Pharmacy First Referrals Requiring Escalation

Pharmacy First referrals requiring escalation

Most patients referred to you will have come through a Health Advisor consultation. The Health Advisor follows the NHS Pathways process, which uses a structured question set to identify the most appropriate service for the patient.

We understand there can be frustration when a patient appears to have been referred to pharmacy but then requires escalation to another service. The purpose of this note is to clarify why this can happen and how the escalation process should be managed.

NHS Pathways is a risk-averse system. It is designed to:

• identify critically unwell patients as early as possible in the triage process;
• use structured question sets to support safe decision-making;
• direct patients to the most appropriate available service based on the information provided at the time;
• operate within question sets and outcomes defined by the NHS Pathways clinical group, supported by a highly regulated governance process.

As part of this approach, it is expected that some patients referred to pharmacy will still need escalation to a higher-acuity service following clinical assessment. This means:

• in a pharmacy setting, where the starting acuity is generally low, this could be up to 20% of referrals;
• escalation does not necessarily mean the original referral was incorrect;
• your clinical assessment adds important value, particularly during a face-to-face consultation;
• further information may become clear if details have been omitted, misunderstood or presented differently by the patient.

When escalating a patient, it is important to close the clinical loop. This means referring the patient to another clinician-led service, such as:

• a Minor Injury Unit;
• the patient’s GP surgery; or
• the NHS 111 Clinical Desk, when other services are not available.

To close the clinical loop:

• call NHS 111 and select the healthcare professional option;
• hand the patient over to the clinical service within NHS 111;
• allow NHS 111 to arrange a call back or direct the patient to an appropriate face-to-face appointment;
• do not ask the patient to call NHS 111 themselves for this escalation.

If the patient is asked to call NHS 111 themselves, they are likely to return through the Health Advisor triage process and may be directed back to pharmacy. This creates a circular route for the patient and places avoidable demand on the NHS 111 system.

Key message for pharmacy teams

If, following your clinical assessment, a patient needs to be escalated to another service:

• close the clinical loop through a clinician-to-clinician referral or handover;
• use the NHS 111 healthcare professional option where NHS 111 support is required;
• do not ask the patient to call NHS 111 themselves for this escalation; and
• support a safer, clearer route to the right care by avoiding repeat triage and reducing the risk of the patient being directed back to pharmacy.