Minor Ailments Scheme
In Pharmacies
Treatment of Minor Ailments by
Community Pharmacists
Contents
Description
Acknowledgements
Service Specification
Introduction
Transfer into Minor Ailment Scheme
Duties of participating Surgeries
Duties of participating Community Pharmacies
Referral procedure
Service funding and payment mechanism
Monitoring and evaluation
Pharm Claim Pro-forma (Pharmacist prescription and patient exemption)
Monthly Summary Sheet
Minor Ailment Protocols:
Page Number
3
4-6
4
4
4
5
5
6
6
7-8
9
12-33
Athlete’s Foot
Cold Sores
Colds / Flu / Earache
Constipation
Cough
Diarrhoea
Hay Fever / Allergy Relief
Head Lice
Temperature
Nappy Rash
Nasal Congestion
Sore Throat
Threadworms
Vaginal Thrush
Veruccas and Warts
13
14
15
17
18
20
22
24
25
27
28
29
30
31
33
Receptionists Protocol
Pharmacists Protocol
Pharmacist Referral Form
Identification of a named professional lead
Flowchart
34
36
37
38
39
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 2 of 39
Approval
Approval to undertake the pilot scheme was made at the Solis Board, Dec 2012
Monitoring and Reporting
This pilot scheme is reported to and monitored by Solihull CCG Members Support team. If a
recommendation to continue the pilot is made, then the responsibility for monitoring and
reporting of the operation of the scheme will need to be assigned.
Solihull CCG
Kate Arnold, Head of Medicines Management, NHS Solihull CCG
Tony Sargent, Commissioning Facilitator, NHS Solihull CCG
Parveen Baden, Community Pharmacy Development Manager,
Birmingham and Solihull NHS Cluster
Pilot Scheme Details
Commencement Date:
February 2013
Review Date:
August 2013
Service Specification and Clinical Protocols developed by Yvonne Murphy and Kalpesh Patel,
Senior Pharmaceutical Adviser Birmingham and Black Country Commissioning Support
Unit.(BBCS CCG)
Pilot Practice
Bosworth Medical Centre
Pharmacists and staff from Community Pharmacies in Pilot
Boots UK Ltd, Crabtree Drive, Chelmsley Wood
Boots UK Ltd, 29-31 Greenwood Way, Chelmsley Wood
Asda Stores Ltd, Bosworth Drive
Lloyds Pharmacy, 3 Bell Lane, Tile Cross
Dudley Taylor Pharmacies, 5 Craig Croft, Chelmsley Wood
Protocol Authorised by:
Dr R Clowes, Bosworth Medical Centre
Kate Arnold, Head of Medicines Management, NHS Solihull CCG
Professionals To Whom This Protocol May Apply
Authorised professionals shall be:

Pharmacists currently registered with the GPhC.

Staff shall have satisfied competence criteria required by their designated responsible
professional in:
o
Knowledge of the clinical situation the protocol applies to
o
Knowledge of medicines listed and their effects
o
Continuing Education requirements
o
Working under protocol for the NHS supply
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 3 of 39
Service Specification
1. Introduction
1.1 This service is available to all patients exempt from prescription charges, including
those with pre payment certificates, registered with the surgeries participating in the
scheme. Patients are at liberty to refuse this service. Patients who pay for their
prescriptions should be referred to a pharmacy to purchase medicines in the usual way.
1.2 The service is only available for the minor ailments identified on page 10.
1.3 Only community pharmacies who are committed to making staff available to provide the
service and who have successfully completed the appropriate training provided by
Birmingham Black Country and Solihull Commissioning Support Unit (BBCS
CSU) on behalf of the Solihull Clinical Commissioning Group (SCCG) will be
included in the scheme. Additionally it is recommended that all pharmacists
participating in the scheme should complete the most recent CPPE package on Minor
Ailments.
1.4 In order to be eligible to participate in the scheme, the pharmacy must have a
consultation room available for carrying out minor ailments consultations.
2. Transfer of Care
2.1 Patients presenting with identified symptoms at the GP surgery will be offered transfer
into this service. Patients may also self refer following initial practice referral and
registration at a participating pharmacy.
2.2 Patients presenting at a participating community pharmacy and registered with a
participating GP will receive the service level of care as laid out in this specification.
2.3 Patients wishing to access the service must present identification and reasonable proof
of registration with a participating practice. This can be
a. Their NHS card or a minor ailments leaflet from their surgery bearing the
surgery stamp/pharmacy stamp with the patients name, address and date
added by surgery/pharmacy staff
b. Be registered on the pharmacy computer system and known to the
pharmacist.
c. Confirmation of registration with the practice through telephone call
2.4 If registration with a participating practice is in doubt the patient will not be eligible for
this scheme and they will be advised to access medical care through the usual
channels.
3
Duties of Participating Surgeries
3.1 All patients requesting appointments (either immediately or on an appointment basis)
for symptoms matching the criteria identified can be offered transfer into the service
using the protocol on page 34.
3.2 Patients presenting in person at the surgery and accepting transfer into the scheme
should be issued with a minor ailments leaflet and given a list of participating
pharmacies. The leaflet should be stamped by the practice for presentation at one of
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 4 of 39
the participating pharmacies; the patient’s name and address should be written on the
back of the leaflet.
3.3 Patients accepting transfer by phone will be advised to take evidence of identity and
registration at the practice to one of the participating community pharmacies. In the
absence of an NHS card or a practice stamped minor ailments leaflet the pharmacist
may telephone the surgery to confirm registration.
3.4 All surgeries should co-operate and liase with the community pharmacists to activate
the referral procedure when required (see section 5).
3.5 All participating GP surgeries should display official posters and provide leaflets
promoting the service.
3.6 For patients under the age of 16 the parent or guardian can accept transfer into the
scheme on behalf of the patient.
4
Duties of participating accredited Community Pharmacists
4.1 Patients should only be accepted into the service if the Pharmacist can confirm their
identity and has reasonable proof of registration with a participating GP.
4.2 Community Pharmacists and any relevant members of staff should attend the training
provided by the BBCS CSU before taking part in the scheme.
4.3 All participating community pharmacies will provide a professional consultation service
for patients registered with participating GPs who present with one of the specified
conditions.
4.4 The Pharmacist will assess the patient’s condition. The consultation will consist of:
4.4.1
Patient assessment
4.4.2
Provision of advice
4.4.3
Provision of a medication if necessary from the agreed formulary, appropriate to
the patient’s condition.
4.4.4
Pharm. Claim (pharmacist’s prescription and patient exemption form) to be
completed. The Pharmacist should ensure that the patient has completed and
signed the declaration of exemption from prescription charges. The Pharmacist
should also ensure that they sign and stamp the paperwork.
4.5 The Code of Ethics and Standards as detailed in the Royal Pharmaceutical Society of
Great Britain’s Medicines, Ethics & Practice should be complied with at all times in the
provision of the service.
4.6 Patient data recorded on the Pharm Claim forms should be stored securely, in
accordance with the Data Protection Act, and kept for 3 years.
4.7 Where possible, record the supply on the patient’s record on the pharmacy computer
system
4.8 Implementation of the rapid referral process if symptoms meet agreed criteria.
4.9 If a patient presents persistently the patient should be referred to their surgery. If the
symptoms do not meet the criteria for rapid referral, patients should be advised to make
an appointment in the normal manner.
4.10 If the Pharmacist suspects that the patient and/or parent is abusing the scheme they
should alert the practice where the patient is registered in the first instance.
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 5 of 39
4.11 Community pharmacies will be required to complete and submit the “Monthly summary
sheet along with the relevant months’ Pharm. Claim pro-formas (Pages 7-9) to the
Medicines Management Team at Solihull CCG unless otherwise directed.
4.12 If there is a Serious Incident associated with the operation of this scheme, the
pharmacist should follow their own process, and notify the Risk Manager at Solihull
CCG.
5
Referral procedure
5.1 If the patient presents with symptoms indicating the need for an immediate consultation
with the GP, the Pharmacist should advise the patient to make an appointment at the
surgery immediately and preferably assist the patient in doing so. If the surgery is
closed and/or the symptoms are sufficiently severe the patient should be advised to
contact the “out of hours” service or attend A & E immediately.
5.2 If the patient presents with symptoms indicating the need for a GP appointment, the
Pharmacist should advise the patient to make an appointment at the surgery and
indicate an approximate time period, for example 2-3 days or one week.
6. Service funding and payment mechanism
The Community Pharmacy will be paid according to the following schedule
6.1
Fee per consultation
6.2
Drug costs (based on Drug Tariff price)
£3.00
The monthly summary sheets (page 9) with relevant Pharm. Claims Pro-formas should be
returned to the Member Support Team at Solihull CCG as soon as possible after the end of
the month. Payments will be made to the participating pharmacy by BACS. Pharmacists are
advised to retain a copy of the summary forms.
Note that claim forms submitted more than 3 months in arrears will not be paid.
7. Monitoring and Evaluation
Participating community pharmacies and surgeries will be expected to participate in
monitoring and evaluation using the consultation data and staff/patient questionnaires.
7.1
Attitudinal survey of
o
GPs
o
Receptionists
o
Community Pharmacists
o
Patients
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 6 of 39
TO BE COMPLETED BY THE PHARMACIST
Pharm. Claim Pro-forma (Pharmacists Prescription)
Only to be completed if the patient is exempt from prescription charges and has signed the declaration
opposite.
Patients Name: ………………………………………………………………................ Date of Birth: ……………………………
Patients Address:……………………………………………………………….…………… ………………………………………….
……………………………………… Postcode: …………………………. NHS No (if known):…………………………………
GPs Name: …………………………… GP Surgery:.………………………………………...........................................................
Minor Ailment Consultation:
Date………………………………..
Time………………………….
Presenting signs, symptoms & duration: ………..…………………………………………………………
………………………………………………………………………………………………………………………
Minor ailment condition diagnosed:…………………………………………………………………………..
Self-help advice given: …………………….…………………………………………………………………….
Advice Only
Referral to GP- same day
Referral to GP- within a fortnight
Medicine supplied: I supplied the above patient with the following item(s):
Product supplied
Product supplied

