What Happens to the General Practitioner When the Pharmacist Tests for Strep Throat? A Systematic Review of Community Pharmacy Sore Throat Services and Their Consequences for General Practice

Community pharmacists in high-income countries assess sore throat using clinical scoring and rapid antigen detection testing, yet consequences for general practitioner workload, prescribing and safety have not been systematically reviewed from a primary care organisation perspective. We searched PubMed, CINAHL, Scopus, Web of Science and the Cochrane Library from 2006 to 15 February 2026 for studies of pharmacy-led sore throat services reporting impact on general practitioner use. Risk of bias was assessed with the JBI Critical Appraisal Checklist for Prevalence Studies for single-arm and descriptive studies, and ROBINS-I for the comparative cohort; certainty was assessed using GRADE. The review followed PRISMA 2020 and SWiM, and was registered on the Open Science Framework (osf.io/tx9y8). In total, 9 studies (5 countries; > 100,000 consultations) were included: 1 comparative cohort with linked data (n = 72,736), 1 interrupted time-series (n = 27,441) and 7 descriptive service evaluations. In the comparative study, pharmacy antibiotic provision at index consultation was 21% versus 39% in general practice (adjusted odds ratio 0.30, 95% confidence interval 0.27-0.32). Across studies, 91%-97% of consultations were managed in pharmacy without general practitioner referral. Peritonsillar abscess rates were similar between settings (0.31% vs. 0.41%; not significant). Certainty was low for antibiotic prescribing and non-referral, and very low for reconsultation and safety outcomes. Heterogeneity precluded meta-analysis; findings were synthesised narratively following SWiM. Available evidence suggests pharmacy services may reduce antibiotic prescribing and manage most presentations without referral. Whether this reflects task redistribution or rapid antigen testing, equally deployable in general practice, remains unresolved. Pharmacy and general practice, moreover, did not manage comparable populations, so lower pharmacy prescribing may in part reflect case-mix. Review Registration: Open Science Framework (https://osf.io/tx9y8).