EMMA Signposted a Patient to Pharmacy First Incorrectly

Purpose of Document

Incorrect Pharmacy First signposting is a clinical concern. If EMMA redirects a patient who is not eligible, that patient may attend a pharmacy that cannot treat them, delay appropriate medical care, or receive incorrect advice. Support staff must understand the current eligibility criteria in full, identify what went wrong, and escalate clinical safety concerns where appropriate.

Background: What Pharmacy First Is

NHS Pharmacy First is a service that allows patients to receive treatment for certain common conditions directly from a pharmacist, including prescription medication where appropriate, without needing to see a GP. EMMA signposts eligible patients to their nearest pharmacy for these conditions, reducing the volume of calls that need to be handled by the practice clinical team.

Pharmacy First signposting is only offered when a patient calls about a condition that falls within the eligible conditions list and passes the safety eligibility checks EMMA performs during the call.

Current Pharmacy First Eligibility Criteria

The following conditions and age restrictions are current as of the Pharmacy First Referral Update and the February 2025 service update. All support staff must know these by category.

Conditions eligible for Pharmacy First signposting:

Conditions no longer eligible for Pharmacy First signposting:

Shingles and impetigo were removed from the Pharmacy First pathway because they require direct medical assessment and are not appropriate for pharmacy-only treatment.

Safety Eligibility Checks EMMA Performs

Before signposting any patient to Pharmacy First, EMMA confirms eligibility by checking all of the following. A patient who does not meet any one of these criteria is not signposted to Pharmacy First.

EMMA confirms Pharmacy First is appropriate only when the patient:

• Is registered with a GP
• Is not pregnant
• Does not have a weakened immune system or take immunosuppressive medication
• Does not have diabetes
• Does not have ongoing, chronic, severe, or recurrent medical conditions
• Is not feeling very unwell with a high temperature that is not improving

These checks were enhanced as part of the Pharmacy First Referral Update to provide clearer, more detailed eligibility confirmation and better alignment with current NHS Pharmacy First guidelines.

Surgery-Specific Pharmacy First Configurations

Not all surgeries use the standard Pharmacy First flow. Support staff must check whether the affected surgery has any custom Pharmacy First configuration before investigating a complaint.

Standard Pharmacy First flow EMMA checks eligibility, confirms the condition and age, performs safety checks, and signposts the patient to their nearest walk-in pharmacy.

Video consultation option (Ashton Medical Centre, March 2026) EMMA offers eligible Ashton Medical Centre callers a video consultation as the first Pharmacy First option. If accepted, an SMS link is sent and the call concludes. If declined, the standard walk-in pharmacy flow continues. Video consultation acceptances are logged for compliance and audit. This applies to Ashton Medical Centre only.

Surgery-specific Pharmacy First enabled or disabled Pharmacy First signposting is enabled per surgery on request. Some surgeries may have it disabled entirely. Check the surgery's configuration before investigating a complaint about incorrect signposting.

Common Causes and What to Check

1. EMMA signposted a patient to Pharmacy First for shingles or impetigo

Both conditions were removed from the Pharmacy First pathway in the February 2025 update. If this is occurring after that date, it is a platform issue.

What to do:

• Review the call recording to confirm what condition the patient described
• Confirm the date of the call
• If this occurred after February 2025 and EMMA signposted a patient with shingles or impetigo to Pharmacy First, escalate to engineering immediately with the call ID and surgery ODS code
• If this is a clinical safety concern because the patient attended a pharmacy and received inappropriate guidance, escalate to the clinical safety lead

2. EMMA signposted a UTI patient who was outside the eligible age range

UTI Pharmacy First signposting is only available for female patients aged 16 to 64. A male patient or a patient outside this age range should not be signposted to Pharmacy First for a UTI.

What to do:

• Review the call recording to confirm what age and sex the patient stated
• Check whether EMMA correctly identified the patient's age and sex during the call
• If EMMA incorrectly identified age or sex and signposted an ineligible patient, check whether this is a speech recognition issue or a logic error
• Escalate to engineering with the call ID if EMMA signposted an ineligible patient despite the patient clearly stating their age and sex correctly

3. EMMA signposted a patient who had one of the safety exclusion criteria

If a patient disclosed during the call that they were pregnant, diabetic, immunocompromised, or very unwell with a high temperature, EMMA should not have signposted them to Pharmacy First.

