Common use of Service description and background Clause in Contracts

Service description and background. 1.1. Patients and the general public access community pharmacies for self-care advice and to purchase over the counter medicines. It is however difficult sometimes for patients to know when it might be more appropriate to access GP advice. It is estimated that 6% of all GP consultations could be safely transferred to a community xxxxxxxx0 (20.4 million appointments per year) and there is good evidence that the advice provided by community pharmacists as part of a consultation about symptoms of minor illness will result in the same outcome as if the patient went to see their GP or attended an Emergency Department.3 1.2. As part of the Pharmacy Integration Fund programme of work to integrate community pharmacy into local NHS urgent care pathways, a new approach is being taken to create a digital process for sending a “referral” to a community pharmacist instead of booking a GP appointment for a low acuity minor illness assessment. 1.3. The term “referral” is used to describe the process where practice staff advise patients that they can attend a local community pharmacy for a consultation with a pharmacist and that personal data about them will be transferred to the pharmacy. The GP practice may use a streaming process or other local protocol to identify patients to be referred dependent on the symptoms declared by the patient. In some instances, this may make use of clinical triage or a referral following an online assessment process. The GP practice is responsible for ensuring the robustness of their chosen method of “referral” to the pharmacy (See Annex A for definitions). 1.4. The NHS England GP CPCS will commence from 1st April 2020 to 31st October 2020 1.5. The GP Community Pharmacist Consultation Service (GP CPCS) will be commissioned as a Local Enhanced Service under the terms of the Community Pharmacy Contractual Framework, with the aim of ensuring that patients have access to care close to home and with a self-care emphasis. 1.6. An electronic transfer of data to support the referral will be sent from the General Practice to a local community pharmacy. Across practices in England there are now GP reception teams that work with care navigators to support the process of booking patients to see the most appropriate member of the multidisciplinary team. Only patients who have been referred from their GP practice are eligible to receive advice and treatment 2 xxxxx://xxx.xxxxxxx.xxx.xx/gp/gpfv/workload/releasing-pressure/ 3 xxxxx://xxxxxxx.xxx.xxx/content/5/2/e006261 under this service. Patients will still be able to access advice and support for self-care from any local pharmacy as a walk-in service as usual. 1.7. On presentation, the pharmacist will assess the patient, looking for any red flags with reference to the NICE Clinical Knowledge Summaries (CKS), provide relevant self-care advice and support (as detailed in point 1.8) and will refer the patient to another service or healthcare professional, where it is appropriate. 1.8. The pharmacist will provide self-care advice and support, including access to printed information and /or electronic resources,4 to all individuals, if appropriate, on the management of low acuity conditions specified in Annex E. 1.9. The end points of the consultation may include: - Advice given only - Advice and the sale of an Over the Counter (OTC) medicine - Advice and referral into a pharmacy local Minor Ailments Service (MAS) (dependent on local commissioning arrangements) - Advice and referral into a local Patient Group Direction service (dependent on local commissioning arrangements) - Advice and referral back to the patient’s GP (pharmacist to arrange appointment for the patient at the patient’s own GP – as part of this service) - Advice and signpost on to another service. 1.10. A GP notification may be required about the consultation depending on outcome to ensure the patient’s primary care record held by their GP is updated. Pharmacists will use their clinical judgement to determine when this is appropriate. The notification may be made using the CPCS IT system or the paper form in Annex C, however digital transmission is preferred. 1.11. Local clinical governance processes will need to be established to ensure the quality of referrals from GP practices to pharmacies. These will need to be reviewed locally and take into account any lessons learned from the outcomes of the consultation with the pharmacist, including cases that have been closed or cases that have required an escalation. 1.12. The patient must be in attendance otherwise the consultation will not qualify as part of the GP CPCS scheme. For patients under the age of 16, pharmacists should use their professional judgement to determine whether the patient needs to be accompanied or not, taking into account the principles of Xxxxxxx competence where required.

