A referral can be clinically appropriate, correctly processed and sent to the right service, yet still result in a patient returning through the practice door.

For Dr Nabeel Arshad, GP Partner, Innovation Lead and Patient Experience Lead at The Brooke Surgery, those moments are worth examining. His work pays particular attention to how pathways are experienced by both patients and staff, and when Pharmacy First launched, the practice was keen to understand how the new pathway would work in day-to-day care.

Staff were trained, referrals began and Dr Arshad used the pathway himself. As experience grew, so did the team’s understanding of the practical factors influencing whether a referral ran smoothly.

Capacity differed between pharmacies. So did the way in which they wanted patients to access the service: a telephone call and allocated time for some, walk-ins for others. Training and readiness were not always consistent, while practices could lack a clear view of which pharmacies were able to receive particular referrals.

“A lot of pharmacies weren't aware of what the Pharmacy First scheme would mean for them,” Dr Arshad explains. “Similarly, there wasn't any two-way communication between pharmacies and GP surgeries.”

Those communication gaps have consequences at both ends of the pathway. Patients can be left uncertain about where to go or what happens next, while practices may find themselves managing returned patients, additional administration and clinical work they had expected the referral to release.

The change at The Brooke Surgery was simple: direct communication with local pharmacies.

By understanding how pharmacies wanted referrals to arrive, what capacity they had and where the limits of the service sat, both sides had a clearer picture of how the pathway could work. Crucially, communication also travelled in the other direction. Inappropriate referrals could be discussed and fed back, allowing the process to be refined rather than the problem recurring.

Dr Arshad describes this openness around demand, staffing and referral quality as fundamental.

“This is the most essential piece of the puzzle,” he says. “Without this you're destined for failure.”

It is a pertinent point as general practice and community pharmacy become more closely connected across primary care. A successful pathway cannot be measured simply by how many referrals leave a practice. The patient still needs to reach the appropriate professional, understand what to expect and receive the intended care without being unnecessarily passed between services.

Building that connection has allowed The Brooke Surgery to release clinical time and direct more focus to patients who need practice-based care. Dr Arshad also highlights patient trust: clearer expectations make a pathway feel joined up, rather than like a handover between two disconnected services.

There is a business consideration too. Dr Arshad says the changes have helped the practice improve clinical care while also releasing time and improving income. For GP partners and practice leaders, that brings another dimension to the discussion: whether redesigned pathways genuinely create value or simply relocate work elsewhere.

At Best Practice Birmingham 2026, Dr Arshad will share the detail behind that experience: what they tried, where the stumbling blocks appeared and the practical changes that strengthened the relationship with local pharmacies. The intention is not to offer one pathway for every practice to replicate, but to give teams that have struggled with Pharmacy First, or have yet to make full use of it, ideas they can apply within their own setting.

And there is optimism behind his approach.

“In a world full of pessimism, budget cuts and uncertainty, we want to share positivity and how practices can thrive in this environment and improve pathways.”

Join Dr Nabeel Arshad at Best Practice Birmingham 2026 to explore how stronger communication between general practice and community pharmacy can turn a referral pathway into a working partnership, with practical lessons to take straight back to practice.