Urgent Care Service Formulary
Introduction
The National Out-of-Hours formulary is a core drug list which contains the minimum
medicines that a patient should be able to access out-of-hours. The Urgent Care Out-ofHours formulary is based on the national Out-of-Hours formulary. Only medicines
contained in the Out-of-Hours formulary will be available in local treatment centres and on
vehicles. They are the only drugs that should normally be prescribed on form FP10 in the
Out-of-Hours period.
When a convenient community pharmacy is open the patient should receive a prescription
to take to the pharmacy to be dispensed. However, when community pharmacies are
closed or the patient will find it difficult to access a pharmacy for any reason they should
be supplied with medication from the treatment centre or vehicle stock.
General guidance
Red drugs
In the Out-of-Hours period only those medicines considered appropriate for prescribing ‘in
hours’ and included on Primary Care Trust formularies should be prescribed. Medicines
categorised as RED on local formularies should not be prescribed out of hours.
Chronic conditions
Out-of-Hours practitioners provide urgent care to manage the immediate situation. It is not
normally appropriate in this situation to commence therapies that are intended to treat
chronic conditions e.g. stable hypertension, asthma prevention. In the Out-of-Hours period
if the patient has an acute exacerbation of a chronic condition which you treat but does not
require emergency admission to hospital they should be referred to their own GP practice
for follow up. If a doctor working in the Service does feel it necessary to prescribe, then
only sufficient treatment for 30 days or the smallest pack size should be prescribed and
the patient advised to see their GP or visit a local practice as a temporary resident at the
earliest opportunity if further supplies are needed.
Emergency supplies
Patients who request prescription only medicines in the OOHs period because they have
forgotten their medication etc. will not be supplied with a prescription. They will be referred
to a community pharmacy to request an ‘Emergency Supply’ of their medication.
Community pharmacies are permitted to sell a prescription only medicine to patients
provided that certain conditions are met.
Regulation 225 (1), the Human Medicines Regulations 2012, requires the pharmacist to
establish that there is an immediate need for the medicine and it is impracticable in the
circumstances to obtain a prescription without delay. The pharmacist must be satisfied that
the medicine has been previously prescribed by an appropriate person for the patient and
satisfy themselves as to the dose that the patient should take.
Not all medicines can be supplied (see table):
Prescription Only Medicine
A POM that :
a) Is a preparation of insulin, an
aerosol for the relief of asthma,
an ointment or cream, and
b) Has been made up for sale in a
package elsewhere than at the
place of sale or supply
An oral contraceptive
Maximum Quantity
The smallest pack that the pharmacist
has available for sale or supply.
A quantity sufficient for a full treatment
cycle
An antibiotic for oral administration in The smallest quantity that will provide a
liquid form
full course of treatment
A controlled drug within the meaning of Five days’ treatment
Schedule 4 or 5 of the Misuse of Drugs
Regulations 2001
Any other POM
30 days’ treatment
There are certain medicines that cannot be supplied including controlled drugs (the
Regulations classify these as drugs on Schedules 1 to 3) unless the drug is phenobarbital
or phenobarbital sodium for the treatment of epilepsy.
A system has been established to safety net requests from vulnerable patients. A
pharmacist will contact the doctor to make the request.
If an OOHs clinician is required to prescribe for a patient then only sufficient
treatment to cover the period that the GP practice is closed plus two days, or the
smallest pack size should be prescribed. If the patient lives out of area, they will
need to contact their own GP and arrange for their prescription to be faxed to a
local pharmacy.
Methadone
Requests from registered addicts for Methadone, Subutex (Buprenorphine) or any other
substance prescribed by the addictions team should be refused. Methadone has a
prolonged half-life of between 15 to 60 hours. Withdrawal symptoms appear slowly and
not usually until 24 to 48hrs after the last dose.
In the rare event that a community pharmacist contacts the Service to request a
prescription on behalf of a client and the OOHs clinician feels that it is appropriate to
provide a prescription, then the OOHs clinician must complete an incident form. This will
allow the circumstances leading to the prescription to be investigated and steps taken to
avoid further similar incidents. The incident forms will be shared with the local Primary
Care Trust and local drug treatment services.
Prescription Forms
Prescriptions should be generated electronically. Handwritten forms are only acceptable
where facilities for overprinting blank green forms do not exist.
Overprinted Prescription forms
Prescription pads (FP10), overprinted with the contact details of the issuing organisation,
are controlled stationary. SERVICE retains a small number of these forms for
prescribers to use when electronic printing facilities do not exist. Every effort should be
made to prevent loss or theft of the forms. More information on the management of
prescription forms can be found in the South Western Ambulance Service NHS
Foundation Trust’s Medicines Management Policy.
Stock medicines reconciliation
Whenever medicines are supplied or administered to patients from treatment centre or
vehicle stock in the Out-of-Hours period this needs to be recorded on Adastra. If the
patient receives a supply of medicine to take home they need to be asked to either sign a
declaration of exemption from prescription charges or they need to be given a promissory
note and asked to pay a prescription charge for the medicines received. Prescription
charges will then be collected by the Ambulance Trust.
Oral syringes, spoons and Child-resistant closures
When dispensing liquid medication, please ensure that the medicine has a child resistant
closure and that a spoon or oral syringe is issued to allow the safe measurement of a dose
of oral liquid.
URGENT CARE SERVICE FORMULARY
DRUG
COMMENT
PREPARATIONS STOCKED IN
TREATMENT CENTRES
PREPARATIONS FOR FP10
PRESCRIBING ONLY (Not
stocked in LTC)
ANALGESIA
Morphine
(Diamorphine*)
Follow SERVICE Standard
Operating Procedures.
Codeine
Codeine has a dual role for
pain relief and diarrhoea. Oral
formulations to be supplied as
a full course to appropriately
treat the presenting condition.