Service description and background. 1.1. Patients and the general public access community pharmacies for self-care advice and to purchase over the counter medicines. It is however difficult sometimes for patients to know when it might be more appropriate to access GP advice. It is estimated that 6% of all GP consultations could be safely transferred to a community xxxxxxxx0 (20.4 million appointments per year) and there is good evidence that the advice provided by community pharmacists as part of a consultation about symptoms of minor illness will result in the same outcome as if the patient went to see their GP or attended an Emergency Department.3 1.2. As part of the Pharmacy Integration Fund programme of work to integrate community pharmacy into local NHS urgent care pathways, a new approach is being taken to create a digital process for sending a “referral” to a community pharmacist instead of booking a GP appointment for a low acuity minor illness assessment. 1.3. The term “referral” is used to describe the process where practice staff advise patients that they can attend a local community pharmacy for a consultation with a pharmacist and that personal data about them will be transferred to the pharmacy. The GP practice may use a streaming process or other local protocol to identify patients to be referred dependent on the symptoms declared by the patient. In some instances, this may make use of clinical triage or a referral following an online assessment process. The GP practice is responsible for ensuring the robustness of their chosen method of “referral” to the pharmacy (See Annex A for definitions). 1.4. Patients need to be supported and feel confident that they are being provided the right care for them at the right time. The GP to pharmacy referral pathway builds on the knowledge gained through the four NHS 111 to pharmacy CPCS regions that have been running in North East England GP CPCS will commence from 1st April 2020 to 31st October 2020(since December 2017) and in the East Midlands, Devon and London (since November 2018). 1.5. The GP Community Pharmacist Consultation Service (GP CPCS) will be commissioned as a Local Enhanced Service under the terms of the Community Pharmacy Contractual Framework, with the aim of ensuring that patients have access to care close to home and with a self-care emphasis. 1.6. An electronic transfer of data to support the referral will be sent from the General Practice to a local community pharmacy. Across practices in England there are now GP reception teams that work with care navigators to support the process of booking patients to see the most appropriate member 2 xxxxx://xxx.xxxxxxx.xxx.xx/gp/gpfv/workload/releasing-pressure/ 3 xxxxx://xxxxxxx.xxx.xxx/content/5/2/e006261 of the multidisciplinary team. Only patients who have been referred from their GP practice are eligible to receive advice and treatment 2 xxxxx://xxx.xxxxxxx.xxx.xx/gp/gpfv/workload/releasing-pressure/ 3 xxxxx://xxxxxxx.xxx.xxx/content/5/2/e006261 under this service. Patients will still be able to access advice and support for self-care from any local pharmacy as a walk-in service as usual. 1.7. On presentation, the pharmacist will assess the patient, looking for any red flags with reference to the NICE Clinical Knowledge Summaries (CKS), provide relevant self-care advice and support (as detailed in point 1.8) and will refer the patient to another service or healthcare professional, where it is appropriate. 1.8. The pharmacist will provide self-care advice and support, including access to printed information and /or electronic resources,4 to all individuals, if appropriate, on the management of low acuity conditions specified in Annex E. 1.9. The end points of the consultation may include: - Advice given only - Advice and the sale of an Over the Counter (OTC) medicine - Advice and referral into a pharmacy local Minor Ailments Service (MAS) (dependent on local commissioning arrangements) - Advice and referral into a local Patient Group Direction service (dependent on local commissioning arrangements) - Advice and referral back to the patient’s GP (pharmacist to arrange appointment for the patient at the patient’s own GP – as part of this service) - Advice and signpost on to another service. 1.10. A GP notification may be required about the consultation depending on outcome to ensure the patient’s primary care record held by their GP is updated. Pharmacists will use their clinical judgement to determine when this is appropriate. The notification may be made using the CPCS IT system or the paper form in Annex C, however digital transmission is preferred. 1.11. Local clinical governance processes will need to be established to ensure the quality of referrals from GP practices to pharmacies. These will need to be reviewed locally and take into account any lessons learned from the outcomes of the consultation with the pharmacist, including cases that have been closed or cases that have required an escalation. 1.12. The patient must be in attendance otherwise the consultation will not qualify as part of the GP CPCS scheme. For patients under the age of 16, pharmacists should use their professional judgement to determine whether the patient needs to be accompanied or not, taking into account the principles of Xxxxxxx competence where required.

