How EMMA Decides When to Signpost a Caller to Pharmacy First?

Purpose of Document

This article exists to give support staff, onboarding teams, and account managers a complete and accurate understanding of the Pharmacy First signposting logic. It is the companion article to Article 20, which covers what to do when signposting goes wrong. This article covers how the system is designed to work and is useful for explaining the process to practices, handling questions from ICBs, and informing Pharmacy First reporting conversations.

Background: Why EMMA Signposts to Pharmacy First

NHS Pharmacy First allows patients to receive treatment for certain common conditions directly from a pharmacist, without needing to see a GP. For practices, this reduces the volume of calls that enter the medical triage pathway for conditions that can be safely and appropriately handled by a community pharmacist.

EMMA's role is to identify whether a caller's condition may be appropriate for Pharmacy First and, if so, to present the option before the call enters the full medical triage flow. This is a deflection step, not a clinical decision. EMMA does not diagnose. EMMA identifies a potential pathway and the patient always has the option to decline and continue through the standard medical flow.

The Full Pharmacy First Decision Flow

Step 1: Red Flag and emergency check

Before any Pharmacy First assessment occurs, EMMA's Red Flag and Sentinel systems assess the call for emergency indicators. If the patient describes symptoms that indicate a potential emergency, EMMA routes directly to the emergency pathway regardless of the condition mentioned. Pharmacy First is never offered to a patient in an emergency.

As of V12 (May 2026), Red Flag has been refined across every language EMMA supports with clinical oversight from Sir David Sloman, former Chief Operating Officer of the NHS.

Step 2: Urgency triage (surgery-specific)

For some surgeries, EMMA asks an upfront urgency question when a caller enters the medical pathway. At Ashton Medical Centre (from March 2026), EMMA asks a single triage question at the start of every medical interaction to identify urgent same-day requests. Urgent callers are transferred to reception immediately. Non-urgent callers continue through the full medical flow including Pharmacy First assessment, capacity checks, and ETW (Estimated Treatment Wait). This applies to Ashton Medical Centre only. Other surgeries continue with their existing flows.

Step 3: Condition identification

EMMA listens to what the patient describes and identifies whether the condition matches one of the Pharmacy First eligible conditions. The conditions are:

If the condition does not match any of the above, EMMA does not offer Pharmacy First and the call continues through the standard medical flow.

If the condition matches, EMMA moves to Step 4.

Step 4: Age and sex eligibility check

EMMA confirms the patient's age and sex where relevant to the condition. For UTIs, EMMA confirms the patient is female and aged between 16 and 64. For ear infections, EMMA confirms the patient is aged between 1 and 17. For conditions with broader age ranges, EMMA confirms the patient meets the minimum age requirement.

If the patient does not meet the age or sex criteria for that condition, EMMA does not offer Pharmacy First and the call continues through the standard medical flow.

Step 5: Safety eligibility checks

If the patient meets the condition and age criteria, EMMA performs the following safety checks. Pharmacy First is only offered if the patient does not have any of the following:

• Pregnancy
• Weakened immune system or immunosuppressive medication
• Diabetes
• Ongoing, chronic, severe, or recurrent medical conditions
• Feeling very unwell with a high temperature that is not improving

EMMA also confirms the patient is registered with a GP.

If any safety exclusion is present, EMMA does not offer Pharmacy First and the call continues through the standard medical flow.

Step 6: Pharmacy First offered to the patient

If all checks pass, EMMA offers Pharmacy First to the patient. The patient is given a clear explanation of the service and is always given the option to decline.

Standard flow: EMMA signposts the patient to their nearest walk-in pharmacy.

Ashton Medical Centre video consultation flow (from March 2026): EMMA offers a video consultation option as the first step. If the patient accepts, an SMS link is sent and the call concludes. If the patient declines the video option, the standard walk-in pharmacy flow continues. Video consultation acceptances are logged for compliance and audit.

Step 7: Patient accepts or declines

If the patient accepts Pharmacy First, the call concludes. The patient has been given the information they need to attend a pharmacy.

If the patient declines Pharmacy First, EMMA continues into the standard medical flow. The patient is not penalised for declining and does not need to go through the full eligibility check again. EMMA moves on to the next step in the medical flow.