1 Clotrimazole Cream 1% 20g
8 Bug buster kit including nit comb
Miconazole Cream 30g
Malathion aqueous lotion (50ml/treatment)
2 Aciclovir 5% w/w cream 2g
Malathion aqueous lotion (200ml)
3 Paracetamol Tablets 500mg (32)
Malathion alcoholic liquid (50ml/treatment)
Paracetamol susp SF 250mg / 5ml (100ml)
Malathion alcoholic liquid (200ml)
Paracetamol susp SF 120mg / 5ml (200ml)
Permethrin crème rinse (59ml)
Ibuprofen 200mg (24)
Dimethicone lotion 50mL
Ibuprofen susp 100mg/5ml (100ml)
Dimethicone lotion 150mL
Menthol & eucalyptus inhalation (100ml)
9 Paracetamol Tablets 500mg (32)
4 Senna tabs (20)
Paracetamol susp SF 250mg / 5ml (100ml)
Fybogel sachets (10)
Paracetamol susp SF 120mg / 5ml (200ml)
Lactulose (300ml)
Ibuprofen 200mg (24)
5 200ml Simple Linctus or
Ibuprofen susp 100mg/5ml (100ml)
200ml Paed Simple linctus
10 Sudocrem Cream
200ml SF Pholcodine linctus
Clotrimazole 1% cream
6 Oral Re-hydration sachets (pack of 6):
11 Menthol & eucalyptus inhalation (100ml)
Loperamide caps (6)
Sodium chloride nasal drops (10ml)
7 Cetirizine tabs 10mg (30)
Xylometazoline 0.1%nasal spray
Cetirizine syrup 5mg/5ml (200ml)
Xylometazoline 0.05% nasal drops
Loratadine tabs 10mg (30)
12 Paracetamol 500mg tabs (32)
Loratadine syrup 5mg/5ml (300ml)
Paracetamol susp SF 120mg / 5ml (200ml)
Sodium Cromoglycate eye drops (10ml)
Paracetamol susp SF 250mg / 5ml (100ml)
Beclomethasone nasal spray (180 sprays)
13 Mebendazole (OVEX®) 100mg – 1 tablets
Chlorphenamine 4mg – 30 tablets
Mebendazole (OVEX®) 100mg – 4 tablets
Chlorphenamine syrup 2mg/5ml (150ml)
14 Clotrimazole Cream 1% 20g
Hydrocortisone Cream 1% (15g)
Clotrimazole Pessary 500mg
Clotrimazole Combi Pack (500mg pessary
+ 1% cream)
15 Salatac Gel 8g
Was evidence of exemption seen?
YES
NO
Referral into scheme by
SELF
PRACTICE
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 7 of 39