Service description and background. 1.1. Patients and the general public access community pharmacies for self-care advice and to purchase over the counter medicines. It is however difficult sometimes for patients to know when it might be more appropriate to access GP advice. It is estimated that 6% of all GP consultations could be safely transferred to a community xxxxxxxx0 (20.4 million appointments per year) and there is good evidence that the advice provided by community pharmacists as part of a consultation about symptoms of minor illness will result in the same outcome as if the patient went to see their GP or attended an Emergency Department.3 1.2. As part of the Pharmacy Integration Fund programme of work to integrate community pharmacy into local NHS urgent care pathways, a new approach is being taken to create a digital process for sending a “referral” to a community pharmacist instead of booking a GP appointment for a low acuity minor illness assessment. 1.3. The term “referral” is used to describe the process where practice staff advise patients that they can attend a local community pharmacy for a consultation with a pharmacist and that personal data about them will be transferred to the pharmacy. The GP practice may use a streaming process or other local protocol to identify patients to be referred dependent on the symptoms declared by the patient. In some instances, this may make use of clinical triage or a referral following an online assessment process. The GP practice is responsible for ensuring the robustness of their chosen method of “referral” to the pharmacy (See Annex A for definitions). 1.4. Patients need to be supported and feel confident that they are being provided the right care for them at the right time. The GP to pharmacy referral pathway builds on the knowledge gained through the four NHS 111 to pharmacy CPCS regions that have been running in North East England GP CPCS will commence from 1st April 2020 to 31st October 2020(since December 2017) and in the East Midlands, Devon and London (since November 2018). 1.5. The GP Community Pharmacist Consultation Service (GP CPCS) will be commissioned as a Local Enhanced Service under the terms of the Community Pharmacy Contractual Framework, with the aim of ensuring that patients have access to care close to home and with a self-care emphasis. 1.6. An electronic transfer of data to support the referral will be sent from the General Practice to a local community pharmacy. Across practices in England there are now GP reception teams that work with care navigators 2 xxxxx://xxx.xxxxxxx.xxx.xx/gp/gpfv/workload/releasing-pressure/ 3 xxxxx://xxxxxxx.xxx.xxx/content/5/2/e006261 to support the process of booking patients to see the most appropriate member of the multidisciplinary team. Only patients who have been referred from their GP practice are eligible to receive advice and treatment 2 xxxxx://xxx.xxxxxxx.xxx.xx/gp/gpfv/workload/releasing-pressure/ 3 xxxxx://xxxxxxx.xxx.xxx/content/5/2/e006261 under this service. Patients will still be able to access advice and support for self-care from any local pharmacy as a walk-in service as usual. 1.7. On presentation, the pharmacist will assess the patient, looking for any red flags with reference to the NICE Clinical Knowledge Summaries (CKS), provide relevant self-care advice and support (as detailed in point 1.8) and will refer the patient to another service or healthcare professional, where it is appropriate. 1.8. The pharmacist will provide self-care advice and support, including access to printed information and /or electronic resources,4 to all individuals, if appropriate, on the management of low acuity conditions specified in Annex E. 1.9. The end points of the consultation may include: - Advice given only - Advice and the sale of an Over the Counter (OTC) medicine - Advice and referral into a pharmacy local Minor Ailments Service (MAS) (dependent on local commissioning arrangements) - Advice and referral into a local Patient Group Direction service (dependent on local commissioning arrangements) - Advice and referral back to the patient’s patient‟s GP (pharmacist to arrange appointment for the patient at the patient’s patient‟s own GP – as part of this service) - Advice and signpost on to another service. 1.10. A GP notification may be required about the consultation depending on outcome to ensure the patient’s patient‟s primary care record held by their GP is updated. Pharmacists will use their clinical judgement to determine when this is appropriate. The notification may be made using the CPCS IT system or the paper form in Annex C, however digital transmission is preferred. 1.11. Local clinical governance processes will need to be established to ensure the quality of referrals from GP practices to pharmacies. These will need to be reviewed locally and take into account any lessons learned from the outcomes of the consultation with the pharmacist, including cases that have been closed or cases that have required an escalation. 1.12. The patient must be in attendance otherwise the consultation will not qualify as part of the GP CPCS scheme. For patients under the age of 16, pharmacists should use their professional judgement to determine whether the patient needs to be accompanied or not, taking into account the principles of Xxxxxxx competence where required.whether

