An Incredible NHS Pharmacy First Plus Intervention: Spot Leukaemia

Published: 10/04/25

The network of Independent Prescribing (IP) community pharmacists in Scotland is continually growing, and the NHS Pharmacy First Plus service has provided a platform for these skilled professionals to extend care to people in their communities.

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Often, it is assumed that the value of the service mainly comes from the pharmacist’s ability to prescribe. However, there is a remarkable amount of work and skill that goes into holistic consultation where the outcomes often result in excellent patient care with no prescribing involved.

Victoria Lang is an Independent Prescribing Community Pharmacist delivering the NHS Pharmacy First Plus service. Last autumn, she received a consultation request through the service from a concerned patient representative about an unwell family member. They had been advised by the GP to speak to their community pharmacist.

When the patient arrived at the pharmacy, they were visibly unwell, requiring support from the family member who had accompanied them. Victoria states that:

“When the [independent prescribing] training says assessment begins at the door, this really was the case for this interaction and on reflection, the patient’s demeanour and presentation that day did ring alarm bells for me.”

Victoria went through her consultation routine of taking a thorough medical history where she spotted a few ‘red flags’ on top of the patient’s presentation.

These included:

• A history of recent neutropenic episodes.

• Allergies and intolerances to previously prescribed antibiotics.

• Sore throat - which typically on its own wouldn’t cause alarm bells but with the other red flag symptoms being present this was a concern.

Due to the outcome of the consultation - during which Victoria identified multiple possible infections and noted the patient’s deteriorating health - she promptly referred the patient to the GP for an urgent same-day appointment. This was quickly arranged after Victoria communicated the findings of the consultation.

This consultation happened to take place during the same week that Victoria’s pharmacy was hosting a Leukaemia Awareness Campaign, as September is Blood Cancer Awareness Month. This, coupled with Victoria’s own journey with a leukaemia diagnosis, allowed her and her pharmacy team to be vigilant to signs and symptoms such as:

• persistent fatigue

• unexplained bruising or bleeding

• frequent infections

• Fever

• night sweats

• bone/joint pain

• swollen lymph nodes

Six weeks later, Victoria and her pharmacy team found out that the patient had indeed been diagnosed with leukaemia and had been referred for treatment immediately. Victoria said:

“Although we refer multiple patients each week to their GP, we don’t usually get to know the outcome and I think we usually hope that our instincts are wrong. The experience has helped me to understand that initial assessment of the patient before any questions are asked does guide our consultation and influence the outcome.”

This is a powerful example of incredible patient care and a commitment to ensuring that any patient using a community pharmacy service receives timely access and a thorough consultation. At Community Pharmacy Scotland (CPS), we recognise the outstanding value that all community pharmacy teams bring to the wider NHS and the local communities they serve. This real-life case highlights the vital role of the community pharmacy network in Scotland and showcases the incredible interventions you carry out every day to ensure people receive the right care in the right place.

Well done to Victoria and her team, and if anyone else would like to get in touch with other remarkable interventions that have been delivered through community pharmacy NHS services, or if you have a good news story please contact me at: sarah.scott@cps.scot

Victoria gave permission for this story to be published.

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