TO BE COMPLETED BY THE PATIENT
Declaration of Exemption
I am entitled to free prescriptions as detailed below (please tick the relevant box):
A
B
C
D
E
F
G
L
H
K
M
S
is under 16 years of age
is 16, 17 or 18 and in full-time education
is 60 years of age or over
has a maternity exemption certificate
has a medical exemption certificate
has a prescription prepayment certificate
has a valid War Pension exemption certificate
is named on a current HC2 charge certificate
*gets income support (IS)
*gets income-based jobseeker’s allowance (JSA (IB))
*is entitled to, or named on a valid NHS Tax Credit Exemption Certificate
*has a partner who gets Pension Credit guarantee credit (PCGC)
Date of birth:
*Name:
5
5
5
5
5
5
5
5
5
5
5
5
NI no.
*Print the name of the person (either you or your partner) who gets IS, JSA (IB), PCGC or Tax Credit
□ I am the patient
□ Patient’s parent/ guardian (if patient under 16)
I have received …………………. (insert number) items of medicine from this pharmacy today.
4
Patient declaration and consent
 The information provided is true and complete to the best of my knowledge
 I understand that if it is not, appropriate action may be taken against me
 For the purposes of verifying entitlement to exemptions, I consent to the disclosure of relevant
information about me, including to and by the Inland Revenue and Local Authorities
 I understand and agree to the Pharmacist discussing any details regarding my medicines with
my GP, if considered appropriate by the Pharmacist
 I consent to have my personal data and details about my prescribed medicines stored by the
pharmacy
 I consent to the use of my data anonymously for statistical purposes
 I declare that I have been counselled by the Pharmacist and I have understood the advice
given, and where a medicine has been supplied, I understand the information given
Patient’s Signature: …………………………Date: ………… Print name: …..…………………………..
I declare that I have given appropriate treatment or referral for the condition presented to me
based on the information given to me by the patient, which to the best of my knowledge is correct.
Pharmacy stamp
Pharmacists Signature: …….………………. ……………………………
Pharmacists Name (print) ………………………………………………...
Date: …..……………………..
TOP COPY – TO GP PRACTICE
MIDDLE COPY- TO SOLIHULL CCG
BOTTOM COPY - PHARMACY
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 8 of 39
Monthly Summary Sheet
(Please attach this form to the Pharm claim proformas for this month and submit monthly claims to Solihull CCG Medicines Management Team)
I declare that for the month of ______________________________ the following items were supplied:
Product supplied
1
2
3
4
5
6
7
No. of
items
Clotrimazole Cream 1% 20g
Miconazole Cream 30g
Aciclovir 5% w/w cream 2g
Paracetamol Tablets 500mg (32)
Paracetamol susp SF 250mg / 5ml (100ml)
Paracetamol susp SF 120mg / 5ml (200ml)
Ibuprofen 200mg (24)
Ibuprofen susp 100mg/5ml (100ml)
Menthol & eucalyptus inhalation (100ml)
Senna tabs (20)
Fybogel sachets (10)
Lactulose (300ml)
200ml Simple Linctus or
200ml Paed Simple linctus
200ml SF Pholcodine linctus
Oral Re-hydration sachets (pack of 6):
Loperamide caps (6)
Cetirizine tabs 10mg (30)
Cetirizine syrup 5mg/5ml (200ml)
Loratadine tabs 10mg (30)
Loratadine syrup 5mg/5ml (300ml)
Sodium Cromoglycate eye drops (10ml)
Beclomethasone nasal spray (180 sprays)
Chlorphenamine 4mg – 30 tablets
Chlorphenamine syrup 2mg/5ml (150ml)
Hydrocortisone Cream 1% (15g)
Product supplied
8
9
10
11
12
13
14
15
Numbers of :
Advice Only
No. of
items
Bug buster kit including nit comb
Malathion aqueous lotion (50ml/treatment)
Malathion aqueous lotion (200ml)
Malathion alcoholic liquid (50ml/treatment)
Malathion alcoholic liquid (200ml)
Permethrin crème rinse (59ml)
Dimethicone lotion 50mL
Dimethicone lotion 150mL
Paracetamol Tablets 500mg (32)
Paracetamol susp SF 250mg / 5ml (100ml)
Paracetamol susp SF 120mg / 5ml (200ml)
Ibuprofen 200mg (24)
Ibuprofen susp 100mg/5ml (100ml)
Sudocrem Cream
Clotrimazole 1% cream
Menthol & eucalyptus inhalation (100ml)
Sodium chloride nasal drops (10ml)
Xylometazoline 0.1%nasal spray
Xylometazoline 0.05% nasal drops
Paracetamol 500mg tabs (32)
Paracetamol susp SF 120mg / 5ml (200ml)
Paracetamol susp SF 250mg / 5ml (100ml)
Mebendazole (OVEX®) 100mg – 1 tablets
Mebendazole (OVEX®) 100mg – 4 tablets
Clotrimazole Cream 1% 20g
Clotrimazole Pessary 500mg
Clotrimazole Combi Pack (500mg pessary
+ 1% cream)
Salatac Gel 8g
Referral to GP-same day
Pharmacy Stamp:
Name of Pharmacist submitting
form
(PLEASE PRINT):
……………………………………
Pharmacist’s signature:
……………………………………
Date: ……………………………..
Referral to GP-within a fortnight
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 9 of 39
For Solihull CCG use only
Grand total = ……………………………………………… plus VAT (at 17.5%) = ………………………………………………………………………………………………….
Number of consultations (number of Pharm claim proformas) = ………………………………… x £3.00 = …………………………..…………………………………….
Total payment …………………………………………………………………………………………………………………………………………………………………………….
Approved:
Signature: ____________________________________
Date: ___________
____________________________________
____________
Member Support Team
Finance Use – Passed for Payment
Signature: ____________________________________________
(code:ref: Minor Ailments)
Date: ______________________
Finance Manager
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 10 of 39
PROTOCOLS FOR
Community Pharmacy
MINOR AILMENTS SCHEME
Details of contraindications, cautions, drug interactions, adverse effects and other
product details are provided under the ‘Description of Treatment’ Section. This section
should be referred to before supplying the medicine. This protocol has been developed
using BNF 61.
Any reports of unexpected severe reactions shall be recorded in the patient's computer
record, the GP informed, and the MHRA informed via the yellow card system
(http://yellowcard.mhra.gov.uk/)
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 11 of 39
Minor Ailment Protocols
Patient with symptoms of the following conditions may be referred in to this scheme and
advice and treatment will follow the regime laid out in the following pages:
1. Athlete’s Foot
Page 13
2. Cold Sores
Page 14
3. Colds / Flu /Earache
Page 15
4. Constipation
Page 17
5. Cough
Page 18
6. Diarrhoea
Page 20
7. Hay Fever / Allergy Relief
Page 22
8. Head Lice
Page 24
9. Temperature
Page 25
10. Nappy Rash
Page 27
11. Nasal Congestion
Page 28
12. Sore Throat
Page 29
13. Threadworms
Page 30
14. Vaginal Thrush
Page 31
15. Veruccas and Warts
Page 33
.
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 12 of 39
1 ATHLETE’S FOOT
Definition / Criteria
Fungal skin infection affecting the foot, most commonly the area between the toes
Criteria for inclusion
Adults and children presenting with symptoms of:
 Itching, scaling and inflammation of the skin between the toes.
And consent has been given
Criteria for exclusion
 Children under 1 year
 Diabetics
 Patients whose infection has spread to toenails
 Previous treatment failure
 Patients not registered with a GP within the scheme
 Known hypersensitivity to the drug or any other ingredient in the product.
 Pregnancy
 Breastfeeding
 See individual products for additional exclusion criteria
Action for excluded patients and non-complying patients Referral to GP
When and how to refer to GP
Rapid referral: - N/A
Consider supply, but patient should be advised to make an appointment to see the GP:
 If toenail become black or discoloured or if infections starts to spread under nails
 If fungal infection spreads to other parts of body
 Bacterial infection suspected
 Patient has had the symptoms for >4weeks
 No improvement after using OTC preparation for 2 weeks
 If there is any other on-going concern
Special considerations / concurrent medication
Antibiotics
Oral steroids / immunosuppressants
Recommended treatments, route and legal status
Frequency of administration and maximum dosage
Clotrimazole Cream 1% 20g
Miconazole Cream 30g
Apply thinly 2-3 times a day.
Apply twice a day. Continue using the cream for two weeks
after the infection has cleared
Follow-up and advice
 Wash & dry feet thoroughly especially between toes.
 Avoid warm damp conditions.
 Care with swimming pools, baths, shared towels or wet floors.
 Wearing clean wool or cotton socks may allow the skin to breath and can reduce
moisture next to skin.
 To prevent re-infection feet should be washed daily and particular attention given to
drying thoroughly – especially between the toes. Tight footwear should be avoided,
socks should be changed frequently and shower shoes should be worn at swimming
pool and sports hall locker rooms and showers, as these are places where the
infection is often picked up.
Side effects and their management
Sensitivity to imidazoles
Occasional local irritation and hypersensitivity reactions include mild burning sensation,
erythema and itching.
Treatment should be discontinued if these are severe.
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 13 of 39
2 COLD SORES
Definition / Criteria
Herpes simplex (Cold sores)
Criteria for inclusion
Adults and children with herpes simplex infection of lips and face
Criteria for exclusion
Patients unsure if it is Herpes simplex infection
Immunocompromised patients
If patient has suspected:
Hand, foot and Mouth disease
Herpes zoster (Shingles) infection
Infectious mononucleosis
Impetigo
Patients not registered with an GP within the scheme
Action for excluded patients and non-complying patients
Referral to General Practitioner
When and how to refer to GP
Rapid referral:
 Immunocompromised patients
 Herpes zoster (shingles)
Conditional referral:
 On 3rd occurrence
Consider supply, but patient should be advised to make an appointment to see the GP:
 Regular occurrence of condition
 Suspected differential diagnosis
 If there is any other on-going concern
Recommended treatments, route and legal status
Frequency of administration and maximum dosage
Aciclovir 5% w/w cream 2g
Adults & Children over 3 months: Apply Five times a day for 5 days
Follow-up and advice
Cream needs to be started in early “tingling” stage of infection
Many cold sores need no treatment at all and resolve in a few days
Antiviral cream will reduce duration and severity of a cold sore but may have no effect
Sunscreen lip balm may help to prevent cold sores if strong sunlight is a trigger
Close contact, e.g. kissing, sharing cups etc, may pass on the virus
Advise paracetamol or ibuprofen if required for pain relief
Drinking fluid in those where infection causes excessive pain and so reduced intake
Side effects and their management
Transient stinging and/or burning – Advise
Occasionally erythema, itching or drying of the skin - Advise
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 14 of 39
3 COLD / FLU / EARACHE
Definition / Criteria
Cold: widespread infectious virus disease causing inflammation of the mucous membranes of
the nose, throat & bronchial tubes.
Flu: highly contagious virus infection that affects the respiratory system
Earache: Associated with URTI
Criteria for inclusion
Patients presenting with symptoms of cold / flu, e.g. fever, temperature, nasal congestion or
other nasal symptoms.
Criteria for exclusion
Patients under one year
Concomitant rash that does not fade under pressure e.g. with glass
Patient is breathless
Light hurts the eyes
It is painful to bend the neck
Systemic decongestants (pseudoephredrine) should not be supplied to patients taking MAOI
inhibitors and used with caution in patients with diabetes, hypertension, hyperthyroidism and
ischaemic heart disease.
Patients not registered with an GP within the scheme
Action for excluded patients and non-complying patients - Referral to GP
When and how to refer to GP
Rapid referral:
Patient presenting with a rash or other symptoms suggesting a serious condition, e.g.
meningitis. Symptoms may include
Development of a rash that does not fade when you press a glass tumbler against the rash
Development of red-flag symptoms
Patient becomes breathless
Painful to bend the neck or light hurts the eyes
 Severe pain in children
 Discharge or bleeding from the ear
 Fever, nausea and vomiting
 Foreign body in the ear
 Neck stiffness
 Tinnitus and vertigo
* Signs and symptoms suggesting increased likelihood of serious illness include:
Pallor: Not responding normally to social cues: Wakes only with prolonged stimulation: Decreased
activity: No smile: Nasal flaring: Tachypnoea: Crackles: Dry mucous membrane: Poor feeding in
infants: Reduced urine output: Fever for > 5 days: Swelling of a limb or joint: Non-weight bearing/
not using extremity: A new lump>2cm. See NICE clinical guideline 47 “Feverish illness in children”
for details
Conditional referral:
 Patients should consult the GP if treatment is ineffective or persists after 7 days.
Patients with other chronic illness e.g. heart, kidney or lung disease, those with
reduced immunity or patients living in long-stay institutions. These patients would
benefit from influenza vaccination.
Consider supply, but patient should be advised to make an appointment to see the GP:
 If more than one request per month
 If there is any on-going concern
 New symptoms develop particularly in the young children, the elderly or the infirm
 Symptoms worsening
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 15 of 39
Recommended treatments, route and legal status
Frequency of administration and maximum dosage
Paracetamol Tablets 500mg (32)
Paracetamol susp SF 250mg / 5ml (100ml)
Paracetamol susp SF 120mg / 5ml (100ml)
po P adults, children over 16yrs
1 -2 qds
Paracetamol new dosage guidance for children
12-16 years 750mg 15mls x 250mg/5ml susp
10-12 years 500mg 10ml x 250mg/5ml susp
8-10 years 375mg 7.5ml x 250mg/5ml susp
6-8 years 250mg 5ml x 250mg/5ml susp
4-6 years 240mg 10ml x 120mg/5ml susp
2-4 years 180mg 7.5ml x 120mg/5ml susp
6-24 months 120mg 5ml x 120mg/5ml susp
3-6 months 60mg 2.5ml x 120mg/5ml susp
Ibuprofen 200mg (24)
These doses may be repeated every 4-6 hours when
necessary (maximum 4 doses in 24 hours)
Ibuprofen susp 100mg/5ml (100ml)
po P adults, children over 12 years 1-2 tds
Adults & Children 12 years and over: 200 - 400mg
Children 10-12 years 300mg (15ml of suspension)
Children 7-10 years 200mg (10ml suspension)
Children 4-7 years 150mg (7.5ml of suspension)
Children 1-4 years 100mg (5ml of suspension)
Children 6 months – 1 year 50mg (2.5ml suspension)
Children 3-6 months (over 5kg body weight)
50mg (2.5ml suspension)
THESE DOSES MAY BE REPEATED UP TO THREE TIMES A
DAY
Menthol & eucalyptus inhalation (100ml)
Inhale GSL To be inhaled PRN
Follow-up and advice
Ibuprofen should not be used in patients suffering from asthma or gastro-intestinal problems.
Caution using ibuprofen in patients with hypertension or those on ACE inhibitors
(increased risk of renal impairment)
Pharmacists should be aware of the NICE guidance in Feverish Children and can
advice on alternating ibuprofen with paracetamol if neither work individually.
Cold / Flu
 Patients should be advised to put 1 tsp. of menthol & eucalyptus in a pint of hot (not
boiling) water and use a cloth/towel over the head to trap the steam.