Service description and background. 1.1. Patients and the general public access community pharmacies for self-care advice and to purchase over the counter medicines. It is however difficult sometimes for patients to know when it might be more appropriate to access GP advice. It is estimated that 6% of all GP consultations could be safely transferred to a community xxxxxxxx0 (20.4 million appointments per year) and there is good evidence that the advice provided by community pharmacists as part of a consultation about symptoms of minor illness will result in the same outcome as if the patient went to see their GP or attended an Emergency Department.3 1.2. As part of the Pharmacy Integration Fund programme of work to integrate community pharmacy into local NHS urgent care pathways, a new approach is being taken to create a digital process for sending a “referral” to a community pharmacist instead of booking a GP appointment for a low acuity minor illness assessment. 1.3. The term “referral” is used to describe the process where practice staff advise patients that they can attend a local community pharmacy for a consultation with a pharmacist and that personal data about them will be transferred to the pharmacy. The GP practice may use a streaming process or other local protocol to identify patients to be referred dependent on the symptoms declared by the patient. In some instances, this may make use of clinical triage or a referral following an online assessment process. The GP practice is responsible for ensuring the robustness of their chosen method of “referral” to the pharmacy (See Annex A for definitions). 1.4. The NHS England GP CPCS will commence from 1st April 2020 to 31st October 2020 1.5. The GP Community Pharmacist Consultation Service (GP CPCS) will be commissioned as a Local Enhanced Service under the terms of the Community Pharmacy Contractual Framework, with the aim of ensuring that patients have access to care close to home and with a self-care emphasis. 1.6. An electronic transfer of data to support the referral will be sent from the General Practice to a local community pharmacy. Across practices in England there are now GP reception teams that work with care navigators to support the process of booking patients to see the most appropriate member of the multidisciplinary team. Only patients who have been referred from their GP practice are eligible to receive advice and treatment 2 xxxxx://xxx.xxxxxxx.xxx.xx/gp/gpfv/workload/releasing-pressure/ 3 xxxxx://xxxxxxx.xxx.xxx/content/5/2/e006261 under this service. Patients will still be able to access advice and support for self-care from any local pharmacy as a walk-in service as usual. 1.7. On presentation, the pharmacist will assess the patient, looking for any red flags with reference to the NICE Clinical Knowledge Summaries (CKS), provide relevant self-care advice and support (as detailed in point 1.8) and 2 xxxxx://xxx.xxxxxxx.xxx.xx/gp/gpfv/workload/releasing-pressure/ 3 xxxxx://xxxxxxx.xxx.xxx/content/5/2/e006261 will refer the patient to another service or healthcare professional, where it is appropriate. 1.8. The pharmacist will provide self-care advice and support, including access to printed information and /or electronic resources,4 to all individuals, if appropriate, on the management of low acuity conditions specified in Annex E. 1.9. The end points of the consultation may include: - Advice given only - Advice and the sale of an Over the Counter (OTC) medicine - Advice and referral into a pharmacy local Minor Ailments Service (MAS) (dependent on local commissioning arrangements) - Advice and referral into a local Patient Group Direction service (dependent on local commissioning arrangements) - Advice and referral back to the patient’s GP (pharmacist to arrange appointment for the patient at the patient’s own GP – as part of this service) - Advice and signpost on to another service. 1.10. A GP notification may be required about the consultation depending on outcome to ensure the patient’s primary care record held by their GP is updated. Pharmacists will use their clinical judgement to determine when this is appropriate. The notification may be made using the CPCS IT system or the paper form in Annex C, however digital transmission is preferred. 1.11. Local clinical governance processes will need to be established to ensure the quality of referrals from GP practices to pharmacies. These will need to be reviewed locally and take into account any lessons learned from the outcomes of the consultation with the pharmacist, including cases that have been closed or cases that have required an escalation. 1.12. The patient must be in attendance otherwise the consultation will not qualify as part of the GP CPCS scheme. For patients under the age of 16, pharmacists should use their professional judgement to determine whether the patient needs to be accompanied or not, taking into account the principles of Xxxxxxx competence where required. 1.13. Pharmacists are not able to divert patients who self-present in the pharmacy with a low acuity condition into CPCS. Those who usually manage their own conditions through self-care and the purchase of OTC or Pharmacy Only medicines should continue to self-manage and treat their conditions as per essential service 6, self-care, of the Community Pharmacy Contractual Framework.

