals since October 29, all of which were on Saturdays.

“NHS 111 referrals occur primarily out-of-hours (OOH),” he explained. “Our opening hours are 9am-6pm during the week – the same as the local GP – and we are open 9am-2pm on a Saturday.”

“Because patients have access to the GP during our opening hours, they only end up calling NHS 111 when the GP is closed [on a Saturday],” Mr Picard suggested.

Sadik Al-Hassan, manager of Well Pharmacy in Kingswood, Bristol has received three referrals since the CPCS launch date; one for an emergency supply, “for a care home patient who needed an antipsychotic medicine, because they had damaged one of [the tablets] and they just needed one to continue the course”, he explained.

The two minor illness referrals his pharmacy processed were for thrush and stomach pain, Mr Al-Hassan said.

Inappropriate referrals from NHS 111

In some cases, pharmacists received NHS 111 referrals from patients in need of a controlled drug, which – with the exception of phenobarbital or phenobarbital sodium to treat epilepsy – cannot be supplied under this service.

Mr Picard said a patient needing pregabalin was sent to his pharmacy. After explaining to the patient that he could not dispense the medicine he needed, Mr Picard called NHS 111 back to ask a doctor to issue a prescription.

“Eventually, I managed to talk to a doctor, and they issued one. But the OOH doctor who issued the prescription made the patient go to the OOH centre to collect it,” he said.

It would have been easier if the patient had been directly referred to an OOH doctor, rather than the pharmacy, in this case, Mr Picard said.

Hitesh Patel, chief officer at City and Hackney LPC, said contractors in his area have also reported cases where they received inappropriate requests for strong painkillers, including controlled drugs, from patients.

“They get upset when the pharmacy turns them away,” he said.

However, in other cases, patients decided not to turn up for their appointments at the pharmacy. Mr Patel believes this could be one of the reasons why pharmacists have reported not being able to conclude the consultations with their patients on Sonar – the IT system London contractors are using for the CPCS.

“A couple of contractors [told me] that when they've chased the patient, they found that they had managed to find a GP appointment and [decided to go to] the GP for their minor illness problem,” he said.

“Are patients ready for this type of service yet?,” Mr Patel questioned.

NHS 111 and pharmacy misunderstandings

A locum pharmacist who works in Shropshire, who has asked to remain anonymous, told C+D they have only dealt with two CPCS referrals for minor illnesses.

In one of the two cases, the pharmacy staff had misunderstood which email address the CPCS referrals were sent to, therefore failing to identify the referral for several hours, the pharmacist said.

Then, when the referral was picked up “NHS 111 call handlers had listed the daughter’s phone number instead of the patient’s”, they explained.

When the pharmacy contacted the patient 18 hours later, they had “left the area and could not attend the appointment”, the pharmacist added.

Do you have any questions around the CPCS? Tune in to C+D’s Facebook Live interview with Andre Yeung on December 10, for your chance to ask the architect behind the local scheme that influenced the national service about the CPCS.

Submit your questions in advance by emailing [email protected]

Have you received many referrals from NHS 111 as part of the CPCS?

Kevin Western, Community pharmacist

Can I assume that 111 are still sending most minor ailments to GPs and A&E if they aren't sending them to Pharmacists? Is this despite their algorithms or have they not been changed to include us?
If it's despite them, how are they making the decisions and are they trained to do so?

Benie Locum, Locum pharmacist

Imagine if NHS 111 tried something really radical such as employing pharmacists and paid them a reasonable salary !?


Leon The Apothecary, Student

Bernie, you might be pleased to know then that NHS 111 is being integrated with emergency services and Pharmacists are being recruited for this very reason!

Abid P, Primary care pharmacist

This service just absolves 111 of any responsibility to find out whether a supply is appropriate or not. Last weekend I got request for lorazepam from a care home and nitrazepam for someone else. The patient calls assuming that a prescription has been sent by 111 and they are just to come to pick up the medication. They need to be told this is a referral service. Not much different to what happened under numsas. 111 need more training and at the very least find out what medication the patient is asking for before passing them on.

Ghengis Pharm, Locum pharmacist

I agree.  Have had Temazepam and Sevredol requested for 2 different patients.  When I referred them back to 111, a 111 operative phoned me and pointed out it was my responsibilty to refer the request to OOH.  When I naively asked whether 111 could have screened requests for Controlled Drugs themselves and sent the referral to OOH rather than a community pharmacy I was told to read the current guidelines!  Whole system - like numsas - badly implemented.

anti-depressed Pharmacist, Manager

Had the same problem with tramadol. Patient told me that the 111 operator knows more about pharmacy than I do and that I should dispense an emergency supply.

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