Maximum use of topical decongestants is seven days.

Simple analgesics to bring temperature down

Steam inhalation (with or without aromatic inhalant)

Maintain a good fluid intake

Encourage rest (if possible)

Warm soothing drinks

Common cold does not require antibiotics for effective treatment

Remind high risk patients of influenza vaccination programmes (over 65’s, and those
patients under 65 with CHD, respiratory disease or diabetes)

Development of new symptoms and or symptoms have deteriorated, consult GP.
Earache
Enquire about concurrent analgesic usage:
 Paracetamol daily dose – avoiding use of other products containing paracetamol
 Other NSAIDs – prescribed or OTC
 Rest, warming, cooling or changing position, may obtain relief from pain.
Patients should be advised to avoid any aggravating factors.
Side effects and their management
Side effects are rare with occasional use of paracetamol when taken at the recommended
dose.
Ibuprofen should be taken with, or after food, to avoid gastro-intestinal side effects
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 16 of 39
4 CONSTIPATION
Definition / Criteria
Increased difficulty and reduced frequency of bowel evacuation compared to normal
Criteria for inclusion
Adults and children 12 years and over presenting with:
 Significant variation from normal bowel evacuation which has not improved following
adjustments to diet and other lifestyle activities (see below).
And consent has been given
Criteria for exclusion
 Children under 12 years.
 Patients not registered with an GP within the scheme
 Known hypersensitivity to the drug or any other ingredient in the product.
 Pregnancy
 Breastfeeding
 See individual products for additional exclusion criteria
 Patients currently receiving laxatives as part of their regular medication. Pharmacists
should exercise their professional judgement to implement dosage alteration to
existing laxative regime
Action for excluded patients and non-complying patients - Referral to GP
When and how to refer to GP
Rapid referral:
 Blood or mucus in the stools
 Abdominal pain, distension or vomiting
Conditional referral:
 If constipation persists beyond one week, consult the GP
Consider supply, but patient should be advised to make an appointment to see the GP:
 If more than one request per month
 Change in bowel habit / repeated bouts of constipation
 If there is any other on-going concern
Special considerations / concurrent medication
Patients taking medication with recognised constipating effects
Pregnant or breast-feeding women
Recommended treatments, route and legal status
Frequency of administration and maximum dosage
Adults only:
Senna tabs (20)
Fybogel sachets (10)
Lactulose solution
(300ml)
po
po
po
P
P
P
2 on prn
1 bd
15mls BD (Adult)
10mls BD (5-10 years)
5mls BD (1-5 years)
Follow-up and advice
 Regular doses of laxatives are rarely required and can cause a “lazy” bowel.
 Advice re considering alteration to diet to prevent the occurrence of further events e.g.
increased fibre and fluid intake and increased physical activity if appropriate.
 Senna should not be used in pregnancy – advise Fybogel instead
Side effects and their management
 If dosage is too large, griping and diarrhoea may result
 Senna may colour the urine yellow or red
 Laxative abuse ( associated with eating disorder) can lead to hypokalaemia
 Lactose intolerance
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 17 of 39
5. COUGH
Definition / Criteria
Coughing arising as a defensive reflex mechanism
Persistent cough of less than 3 weeks duration
Criteria for inclusion
Adults and children aged 2 years and over presenting with:

A dry unproductive cough requiring a degree of suppression

Troublesome cough requiring soothing, with or without attendant mucous production
And consent has been given
Criteria for exclusion

Children under 2 years old (See MHRA guidance below)

Patients with a history of chronic bronchitis

Cough productive of green / blood stained sputum

Asthmatics presenting with wheeze or reduced peak-flow

Patients experiencing sudden weight loss

Patients not registered with a GP within the scheme

Known hypersensitivity to the drug or any other ingredient in the product.

Pregnancy

Breastfeeding

COPD and bronchiectasis

Significant co-morbidities (heart, lung, renal, liver or neuromuscular disease,
immunosuppression, CF)

See individual products for additional exclusion
Action for excluded patients and non-complying patients Referral to GP
When and how to refer to GP
Rapid referral:

Constant chest pain or chest pain on normal inspiration

Difficulty breathing (e.g. shortness of breath at rest)

Cough productive of green/yellow/blood stained sputum

If pain related to exertion

If cough and other symptoms persist beyond one week the patient should consult the GP

Asthmatics presenting with wheeze or reduced peak-flow

Difficulty breathing

Weight loss

Night sweats

COPD and bronchiectasis or significant co-morbidities as above

Elevated Respiratory rate or large respiratory effort

High temperature

Tachycardia

Reduced PEFR esp if <50% predicted

Older than 65 years plus two or older than 80 years plus one of the following:
o Hospitalisation in previous year
o Type 1 or 2 diabetes
o Congestive heart failure
o Current use of oral steroids (based on NICE CG 69)
o
Consider supply, but patient should be advised to make an appointment to see the GP:

If cough and other symptoms persist beyond one week

A persistent, dry, night time cough particularly in children

A dry cough in a patient prescribed an ACE inhibitor

Patients diagnosed with asthma, GORD or post nasal drip.

If there is any other on-going concern
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 18 of 39
Recommended treatments, route and legal status
Frequency of administration and maximum dosage
Simple Linctus x200ml Adults (12yrs & over)
Paediatric Simple Linctus X200ml Children (212yrs)
Sugar free Pholcodine Linctus 5mg/5ml
x200ml Adults (12yrs and over)
Children (6-12yrs) generally not recommended
po
po
GSL
GSL
5-10ml up to qds
5-10ml up to qds
po
GSL
5-10ml up to qds
po
2.5ml up to
3-4 times a day
MHRA: Children 6-12 years: Should only be considered after basic principles of best
care have been tried and treatment restricted to five days only.
Patient should be advised not to smoke and to try to avoid smoky or dusty atmospheres.
Making sure the air is humid enough may be beneficial, e.g. placing a damp towel over a
radiator.
Patients can manage their cough by:
o Using a steam inhalation
o Sucking lozenges, preferably sugar free and keeping to the recommended dose
o Taking warm drinks, such as a teaspoon each of honey and lemon dissolved in warm
water
The MHRA has stated that non-prescription cough and cold medicines containing the
following active ingredients should not be used in children under 6 years old and may have
limited efficacy in children under 12 years old:
 Antihistamines – brompheniramine, chlorphenamine and diphenhydramine
 Cough expectorants – guaifenesin and ipecacuanha
 Cough suppressants – dextromethorphan and pholcodine
 Decongestants – phenylephrine, pseudoephedrine, ephedrine, oxymetazoline and
xylometazoline
Follow-up and advice
Check smoking status , where appropriate offer smoking cessation/referral information
Maintain fluid intake with chesty cough
Side effects and their management
Constipation
Respiratory depression
NICE CG 69 http://www.nice.org.uk/nicemedia/live/12015/41322/41322.pdf
Prodigy http://prodigy.clarity.co.uk/cough/management/scenario_diagnosis_cough_less_than_3_weeks#451191006
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 19 of 39
6 DIARRHOEA
Definition / Criteria
Increased frequency and fluidity of defecation.
Criteria for inclusion
Adults and children > 1 presenting with the above symptoms, and consent has been given
Criteria for exclusion*
 Patients not registered with a GP within the scheme
 Patients with chronic diarrhoea problems
 Children under 1 year
 Where clinical shock is suspected or confirmed
 Known hypersensitivity to the drug or any other ingredient in the product.
 Pregnancy
 Suspicion of abuse
 See individual products for additional exclusion criteria
Action for excluded patients and non-complying patients
Referral to General Practitioner - offer dietary advice
When and how to refer to GP
Rapid referral:
 Adults where symptoms have lasted more than 5 days
 Children where symptoms have lasted more than 48 hours or who look ill or
dehydrated
 Rectal bleeding or blood or mucus in the stool
 Severe symptoms, including abdominal pain
 Children who are immunocompromised
 Elderly >70 years
 Weight loss
 Recent travel abroad
 Food handlers
 Red flag Signs of clinical dehydration or shock**
 If a child persistently vomits the ORS solution.
Consider supply but patient should be advised to make an appointment with the GP:
 If symptoms persist beyond 48 hours
 If septicaemia is suspected
 Patients taking medications with recognised diarrhoea effect
 If there is any other on-going concern
Recommended treatments, route and legal status
Frequency of administration and maximum dosage
First line
Oral Re-hydration sachets (pack of 6):

Child: (1-12 years) 200ml after every loose motion.