Service description and background. 1.1. Patients and the general public access community pharmacies for self-care advice and to purchase over the counter medicines. It is however difficult sometimes for patients to know when it might be more appropriate to access GP advice. It is estimated that 6% of all GP consultations could be safely transferred to a community xxxxxxxx0 (20.4 million appointments per year) and there is good evidence that the advice provided by community pharmacists as part of a consultation about symptoms of minor illness will result in the same outcome as if the patient went to see their GP or attended an Emergency Department.3 1.2. As part of the Pharmacy Integration Fund programme of work to integrate community pharmacy into local NHS urgent care pathways, a new approach is being taken to create a digital process for sending a “referral” to a community pharmacist instead of booking a GP appointment for a low acuity minor illness assessment. 1.3. The term “referral” is used to describe the process where practice staff advise patients that they can attend a local community pharmacy for a consultation with a pharmacist and that personal data about them will be transferred to the pharmacy. The GP practice may use a streaming process or other local protocol to identify patients to be referred dependent on the symptoms declared by the patient. In some instances, this may make use of clinical triage or a referral following an online assessment process. The GP practice is responsible for ensuring the robustness of their chosen method of “referral” to the pharmacy (See Annex A for definitions). 1.4. The NHS England GP CPCS will commence from 1st April 2020 to 31st October 2020 1.5. The GP Community Pharmacist Consultation Service (GP CPCS) will be commissioned as a Local Enhanced Service under the terms of the Community Pharmacy Contractual Framework, with the aim of ensuring that patients have access to care close to home and with a self-care emphasis. 1.6. An electronic transfer of data to support the referral will be sent from the General Practice to a local community pharmacy. Across practices in England there are now GP reception teams that work with care navigators to support the process of booking patients to see the most appropriate member of the multidisciplinary team. Only patients who have been referred from their GP practice are eligible to receive advice and treatment 2 xxxxx://xxx.xxxxxxx.xxx.xx/gp/gpfv/workload/releasing-pressure/ 3 xxxxx://xxxxxxx.xxx.xxx/content/5/2/e006261 under this service. Patients will still be able to access advice and support for self-care from any local pharmacy as a walk-in service as usual. 1.7. On presentation, the The pharmacist will assess the patient, face to face or remotely, looking for any red flags with reference to the NICE Clinical Knowledge Summaries (CKS), provide relevant self-care advice and support (as detailed in point 1.8) and will refer the patient to another service or healthcare professional, where it is appropriate. 1.8. The pharmacist will provide self-care advice and support, including access to printed information and /or electronic resources,4 to all individuals, if appropriate, on the management of low acuity conditions specified in Annex E. 1.9. The end points of the consultation may include: - Advice given only - Advice and the sale of an Over the Counter (OTC) medicine - Advice and referral into a pharmacy local Minor Ailments Service (MAS) (dependent on local commissioning arrangements) - Advice and referral into a local Patient Group Direction service (dependent on local commissioning arrangements) - Advice and referral back to the patient’s GP (pharmacist to arrange appointment for the patient at the patient’s own GP – as part of this service) - Advice and signpost on to another service. 1.10. A GP notification may be required about the consultation depending on outcome to ensure the patient’s primary care record held by their GP is updated. Pharmacists will use their clinical judgement to determine when this is appropriate. The notification may be made using the CPCS IT system or the paper form in Annex C, however digital transmission is preferred. 1.11. Local clinical governance processes will need to be established to ensure the quality of referrals from GP practices to pharmacies. These will need to be reviewed locally and take into account any lessons learned from the outcomes of the consultation with the pharmacist, including cases that have been closed or cases that have required an escalation. 1.12. The patient must be in attendance either face to face or remotely otherwise the consultation will not qualify as part of the GP CPCS scheme. For patients under the age of 16, pharmacists should use their professional judgement to determine whether the patient needs to be accompanied or not, taking into account the principles of Xxxxxxx competence where required.