What to do:

• Review the call recording carefully
• Check whether the patient disclosed the exclusion criteria and whether EMMA responded correctly
• If the patient disclosed an exclusion clearly and EMMA still signposted them, this is a clinical safety concern requiring escalation
• If the patient did not disclose an exclusion during the call, EMMA's behaviour was based on the information available and is not a platform fault

4. EMMA signposted an under-age patient to Pharmacy First

As of March 2026, EMMA identifies callers who are under 18 and immediately transfers them to the surgery reception team rather than continuing through self-service flows. For Pharmacy First specifically, age eligibility is checked during the signposting flow.

What to do:

• Review the call recording to confirm what age the patient or parent stated
• Check whether the age-specific eligibility criteria were correctly applied for the condition described
• If EMMA signposted a patient who clearly falls outside the age range for that condition, escalate to engineering with the call ID

5. The practice believes EMMA signposted incorrectly but the signposting was actually appropriate

Occasionally a practice raises a concern because a patient complained after being sent to a pharmacy, but EMMA's signposting was correct based on the information the patient provided during the call.

What to do:

• Review the call recording
• Confirm what the patient said during the call
• Confirm whether EMMA's eligibility assessment was correct based on that information
• If EMMA's signposting was correct, explain this to the practice with reference to the call recording
• Advise the practice that patients sometimes provide incomplete information during calls, and the clinical team's review of any subsequent submission is the final safety check

Step-by-Step Triage Process

1. Ask the practice to describe the specific complaint. Which patient? What condition? What did EMMA tell them?
2. Pull the call recording and listen to the full Pharmacy First interaction.
3. Check the condition the patient described against the current eligibility criteria table above.
4. Check the age and sex the patient stated against the age-specific criteria for that condition.
5. Check whether the patient disclosed any safety exclusion criteria during the call.
6. Confirm whether the surgery uses a standard or custom Pharmacy First configuration.
7. If EMMA's signposting was correct based on the information the patient provided, explain this to the practice.
8. If EMMA signposted an ineligible patient despite correct information being provided, escalate to engineering.
9. If a clinical safety concern exists because an ineligible patient received inappropriate pharmacy guidance, escalate to the clinical safety lead.

What to Tell the Practice

Example wording when EMMA's signposting appears correct based on what the patient said:

"Having reviewed the call recording, EMMA signposted this patient based on the information they provided during the call. The condition they described and the age they gave meet the current NHS Pharmacy First eligibility criteria. If the patient had additional health conditions that would have excluded them, these were not mentioned during the call. EMMA can only assess eligibility based on what the patient tells her."

Example wording when EMMA's signposting was incorrect:

"We have reviewed the call recording and can see that EMMA signposted this patient to Pharmacy First in a way that does not align with the current eligibility criteria. We are investigating this as a priority and will come back to you with our findings. In the meantime, if there are any clinical concerns about the care the patient received as a result, please let us know immediately."

Common Mistakes

• Telling a practice the complaint is correct without first reviewing the call recording
• Not knowing that shingles and impetigo were removed from the Pharmacy First pathway in February 2025
• Not checking whether the surgery has a custom Pharmacy First configuration before investigating
• Treating a complaint as a platform fault when the patient did not disclose an exclusion criterion during the call
• Not escalating to the clinical safety lead when a patient may have received clinically inappropriate pharmacy guidance

Escalation Guidance

Escalate to engineering if:

• EMMA signposted a patient with shingles or impetigo to Pharmacy First after February 2025
• EMMA signposted a patient who clearly stated an age or sex outside the eligible criteria for that condition
• EMMA signposted a patient who clearly disclosed a safety exclusion criterion such as pregnancy, diabetes, or immunosuppression

Escalate to the clinical safety lead if:

• A patient received clinically inappropriate care at a pharmacy as a result of EMMA's signposting
• A clinical harm concern has been raised by the practice, the patient, or a pharmacist

When escalating, always include:

• Surgery name and ODS code
• Call ID and timestamp
• Condition the patient described
• Age and sex the patient stated
• Whether the patient disclosed any safety exclusion criteria
• What EMMA communicated to the patient during the call
• Whether any clinical concern has been raised

Last Reviewed: May 2026 Owner: Support and Customer Success