Adult: According to fluid loss, usually 200 - 400ml solution after every loose motion.
Oral re-hydration sachets(6)
po GSL Reconstitute one sachet with 200ml of water
(freshly boiled & cooled for infants) Any unused
reconstituted solution should be discarded 1
hour after preparation. If stored in a fridge the
solution can be kept for up to 24 hours
Second line if required for circumstances (adults only and children>12)
Loperamide caps (6)
GSL 2 capsules stat then 1 after every loose motion
(max 8 in 24 hours)
Note: Should not be provided if patient has
recently taken anti-biotics
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 20 of 39
Follow-up and advice
 Explain that diarrhoea usually lasts for 5-7 days and stops within 2 weeks, and vomiting
usually lasts for 1-2 days and stops within 3 days.
 Explain treatment and course of action
 Explain that after reconstitution any unused solution should be discarded no later than 1
hour after preparation unless stored in a refrigerator when it may be kept for 24 hours.
 Monitor condition and seek medical advice if symptoms of dehydration develop, or
symptoms do not resolve as expected
 During rehydration therapy do not give solid foods to children
 For children without red flag signs, do not routinely give oral fluids other than ORS
solution; however consider supplementing with usual fluids (including milk feeds or water,
but not fruit juices or carbonated drinks) if they consistently refuse ORS solution
 In infants, breast feeding or normal formula feeds should be offered between oral
rehydration drinks.
 After rehydration, give full-strength milk straight away, reintroduce child’s usual solid food,
avoid giving fruit juices or carbonated drinks until the diarrhoea has stopped.
 Adult patients should take clear fluids for 24-48 hours until symptoms resolve. If condition
worsens or symptoms persist then seek further medical advice
 Advise parents, carers and children that:
− washing hands with soap (liquid if possible) in warm running water and careful drying
are the most important factors in preventing the spread of gastroenteritis
− hands should be washed after going to the toilet (children) or changing nappies
 (parents/carers) and before preparing, serving or eating food
− towels used by infected children should not be shared
− children should not attend any school or other childcare facility while they have
diarrhoea or vomiting caused by gastroenteritis
− children should not go back to their school or other childcare facility until at least 48
hours after the last episode of diarrhoea or vomiting
− children should not swim in swimming pools for 2 weeks after the last episode of
diarrhoea.
 All severe adverse reactions, including anaphylaxis, should be reported to the MHRA via
the yellow card system and recorded in the medical records.
 Verbal information should be provided to patients / carers and, if requested, written
information in the form of a patient information leaflet should be given.
 Reconstitute 1 sachet with 200mL of water (freshly boiled & cooled for infants)
 Patients should eat as soon as they are able - foods rich in carbohydrates eg rice, pasta,
bread, potatoes recommended
 Avoid dehydration by drinking plenty of fluids
 Babies, small children and the elderly are more susceptible to dehydration
 Avoid all dairy products
Side effects and their management
Loperamide can cause abdominal pain and bloating and should not be provided if the patient
has recently taken anti-biotics
*NICE Clinical Guideline 84 Diarrhoea and vomiting in children
** Red Flag signs of clinical dehydration include : Appears to be unwell or deteriorating, Altered
responsiveness, sunken eyes, tachycardia, tachypnoea, reduced skin turgor. Symptoms of
clinical shock include: decreased level of consciousness, pale or mottled skin, cold extremities,
weak peripheral pulses. See NICE Clinical Guideline 84 for further details.
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 21 of 39
7 HAY FEVER /ALLERGY RELIEF
Definition / Criteria
Treatment of allergic reactions e.g. hayfever and urticaria, bites and stings
Criteria for inclusion
Adults and children over 6 years presenting with:
 Allergic rhinitis (hayfever)
 Allergic reactions resulting in a rash or inflammation and itchiness
And consent has been given
Children over 6 years (N.B. Follow specific age restrictions for individual product - some are
not licensed for children under 12 years)
Adults and children over the age of 10 years presenting who:

Have been bitten or stung by small insects,

Have localised minor irritation to the skin
Criteria for exclusion
 Patients not registered with a GP within the scheme
 Known hypersensitivity to the drug or any other ingredient in the product.
 Pregnancy
 Breastfeeding
 Epilepsy
 See individual products for additional exclusion criteria
Specific to Hydrocortisone
Children under the age of 10 years

Bites or stings to the face or anogenital region

Where skin is broken or infected

In acne rosacea
Action for excluded patients and non-complying patients - Referral to GP
When and how to refer to GP
Rapid referral:
 Shortness of breath
 Pain in eyes
 Nasal ulceration/ crusting
Conditional referral:
 Patient should consult the GP if treatment is ineffective or persists after the end of
September
 If there is any other on-going concern
Special considerations / concurrent medication
Glaucoma (antihistamines contra-indicated)
Patients on anti-arrhythmic drugs (antihistamines contra-indicated)
Recommended treatments, route and legal status
Frequency of administration and maximum dosage
Cetirizine tabs 10mg (30)
Cetirizine syrup 5mg/5ml (200ml)
po
po
P
P
Loratadine tabs 10mg (30)
po
P
10mg daily
Adult 10mg daily
2-6 years 2.5mg BD
6-12 years 5mg BD
10mg daily
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 22 of 39
Loratadine syrup 5mg/5ml (300ml)
po
P
Sodium Cromoglycate eye drops (10ml)
Beclomethasone nasal spray (180 sprays)
Adults over 18 years only
Chlorphenamine 4mg – 30 tablets (over 6
years – check dose)
Chlorphenamine syrup 2mg/5mL – 150mL
(over 1 year)
Hydrocortisone Cream 1% 1x15g
.
topical P
topical P
po
P
po
P
topical P
Adult 10mg daily
Body weight under 30kg 5mg
daily (not recommended
under 2 years)
Body weight over 30kg 10mg
daily
1 drop QDS
2 sprays each nostril BD
Dose (including maximum
dose):
Adults & Children 10 years
and over:
Apply sparingly over the
affected area 1-2 times daily
for a maximum of 7 days
Follow-up and advice
 Explain treatment and course of action
 Advise patient not to exceed the stated dose
 If condition worsens or symptoms persist then seek further medical advice
 All severe adverse reactions, including anaphylaxis, should be reported to the MHRA
via the yellow card system and recorded in the medical records.
 Verbal information should be provided to patients / carers and, if requested, written
information in the form of a patient information leaflet should be given.
 If there is transient drowsiness, do not drive or operate machinery
 Advise patient to take pollen avoidance measures and to check daily pollen count
 Advise re smoking cessation where appropriate.
Side effects and their management
There are unlikely to be any side effects if treatments used at recommended doses.
 Fatigue, headache and nausea have been reported rarely
 Potentially may cause drowsiness
Refer to current BNF and individual product information for full detail
 Beclometasone spray
 Dryness and irritation of the nose and throat
 Epistaxis
 Headache
 Smell and taste disturbances
 Hypersensitivity reactions including bronchospasm
Specific to Hydrocortisone
Potential Adverse Effects

Rare with mild corticosteroids used for short periods

Sensitivity reactions – discontinue treatment

Refer to current BNF and individual product information for full details
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 23 of 39
8 HEAD LICE
Definition / Criteria
Infection with live moving head lice
Criteria for inclusion
Patients who are proven to be infected with live moving head lice.
Criteria for exclusion
 Family/siblings of patient, who are not proven to be infected (note: infection is not
indicated by the presence of nits (hatched & empty egg shells)
 Children under the age of 6 months
 Patients not registered with an GP within the scheme
 A second request within one week
Action for excluded patients and non-complying patients Referral to GP
When and how to refer to GP
Rapid referral: - N/A
Conditional referral:

Pregnant or breastfeeding – wet combing method only or refer to GP

If head lice persist after two lots of treatment within one month
Consider supply, but patient should be advised to make an appointment to see the GP:
 If requesting repeat treatment more than twice in a month
 If there is any other on-going concern
Special considerations / concurrent medication
Alcoholic lotions not recommended for head lice in severe eczema / asthma.
Pregnant or breast feeding
Recommended treatments, route and legal status
Frequency of administration and maximum dosage
* First line treatment Wet combing method (Bug Busting)
Bug Buster Kit
* Second line treatment Insecticide
Malathion aqueous lotion (50ml/treatment)
topically
P
Malathion aqueous lotion (200ml)
topically
P
Malathion alcoholic liquid (50ml/treatment)
topically
P
Malathion alcoholic liquid (200ml)
topically
P
Permethrin crème rinse (59ml)
topically
P
Dimethicone lotion 50mL
topically
P
Dimethicone lotion 150mL
topically
P
The 200ml sizes are for use when two or more family members are affected.
Follow-up and advice
 Wet comb well conditioned hair using a detection or nit comb to remove dead lice / eggs
 Regular weekly detection combing is recommended.
 Where Permethrin crème rinse is used, the patient should be advised to wash hair as
normal prior to application, using shampoo ONLY, not 2 in 1 products or conditioner. Apply
the Permethrin crème rinse to the clean damp hair & rinse after 10 minutes.
 With Malathion alcoholic liquid rub preparation into dry hair & scalp, allow hair to dry
naturally, wash off after 12 hours. Two treatments are now recommended 7 days apart (this
is different advice from package insert)
 Alcoholic solutions are suitable for people with normal healthy skin. These may be slightly
more effective.
 Aqueous lotions are suitable for asthmatics or eczema/skin disorders
 Treatment to be repeated in seven days. The BNF recommends after 7 days to prevent lice
emerging from eggs that survive the first time.
 The same chemical should not be used for the next re-infestation i.e. alternate treatments
Side effects and their management - Side effects are rarely experienced
Guidance reference: PRODIGY: http://www.prodigy.nhs.uk/guidance.asp?gt=Head%20lice
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 24 of 39
9 TEMPERATURE
Definition / Criteria
Raised body temperature
Criteria for inclusion
Adults and children presenting who:

Need relief from symptoms e.g. feeling hot or cold or shivery, and are generally unwell

Patients requiring relief of pain / fever associated with upper respiratory tract infections
And consent has been given
Criteria for exclusion *

Children under 3 months

Patients not registered with an GP within the scheme

Known hypersensitivity to the drug or any other ingredient in the product.

Pregnancy

Breastfeeding

Recurrent or severe pain

See individual products for additional exclusion criteria
Action for excluded patients and non-complying patients Referral to GP
When and how to refer to GP
Emergency referral:

Suspected meningitis (vomiting, fever, stiff neck, light aversion, drowsiness, joint pain,
fitting, cold extremities, nonblanching rash) – 999 call to avoid unnecessary delay
Rapid Referral
* Signs and symptoms suggesting increased likelihood of serious illness include:
Pallor: Not responding normally to social cues: Wakes only with prolonged stimulation:
Decreased activity: No smile: Nasal flaring: Tachypnoea: Crackles: Dry mucous membrane:
Poor feeding in infants: Reduced urine output: Fever for > 5 days: Swelling of a limb or joint:
Non-weight bearing/ not using extremity: A new lump>2cm. See NICE clinical guideline 47
“Feverish illness in children” for details.
Consider supply but patient should be advised to make an appointment to see the GP:

If symptoms have been present for longer than a week

For children under 5 years where signs or symptoms suggest increased likelihood of
serious illness*

Patients recently returned from foreign travel (particularly in malarial regions)

Patients that appear very unwell or have symptoms that suggest an infection that may
need other GP input.

If more than one request per month

If there is any other on-going concern
Recommended treatments, route and legal status
Frequency of administration and maximum dosage
Paracetamol Tablets 500mg (32)
Dose (including maximum dose):
Adult and children over 16 years 500 – 1000mg (1-2 x
500mg) tablets
Paracetamol susp SF 250mg / 5ml (100ml)
Paracetamol susp SF 120mg / 5ml (200ml)
Paracetamol new dosage guidance for children
12-16 years 750mg 15mls x 250mg/5ml susp
10-12 years 500mg 10ml x 250mg/5ml susp
8-10 years 375mg 7.5ml x 250mg/5ml susp
6-8 years 250mg 5ml x 250mg/5ml susp
4-6 years 240mg 10ml x 120mg/5ml susp
2-4 years 180mg 7.5ml x 120mg/5ml susp
6-24 months 120mg 5ml x 120mg/5ml susp
3-6 months 60mg 2.5ml x 120mg/5ml susp
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 25 of 39
These doses may be repeated every 4-6 hours when
necessary (maximum 4 doses in 24 hours)
Dose (including maximum dose):
Ibuprofen 200mg (24)
Ibuprofen susp 100mg/5ml (100ml)
po P adults, children over 12 years 1-2 tds
Adults & Children 12 years and over: 200 - 400mg
Children 10-12 years 300mg (15ml of suspension)
Children 7-10 years 200mg (10ml suspension)
Children 4-7 years 150mg (7.5ml of suspension)
Children 1-4 years 100mg (5ml of suspension)
Children 6 months – 1 year 50mg (2.5ml suspension)
Children 3-6 months (over 5kg body weight)
50mg (2.5ml suspension)
THESE DOSES MAY BE REPEATED UP TO THREE TIMES
A DAY
Ibuprofen should not be used in patients suffering from asthma or gastro-intestinal problems.
Caution using ibuprofen in patients with hypertension or those on ACE inhibitors
(increased risk of renal impairment)
Pharmacists should be aware of the NICE guidance in Feverish Children and can
advice on alternating ibuprofen with paracetamol if neither work individually.
Follow-up and advice
Enquire about concurrent analgesic usage:

Paracetamol daily dose – avoiding use of other products containing paracetamol

Other NSAIDs – prescribed or OTC

Rest, warming, cooling or changing position, may obtain relief from pain.

Patients should be advised to avoid any aggravating factors.

NB overuse of analgesics can cause headaches
Side effects and their management
Side effects are rare with occasional use of paracetamol when taken at the recommended
dose.
Ibuprofen should be taken with, or after food, to avoid gastro-intestinal side effects
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 26 of 39
10 NAPPY RASH
Definition / Criteria
Rash often caused by local dermatitis
Criteria for inclusion
Child with identified rash in nappy contact area
Criteria for exclusion
If nappy rash diagnosis is uncertain
Patients not registered with an GP within the scheme
Action for excluded patients and non-complying patients
Referral to General Practitioner
When and how to refer to GP
Rapid referral:
 Suspected systemic candidiasis
Conditional referral:
 on 3rd occurrence
Consider supply, but patient should be advised to make an appointment to see the GP:
 Patient not responding to initial treatment
 Widespread severe infection
 If there is any other on-going conncern
Recommended treatments, route and legal status
Frequency of administration and maximum dosage
1st Line: Sudocrem Cream
Apply GSL Apply at each nappy change
nd
2 Line: Clotrimazole 1% cream Apply P
Apply thinly to the affected area twice daily
Follow-up and advice
Advise if symptoms do not resolve within 7 days to make an appointment to see a GP
Advise guardian to ensure nappy change frequently and to avoid tightly fitting water-proof
pants
Advise on application of 2nd line therapy thinly
Side effects and their management
Sensitivity to Imidazoles, occasional local irritation. Discontinue if severe
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 27 of 39
11 NASAL CONGESTION
Definition / Criteria
Blocked nose associated with colds and upper respiratory tract
Criteria for inclusion
Adults and children presenting with:

Congestion where seasonal allergy has been excluded and consent has been given
Criteria for exclusion

Known hypersensitivity to the drug or any other ingredient in the product.

Pregnancy

Diabetes or hyperthyroidism

Recurrent nose bleeds

Patients not registered with an GP within the scheme

See individual products for additional exclusion criteria
Action for excluded patients and non-complying patients - Referral to GP
When and how to refer to GP
Rapid referral:
 If suspected foreign body within nostril
 Swelling of the eyes, temples, nose or cheek
Consider supply, but patient should be advised to make an appointment to see the GP:
 If symptoms persist for more than 2 weeks
 If more than one request per month
 If there is any other on-going concern
Special considerations / concurrent medication
 Caution in hypertensive patients and patients with ischaemic heart disease
 Topical decongestants are contra-indicated in patients taking MAOIs
Recommended treatments, route and legal status
Frequency of administration and maximum dosage
Menthol & eucalyptus inhalation (100ml)
Sodium chloride nasal drops (10ml)
inhalation
nasal
GSL
GSL
Xylometazoline 0.1%nasal spray (adults &
children over 12yrs)
Xylometazoline 0.05% nasal drops (6-12yrs)
nasal
GSL
nasal
GSL
To be inhaled prn
1-2 drops into each nostril 3-4 x per
day (before feeds for babies)
1 spray in each nostril 2-3 x per day
(Max 7 days)
1-2 drops each nostril 1-2 x a day prn
MHRA: Children 6-12 years should only be treated after basic principles of best care
have been tried. Up to 5 days treatment only.
Follow-up and advice
 N.B. Systemic products should only be supplied when topical products have been tried
without success
 Patients should be advised to put 1 teaspoon of menthol & eucalyptus in a pint of hot (not
boiling) water and use a cloth / towel over the head to trap and inhale the steam
 Maximum use of topical decongestants is seven days
The MHRA has stated that non-prescription cough and cold medicines containing the
following active ingredients should not be used in children under 6 years old and may have
limited efficacy in children under 12 years old:
 Antihistamines – brompheniramine, chlorphenamine and diphenhydramine
 Cough expectorants – guaifenesin and ipecacuanha
 Cough suppressants – dextromethorphan and pholcodine
 Decongestants – phenylephrine, pseudoephedrine, ephedrine, oxymetazoline and
xylometazoline
Side effects and their management
 Local Irritation
 Nausea, headache
 After excessive use tolerance with diminished effect, rebound congestion
 Cardiovascular effects also reported
 Refer to current BNF and individual product information for full details
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 28 of 39
12 SORE THROAT
Definition / Criteria
A painful throat, often accompanied by viral symptoms (e.g. temperature and/or fever)
Criteria for inclusion
Adults and children presenting with:

Sore throat that requires soothing
And consent has been given
Criteria for exclusion

Patients under 2 years

Patients taking DMARDS carbimazole

Patients not registered with an GP within the scheme

Known hypersensitivity to the drug or any other ingredient in the product.