Service description and background. 1.1. Patients and the general public access community pharmacies for self-care advice and to purchase over the counter medicines. It is however difficult sometimes for patients to know when it might be more appropriate to access GP advice. It is estimated that 6% of all GP consultations could be safely transferred to a community xxxxxxxx0 (20.4 million appointments per year) and there is good evidence that the advice provided by community pharmacists as part of a consultation about symptoms of minor illness will result in the same outcome as if the patient went to see their GP or attended an Emergency Department.3 1.2. As part of the Pharmacy Integration Fund programme of work to integrate community pharmacy into local NHS urgent care pathways, a new approach is being taken to create a digital process for sending a “referral” to a community pharmacist instead of booking a GP appointment for a low acuity minor illness assessment. 1.3. The term “referral” is used to describe the process where practice staff advise patients that they can attend a local community pharmacy for a consultation with a pharmacist and that personal data about them will be transferred to the pharmacy. The GP practice may use a streaming process or other local protocol to identify patients to be referred dependent on the symptoms declared by the patient. In some instances, this may make use of clinical triage or a referral following an online assessment process. The GP practice is responsible for ensuring the robustness of their chosen method of “referral” to the pharmacy (See Annex A for definitions). 1.4. The NHS England and NHS Improvement GP CPCS will commence from 1st April 2020 to 31st October 2020 1.5. The GP Community Pharmacist Consultation Service (GP CPCS) will be commissioned as a Local Enhanced Service under the terms of the Community Pharmacy Contractual Framework, with the aim of ensuring that patients have access to care close to home and with a self-care emphasis. 1.6. An electronic transfer of data to support the referral will be sent from the General Practice to a local community pharmacy. Across practices in England there are now GP reception teams that work with care navigators to support the process of booking patients to see the most appropriate member of the multidisciplinary team. Only patients who have been referred from their GP practice are eligible to receive advice and treatment 2 xxxxx://xxx.xxxxxxx.xxx.xx/gp/gpfv/workload/releasing-pressure/ 3 xxxxx://xxxxxxx.xxx.xxx/content/5/2/e006261 under this service. Patients will still be able to access advice and support for self-care from any local pharmacy as a walk-in service as usual. 1.7. On presentation, the pharmacist will assess the patient, looking for any red flags with reference to the NICE Clinical Knowledge Summaries (CKS), provide relevant self-care advice and support (as detailed in point 1.8) and will refer the patient to another service or healthcare professional, where it is appropriate. 1.8. The pharmacist will provide self-care advice and support, including access to printed information and /or electronic resources,4 to all individuals, if appropriate, on the management of low acuity conditions specified in Annex E. 1.9. The end points of the consultation may include: - Advice given only - Advice and the sale of an Over the Counter (OTC) medicine - Advice and referral into a pharmacy local Minor Ailments Service (MAS) (dependent on local commissioning arrangements) - Advice and referral into a local Patient Group Direction service (dependent on local commissioning arrangements) - Advice and referral back to the patient’s patient‟s GP (pharmacist to arrange appointment for the patient at the patient’s patient‟s own GP – as part of this service) - Advice and signpost on to another service. 1.10. A GP notification may be required about the consultation depending on outcome to ensure the patient’s patient‟s primary care record held by their GP is updated. Pharmacists will use their clinical judgement to determine when this is appropriate. The notification may be made using the CPCS IT system or the paper form in Annex C, however digital transmission is preferred. 1.11. Local clinical governance processes will need to be established to ensure the quality of referrals from GP practices to pharmacies. These will need to be reviewed locally and take into account any lessons learned from the outcomes of the consultation with the pharmacist, including cases that have been closed or cases that have required an escalation. 1.12. The patient must be in attendance otherwise the consultation will not qualify as part of the GP CPCS scheme. For patients under the age of 16, pharmacists should use their professional judgement to determine whether the patient needs to be accompanied or not, taking into account the principles of Xxxxxxx competence where required.

