When services are unsafe, unavailable, or need urgent referral

Some of the most difficult consultations occur when the answer is not "yes". A service may be clinically unsuitable, a medicine unavailable, or the person's presentation may require a more urgent setting than they expected.

High-risk pharmacy situations

• Service unsuitability: the person does not meet clinical criteria, has red-flag symptoms, or needs another clinician or setting.
• Non-supply for safety reasons: the medicine request cannot be supported because of contraindications, interactions, misuse concerns, or missing information.
• Urgent referral: the consultation suggests same-day assessment, emergency care, or another urgent pathway.
• Medicine shortages or unexpected unavailability: the person may need an alternative, an emergency plan, or realistic advice on likely timescales.

How to communicate these situations well

• Be clear about the safety reason: people respond better when they know the decision protects their safety rather than blocks access.
• Avoid vague phrases: saying "we can't do this" without explanation often increases anger and confusion.
• Give a route forward: explain who to contact, how urgently, and what to do if symptoms worsen.
• Use written backup where possible: if the advice is important or urgent, provide a clear written record of next steps.
• Document appropriately: record clinically significant, time-sensitive, or contested decisions accurately.

Whole-pharmacy preparation

When the answer is "not here", "not now", or "not safely", people still need a compassionate explanation and a realistic route forward.