Pregnancy

Breastfeeding

Significant co-morbidities (heart, lung, renal, liver or neuromuscular disease, immunosuppression,
CF)

See individual products for additional exclusion criteria
Action for excluded patients and non-complying patients Referral to GP
When and how to refer to GP
Rapid referral:

Patients on immunosuppressants / oral steroids / drugs causing bone marrow suppression or
accompanied by other clinical symptoms of blood disorders)

Quinsy, large lesions, blisters in throat, possible strep throat

Non blanching rash

Patients taking methotrexate or carbimazole
Assessment of Centor criteria (3 of Tonsillar exudates, Tender anterior cervical nodes, history of
fever, absence of cough)
Consider supply but patient should be advised to make an appointment with the GP:

Symptoms suggesting oral candidiasis / tonsillitis/ strep throat

The condition has persisted more than 10 days

A second request within 1 month

If there is any other on-going concern

Assessment of Centor criteria (2 of Tonsillar exudates, Tender anterior cervical nodes, history of
fever, absence of cough)
Recommended treatments, route and legal status
Frequency of administration and maximum dosage
Paracetamol 500mg tabs (32)
Paracetamol susp SF 120mg / 5ml (200ml)
Paracetamol susp SF 250mg / 5ml (100ml)
Dose (including maximum dose):
Adult 500 – 1000mg 1-2 x 500mg tablets
Paracetamol new dosage guidance
12-16 years 750mg 15mls x 250mg/5ml susp
10-12 years 500mg 10ml x 250mg/5ml susp
8-10 years 375mg 7.5ml x 250mg/5ml susp
6-8 years 250mg 5ml x 250mg/5ml susp
4-6 years 240mg 10ml x 120mg/5ml susp
2-4 years 180mg 7.5ml x 120mg/5ml susp
6-24 months 120mg 5ml x 120mg/5ml susp
3-6 months 60mg 2.5ml x 120mg/5ml susp
1-2
qds
These doses may be repeated every 4-6 hours when necessary (maximum 4 doses in 24 hours)
Follow-up and advice
 Patients should be advised to gargle with salty water
 Patients should avoid smoky or dusty atmospheres and reduce or stop smoking.
 Patients who find swallowing painful should take a light fluid diet.
 Maximum daily doses of paracetamol should be reinforced, along with avoiding use of other
products containing paracetamol.
Side effects and their management
There are unlikely to be any side effects with Paracetamol taken at the recommended dose.
Ref: Prodigy
http://prodigy.clarity.co.uk/sore_throat_acute/management/scenario_management/management_admission_not_required/prescribin
g_an_antibiotic/additional_information#-328994
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 29 of 39
13 THREADWORMS
Definition / Criteria
Enterobius vermicularis (threadworm) infection
Criteria for inclusion
Adults and children (over 2 years) with identified threadworm infection
Patients not registered with an GP within the scheme
Criteria for exclusion
Patients under 2 years
Pregnant and/or breastfeeding women
Patients unsure if it is threadworm infestation
Those taking cimetidine
Action for excluded patients and non-complying patients
Referral to General Practitioner
When and how to refer to GP
Rapid referral:

Heavy cases or persistent cases
Conditional referral:
 On 3rd occurrence
Consider supply, but patient should be advised to make an appointment to see the GP:
 Other type of worm infection
 Perianal itching in adults (possible differential diagnosis)
 If there is any other on-going concern
Recommended treatments, route and legal status
Frequency of administration and maximum dosage
Mebendazole (OVEX®) 100mg
PO
P
One tabled chewed or swallowed whole
[1 or 4 tablet pack as necessary]
Follow-up and advice
 Advise if symptoms do not resolve within 7 days to make an appointment to see a GP
 Pregnant and /or breastfeeding women to follow hygiene advice for 6 weeks
 Repeat after two weeks if necessary
 All family members should be treated
 Importance of personal hygiene should be stressed (Issue PIL)
Side effects and their management
Rarely abdominal pain, diarrhoea, hypersensitivity reactions. Reassure patient
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 30 of 39
14 VAGINAL THRUSH
Definition / Criteria
Vaginal Candidiasis (Thrush)
Criteria for inclusion
Adult females presenting with:
 Symptoms of vaginal thrush
 Who have had a previous diagnosis of thrush
 Who are confident this is a recurrence of the same condition
And consent has been given
Criteria for exclusion
 Patients under 16 years or over 60
 Patients unsure if this is thrush

Patients not registered with an GP within the scheme
Known hypersensitivity to the drug or any other ingredient in the product.
Pregnancy
No previous diagnosis by GP
Recurrent (more than 2 episodes in 6 months)
See individual products for additional exclusion criteria





Action for excluded patients and non-complying patients
Referral to GP
When and how to refer to GP
Rapid referral:
 Presence of loin pain, abdominal pain or fever
 Blood present in discharge
 Offensive smelling or coloured (other than colourless or white) discharge
 Irregular vaginal bleeding
 Severe infection
 Regular attack more frequently than twice in the previous six months
 Diarrhoea, nausea or vomiting
 Ulcers or blisters on the vagina or vulva
 Treatment failure (7 – 14 days following treatment for same symptoms)
Conditional referral:
 Refer on 3rd recurrence within six months
Consider supply, but advise patient to make an appointment to see the GP:
 Post menopausal women
 Consider undiagnosed diabetes in at risk patients
 Patients with diabetes – could be a sign of poor diabetes control
 If there any other ongoing concern
Special considerations / concurrent medication
Diabetic patients
Patient taking antibiotics
Patient taking immunosuppressants or oral steroids
Recommended treatments, route and legal status
Frequency of administration and maximum dosage
Clotrimazole Cream 1% 20g
Route
pv
Clotrimazole Pessary 500mg
pv
Legal Status Dosage
GSL
Apply thinly to the area 2-3 times a day and
rub in gently
GSL
Insert pessary into the vagina at night using
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 31 of 39
Clotrimazole Combi Pack
(500mg pessary + 1% cream)
Fluconazole capsule 150mg
(not for use in nursing mothers)
pv
GSL
oral
P
the applicator provided
Instructions as per above for cream & pessary
One dose
Follow-up and advice
Explain treatment and course of action
 Advise patient that any sexual partners should be treated concurrently if symptomatic
 Advise patient not to exceed the stated dose
 Advise patient to avoid use of vaginal deodorants and scented soap etc
 If condition worsens or symptoms persist beyond 7 days then seek further medical advice
 All severe adverse reactions, including anaphylaxis, should be reported to the MHRA via
the yellow card system and recorded in the medical records.
 Verbal information should be provided to patients / carers and, if requested, written
information in the form of a patient information leaflet should be given.
 Avoid highly perfumed soaps, bubble baths & vaginal deodorants. Wear loose fitting cotton
underwear. Keep genital area cool.
 Remind your doctor that you are prone to thrush if they are prescribed antibiotics or other
medication.
 Advise to discuss with sexual partners and consider treating concurrently
 The treatment may damage latex condoms and diaphragms
Side effects and their management