Service description and background. 1.1. Patients and the general public access community pharmacies for self-care advice and to purchase over the counter medicines. It is however difficult sometimes for patients to know when it might be more appropriate to access GP advice. It is estimated that 6% of all GP consultations could be safely transferred to a community xxxxxxxx0 (20.4 million appointments per year) and there is good evidence that the advice provided by community pharmacists as part of a consultation about symptoms of minor illness will result in the same outcome as if the patient went to see their GP or attended an Emergency Department.3 1.2. As part of the Pharmacy Integration Fund programme of work to integrate community pharmacy into local NHS urgent care pathways, a new approach is being taken to create a digital process for sending a “referral” to a community pharmacist instead of booking a GP appointment for a low acuity minor illness assessment. 1.3. The term “referral” is used to describe the process where practice staff advise patients that they can attend a local community pharmacy for a consultation with a pharmacist and that personal data about them will be transferred to the pharmacy. The GP practice may use a streaming process or other local protocol to identify patients to be referred dependent on the symptoms declared by the patient. In some instances, this may make use of clinical triage or a referral following an online assessment process. The GP practice is responsible for ensuring the robustness of their chosen method of “referral” to the pharmacy (See Annex A for definitions). 1.4. Patients need to be supported and feel confident that they are being provided the right care for them at the right time. The GP to pharmacy referral pathway builds on the knowledge gained through the four NHS 111 to pharmacy DMIRS regions that have been running in North East England GP CPCS will commence from 1st April 2020 to 31st October 2020(since December 2017) and in the East Midlands, Devon and London (since November 2018). 1.5. The GP Community Pharmacist Consultation Digital Minor Illness Referral Service (GP CPCSDMIRS) will be commissioned as a Local Enhanced Service under the terms of the Community Pharmacy Contractual Framework, with the aim of ensuring that patients have access to care close to home and with a self-care emphasis. 1.6. An electronic transfer of data to support the referral will be sent from the General Practice to a local community pharmacy. Across practices in England there are now GP reception teams that work with care navigators 2 xxxxx://xxx.xxxxxxx.xxx.xx/gp/gpfv/workload/releasing-pressure/ 3 xxxxx://xxxxxxx.xxx.xxx/content/5/2/e006261 to support the process of booking patients to see the most appropriate member of the multidisciplinary team. Only patients who have been referred from their GP practice are eligible to receive advice and treatment 2 xxxxx://xxx.xxxxxxx.xxx.xx/gp/gpfv/workload/releasing-pressure/ 3 xxxxx://xxxxxxx.xxx.xxx/content/5/2/e006261 under this service. Patients will still be able to access advice and support for self-care from any local pharmacy as a walk-in service as usual. 1.7. On presentation, the pharmacist will assess the patient, looking for any red flags with reference to the NICE Clinical Knowledge Summaries (CKS), provide relevant self-care advice and support (as detailed in point 1.8) and will refer the patient to another service or healthcare professional, where it is appropriate. 1.8. The pharmacist will provide self-care advice and support, including access to printed information and /or electronic resources,4 to all individuals, if appropriate, on the management of low acuity conditions specified in Annex E. 1.9. The end points of the consultation may include: - Advice given only - Advice and the sale of an Over the Counter (OTC) medicine - Advice and referral into a pharmacy local Minor Ailments Service (MAS) (dependent on local commissioning arrangements) - Advice and referral into a local Patient Group Direction service (dependent on local commissioning arrangements) - Advice and referral back to the patient’s patient‟s GP (pharmacist to arrange appointment for the patient at the patient’s patient‟s own GP – as part of this service) - Advice and signpost on to another service. 1.10. A GP notification may be required about the consultation depending on outcome to ensure the patient’s patient‟s primary care record held by their GP is updated. Pharmacists will use their clinical judgement to determine when this is appropriate. The notification may be made using the CPCS DMIRS IT system or the paper form in Annex C, however digital transmission is preferred. 1.11. Local clinical governance processes will need to be established to ensure the quality of referrals from GP practices to pharmacies. These will need to be reviewed locally and take into account any lessons learned from the outcomes of the consultation with the pharmacist, including cases that have been closed or cases that have required an escalation. 1.12. The patient must be in attendance otherwise the consultation will not qualify as part of the GP CPCS DMIRS scheme. For patients under the age of 16, pharmacists should use their professional judgement to determine whether the patient needs to be accompanied or not, taking into account the principles of Xxxxxxx competence where required.whether