Step 8: Patient returns after Pharmacy First

Some patients attend a pharmacy and then call back because the pharmacy could not help them or because their condition has not improved. EMMA handles returning Pharmacy First callers through the standard medical flow without re-offering Pharmacy First for the same condition.

For Ashton Medical Centre, the triage behaviour after a Pharmacy First return is consistent with the upfront urgency triage applied at the start of medical calls.

Pharmacy First Reporting in V12

As of V12 (May 2026), every Pharmacy First signpost is now tied to a named patient through Patient ID. This means:

• Complete Pharmacy First referral visibility by named patient
• Every Pharmacy First signpost is attributed to a verified patient record from the start of the call
• Practices can report Pharmacy First activity accurately against NHS contract requirements
• The data supports QOF contribution and practice-level access metric reporting introduced in April 2026

This is a significant improvement from pre-V12 where Pharmacy First signposts were not always attributable to a named patient.

What Happens at Each Stage If a Patient Is Ineligible

How to Enable or Disable Pharmacy First for a Surgery

Pharmacy First signposting is enabled per surgery on request. It is not active by default for all surgeries.

To enable Pharmacy First for a surgery:

• Confirm the surgery name and ODS code
• Confirm which Pharmacy First flow they want: standard walk-in, video consultation option, or a custom flow
• Raise a configuration request with the engineering or configuration team
• Confirm with the surgery once live and ask them to test with a sample call

To disable Pharmacy First for a surgery:

• Confirm the surgery name, ODS code, and reason for disabling
• Raise a configuration request
• Confirm with the surgery once disabled

Common Questions From Practices

"Why is EMMA offering Pharmacy First to patients who we would prefer to come to us?"

Pharmacy First is designed to reduce unnecessary GP appointments for conditions that pharmacists are trained and equipped to treat. If the practice would prefer EMMA not to offer Pharmacy First for specific conditions or at all, this can be configured on request.

"A patient came back from the pharmacy and said they could not be treated there. What went wrong?"

There are two possible explanations. Either the patient provided information during the call that suggested eligibility but had an undisclosed condition that made them ineligible at the pharmacy, or the specific pharmacy the patient attended does not participate in the NHS Pharmacy First scheme. EMMA cannot know which pharmacies in the patient's area are actively participating. This is worth flagging to the practice.

"Can EMMA signpost to a specific pharmacy rather than the nearest one?"

Currently EMMA signposts to Pharmacy First as a service rather than directing patients to a specific named pharmacy. If the surgery wants to include specific pharmacy recommendations, this can be discussed as a configuration request.

"Does EMMA log Pharmacy First referrals anywhere?"

Yes. As of V12, every Pharmacy First signpost is attributed to a named verified patient and included in practice-level reporting. This supports NHS contract compliance reporting.

What to Tell the Practice

Example wording explaining the Pharmacy First decision process:

"EMMA only offers Pharmacy First after checking that the patient's condition and age match the NHS Pharmacy First eligibility criteria and that none of the safety exclusions apply, such as pregnancy, diabetes, or a weakened immune system. If the patient passes all those checks, EMMA offers Pharmacy First as an option. The patient can always decline and continue through the standard medical process. If you would prefer EMMA not to offer Pharmacy First at your surgery, we can turn this off."

Common Mistakes

• Thinking Pharmacy First is active by default for all surgeries. It is enabled per surgery on request.
• Not knowing the Ashton Medical Centre video consultation flow when investigating a complaint from that surgery.
• Telling a practice EMMA cannot disable Pharmacy First. It can be disabled at any time.
• Not knowing that every Pharmacy First signpost in V12 is attributed to a named patient for reporting purposes.
• Forgetting that shingles and impetigo were removed from the Pharmacy First pathway in February 2025.

Escalation Guidance

Escalate to engineering if:

• EMMA is offering Pharmacy First for conditions not on the eligible list after the February 2025 update
• EMMA is offering Pharmacy First despite a patient clearly stating a safety exclusion criterion
• Pharmacy First signposts are not being attributed to named patients on a V12 surgery

Escalate to the clinical safety lead if:

• A patient received clinically inappropriate care at a pharmacy as a result of an incorrect EMMA signpost

When escalating, always include:

• Surgery name and ODS code
• Call ID and timestamp
• Condition the patient described
• Age, sex, and safety check responses the patient gave
• What EMMA communicated to the patient

Last Reviewed: May 2026 Owner: Support and Customer Success