Sensitivity to imidazoles
Occasional local irritation
Drug interactions – pharmacist should consider interactions, for example with
anticoagulants, some antihistamines, tranquilizers, statins etc
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 32 of 39
15 VERUCCAS AND WARTS
Definition / Criteria
Warts on the foot caused by human papilloma virus (Verruca)
Criteria for inclusion
Adults and children
Criteria for exclusion
Uncertain diagnosis of verruca / Wart
Sensitivity to salicylic acid preparations
Patients not registered with an GP within the scheme
Action for excluded patients and non-complying patients
Referral to General Practitioner
When and how to refer to GP
Rapid referral:
 Multiple, debilitating verrucas / warts
Conditional referral:
 On 3rd occurrence
Consider supply, but patient should be advised to make an appointment to see the GP:
 Verrucas / warts are very painful
 Severe inflammation of surrounding skin
 Suspected alternative diagnosis
 If there is any other on-going concern
Recommended treatments, route and legal status
Frequency of administration and maximum dosage
Salatac Gel 8g
Apply P
Apply daily
Follow-up and advice
Remove film from previous application before applying
Verrucas / warts may regress on their own
Care should be taken to avoid treating normal skin
Side effects and their management
Irritation to normal skin
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 33 of 39
Minor Ailment and Community Pharmacy Scheme
Reception Protocol
For patients making an appointment by telephone or in person at the surgery
1.
If the patient is telephoning a request and practice policy allows you to enquire
about the nature of the requested appointment then use this opportunity to tell
the patient that if their appointment is for one of the minor ailments they can use
the new scheme in operation. If practice policy does not allow you to question
the nature of the appointment then you may read out the list rather than asking
directly what their appointment is for.
2.
If the patient is presenting in person show them the list of minor ailments,
asking if their request for an appointment is for one of the listed ailments.
Inform them that there is a new scheme in operation “Minor Ailments in
Pharmacies” where patients can be referred to a local Community Pharmacy for
advice and treatment rather than waiting for an appointment.
If the patient is exempt from prescription charges then the medicines will be
free. If the patient pays for prescriptions the patient can go to the pharmacy and
purchase a medicine in the normal way. (This will usually be less than a
prescription charge).
3.
If the patient is present at the surgery and accepts transfer into the scheme they
should be given a minor ailments patient information leaflet and asked to
present this at a participating pharmacy.
The leaflet should be stamped with the practice stamp on the back and the
patients’ details filled in by the surgery staff before issuing to the patient.
For patients who decide to go to the pharmacy following a telephone request for
an appointment: if they are not known to the pharmacy they will need to prove
that they are registered with a participating GP practice by taking some form of
identification and proof of GP registration (eg NHS card) with them. The
pharmacy may contact the practice to confirm registration.
4.
If a patient is referred to the pharmacy for treatment through the scheme, it is
good practice to record this in the patients’ notes or computer record and read
codes for the service are available on most clinical systems.
Alternatively, this can be done upon receipt of a Pharm. form, which will be sent
to the practice by the pharmacy when a registered patient uses the scheme to
obtain treatment for a minor ailment covered by the scheme. For good practice
the form should be scanned into the patients’ record.
5.
If a patient refuses transfer into the scheme then an appointment should be
made for them in the surgery in the usual manner.
For patients self-referring at the Pharmacy
The pharmacist is required to confirm the patient’s identification and registration with
your surgery. If the pharmacist does not know the patient or does not have a previous
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 34 of 39
prescription record for them, then they may ring the surgery to check they are
registered. Please co-operate with these requests.
Referral
On some occasions the Pharmacist may consider that the patient needs to be seen
by a doctor. The urgency will depend upon the symptoms. In these circumstances the
Pharmacist will advise the patient to make an appointment and indicate an
appropriate time period for the patient to be seen by their Doctor, for example the
same day for more serious conditions, within 2-3 days for less serious conditions or
within the next 2 weeks if symptoms persist. Sometimes if the surgery is closed the
Pharmacist may advise the patient to call the emergency number or go straight to
A&E.
The pharmacist will complete a referral form and give this to the patient to bring to the
surgery. If an urgent appointment is required, the pharmacist will phone the surgery
to arrange this.
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 35 of 39
Minor Ailment Scheme in Pharmacies
Pharmacy Protocol
Role of the Pharmacist and supporting staff
Each patient should receive the Minor Ailments Pharmacy Patient information
leaflet. If they have not already got one please give them a leaflet at this stage
to allow them to understand the scheme
1.
The client presenting for a Minor Ailment Pharmacist Advice Request must be
seen by the Pharmacist.
2.
Ensure that some evidence of registration with the named GP practice is
shown. This can be a medical card, a tear-off slip from a previous prescription
or if referred from the practice a stamped Minor ailments leaflet. Confirmation of
patient registration may be obtained directly from the practice if required.
3.
Ascertain whether the referral is from the practice (they may or may not have a
stamped Minor Ailments Leaflet) or Self-referral.
4.
For patients who go to the pharmacy following a telephone request, if they are
not known to the pharmacy they will need to prove that they are eligible for the
scheme by taking some form of identification, proof of GP registration with them
and proof of exemption from prescription charges. Confirmation of patient
registration may be obtained directly from the practice if required
5.
During the consultation with the client complete the Pharm Claims Pro-forma
6.
If a medicine is to be supplied, complete the section of the form detailing the
name and the quantity supplied (Refer to formulary if in doubt as these are the
only medicines that will be reimbursed)
7.
Following transfer into the scheme it is good practice to record this in the
Patient Medication Records
For patients self-referring at the Pharmacy
The pharmacist is required to confirm their identification and registration with your
surgery. If the pharmacist does not know the patient or does not have a previous
prescription record for them, then they may ring the surgery to check their
registration. Please cooperate with these requests.
Referral
On some occasions the Pharmacist may consider that the patient needs to be seen
by a doctor. The urgency will depend upon the symptoms. In these circumstances
the Pharmacist will advise the patient to make an appointment and indicate an
appropriate time, for example the same day for more serious conditions, within 2-3
days for less serious conditions or within the next 2 weeks if symptoms persist.
The pharmacist will complete a referral form and give this to the patient. If urgent the
pharmacist may phone the surgery to arrange referral. Sometimes if the surgery is
closed the Pharmacist may advise the patient to call the emergency number or go
straight to A & E.
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 36 of 39
Minor Ailments and Community Pharmacy Scheme
Pharmacist Referral Form
Dear Patient,
Your pharmacist has reviewed your symptoms and feels that you should see your doctor for
further advice or treatment.
Please take this form and show it to your doctor. Your pharmacist will advise you how quickly
you should see your doctor and help you make arrangements if you need to be seen quickly.
Patients Name: ………………………………………………………………................ Date of Birth: ……………………………
Patients Address:……………………………………………………………….…………… ………………………………………….
…………………………………………………………………………………………………
Postcode: ………………………….
GPs Name: ……………………………………….… GP surgery: ……………………................................................................
Symptoms reported: .....................................................................................................................
………………………………………………………………………………………………………………..
Reason for referral………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………
Has any medicine been supplied:
Yes
No
How soon does the patient require to be seen
□ Immediately (pharmacist to phone the surgery to arrange)
Appointment date:………………………….
Appointment time:……………………
□ Next routine appointment
Pharmacy stamp
Name of pharmacist referring: ……………………………………………..………….
Contact telephone number: …………………………………………………………….
Date of referral: …………………………………………………………………………….
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 37 of 39
Identification of a Named Professional Lead in the Minor Ailments Scheme
Name of professional lead
Profession
..............................................................................................................
...............................................................................................................................................
I agree with the terms laid out in the service specification and I am happy to take the
professional lead on the Minor Ailments Scheme for this practice/pharmacy.
I will keep all staff (including any locum staff) informed of the protocol and all relevant
documentation and I will provide updates following any amendments.
Where necessary I will either provide training or highlight any training requirements to
the Member Support Team at Solihull CCG.
Pharmacists must ensure that they are competent to undertake the professional
elements of the scheme. Refresher training is available as a CPPE package entitled
“Minor Ailments”.
It is essential that the pharmacists participating in the scheme are covered by
professional indemnity insurance before they begin to participate.
The pharmacist must ensure that the patient declaration is completed correctly.
Reimbursement of the pharmacist for the cost of the product will be dependent on the
submission of a fully completed declaration.
Incident Reporting Forms should be used to inform Solihull CCG Member Support
Team immediately of any incidents regarding the scheme.
All complaints should be directed to the relevant Practice Manager in the first instance,
who will then liaise with the Member Support Team at Solihull CCG.
Signature
.............................................................................. Date ……………………………………….
Practice/Pharmacy stamp:
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 38 of 39
Minor Ailments Scheme
Patient contacts surgery for appointment or enquires about the service
Telephone Call
Patient calls into surgery
Patient self-referral to
participating pharmacy
If the patient says they have at least one of the minor ailments and is
registered at the practice, they will be given an information leaflet and/or an
explanation of the service and informed of the nearest participating pharmacy.
They are given the option to take part
Patient not happy to
take part
Appointment arranged
with GP as usual
Patient happy to
take part
The receptionist will provide a stamped “Minor
Ailments” leaflet to the patient
Patient visits participating pharmacy where they are asked for proof of registration at
surgery. (see scheme details) The service is then explained to them and they will be
asked to register with the pharmacy to use the scheme. A stamped “Minor ailments”
leaflet will be provided if they do not already have one.
Pharmacist carries out consultation and patient describes symptoms
Pharmacist gives advice
only
Pharmacist gives advice
and treatment
Pharmacist refers back
to GP
Pharmacist and Patient complete Pharmacy proforma and exemption declaration
where appropriate. Pharmacist completes PMR and labels item(s) supplied where
appropriate. Pharmacist should ensure that top copy of proforma is sent to the
GP as soon as possible
At the end of the month, pharmacist completes monthly summary sheet and
returns it, along with copies of Pharmacy proforma to Medicines Management
Team at CCG. GP is also sent list of their patients registered with the pharmacy.
d:\106766851.doc
Solihull CCG: Treatment of Minor Ailments in Community Pharmacies (Dec 2012)
Page 39 of 39