Oral formulations to be
supplied as a full course to
appropriately treat the
presenting condition.
Rectal formulations to be
supplied as a full course to
appropriately treat the
presenting condition.
Oral formulations to be
supplied as a full course to
appropriately treat the
presenting condition.
Oral formulations to be
supplied as a full course to
appropriately treat the
presenting condition.
Ibuprofen
Diclofenac
Naproxen 250mg
EC
Paracetamol
Morphine sulphate injection 10mg
Morphine sulphate oral solution 10mg
in 5ml (100ml)
Codeine phosphate tablets 15mg
(28s)
Diamorphine injection
Ibuprofen 100mg in 5ml suspension
(150ml)
Ibuprofen 200mg tablets (24s)
Ibuprofen 400mg
Codeine phosphate tablets
30mg
Diclofenac 75mg in 3ml injection (10s)
Diclofenac suppositories 50mg (10s)
Naproxen 250mg EC tablets (28s)
Naproxen 500mg EC tablets
Paracetamol 120mg in 5ml
suspension (100ml)
Paracetamol 250mg in 5ml
suspension (100ml)
Paracetamol 500mg caplets (16s)
Paracetamol 500mg soluble
tablets
Paracetamol suppositories
120mg suppositories (10s)
Paracetamol suppositories
240mg suppositories (10s)
DRUG
COMMENT
PREPARATIONS STOCKED IN
DORSET TREATMENT CENTRES
PREPARATIONS FOR FP10
PRESCRIBING ONLY (Not
stocked in LTC)
ASTHMA/RESPIRATORY
Ipratropium
Salbutamol
Prednisolone
Dexamethasone
Supply as a full course to
appropriately treat the
presenting condition.
Supply as a full course to
appropriately treat the
presenting condition.
Oral formulations to be
supplied as a full course to
appropriately treat the
presenting condition. Soluble
tablets may be used in adults
and children.
Single dose (150mcg/kg) to be
given orally in cases of severe
croup or mild croup that might
cause complications prior to
transfer to hospital.
Spacer device
Adrenaline
Aspirin
Atropine
Morphine
(Diamorphine)
Ipratropium bromide 250mcg in 1ml
nebules (20s)
Salbutamol 2.5mg in 2.5ml nebules
(20s)
Salbutamol 100mcg per metered
dose CFC free inhaler
Prednisolone 5mg tablets
Prednisolone 5mg soluble (30s)
Dexamethasone 2mg in 5ml oral
solution (150ml) or
Dexamethasone injection 4mg/ml (for
oral use)
Aerochamber Plus Adult (Blue)
Aerochamber Plus Child (with mask)
(Yellow)
Aerochamber Plus Infant (with mask)
(Orange)
CARDIAC EMERGENCIES
Suitable for treatment of
cardiac arrest.
For use in all patients with
suspected myocardial
infarction unless
contraindicated or already
taken.
For use in cardiac
emergencies
(See above ‘Analgesia’)
Ipratropium bromide 20mcg
per metered dose CFC free
inhaler
Salbutamol 5mg in 2.5ml
nebules (20s)
Adrenaline 1 in 10,000 10ml Min-I-Jet
X 6 per site
Aspirin 300mg soluble tablets (32s)
Atropine sulphate 1mg in 5ml Prefilled syringe X 6 per site
Atropine sulphate 3mg in 10ml Prefilled syringe X 6 per site
(Mini-jets for both strengths may be
supplied)
Volumatic
Aerochamber Plus Adult (with
mask) (Blue)
Frusemide
Glyceryl trinitrate
sublingual
DRUG
Supply as a full course to
appropriately treat the
presenting condition. Full
course of oral tablets is
expected to be 7 days
maximum.
Supply as a full course to
appropriately treat the
presenting condition.
COMMENT
Furosemide 40mg tablets (7s)
Furosemide 50mg injection (10s)
Glyceryl trinitrate 400mcg per
metered dose spray (75 dose or 200
dose)
PREPARATIONS STOCKED IN
DORSET TREATMENT CENTRES
PREPARATIONS FOR FP10
PRESCRIBING ONLY (Not
stocked in LTC)
ALLERGY/ANAPHYLAXIS
Adrenaline
Suitable for the treatment of
anaphylaxis
Adrenaline 1 in 1000 (1mg in 1ml)
ampoules (10s)
Adrenaline (Epipen) 0.3mg injection
Adrenaline (Epipen) 0.15mg injection
Hydrocortisone
Hydrocortisone sodium
succinate can be used for
anaphylaxis, asthma and
hypoadrenalism.
Supply as a full course to
appropriately treat the
presenting condition.
Hydrocortisone sodium phosphate
100mg in 1ml injection (5s)
Chlorphenamine
Chlorphenamine 10mg in 1ml
injection (5s)
Chlorphenamine 2mg in 5ml oral
liquid (50ml)
Chlorphenamine 4mg tablets (28s)
Cetirizine 10mg tablets (7s)
Cetirizine 5mg/5ml oral solution
(200ml)
DIABETIC EMERGENCIES
Non-sedating
antihistamine
Supply as a full course to
appropriately treat the
presenting condition.
Glucagon
injection
Glucose
Children may not respond to
Glucagon so are more likely to
need glucose. Patients not
responding should be
admitted.
Glucagon 1mg injection
Glucagel 3 x 23g
OPIOID OVERDOSE
Naloxone
Any patient with an opioid
Naloxone 400mcg in 1ml ampoules
overdose should be admitted
(10s)
to hospital, as repeated doses Naloxone HCl 2mg in 2ml Pre-filled
may be necessary.
syringe
MIDAZOLAM OVERDOSE
Flumazenil
Antacid
Flumazenil injection 500microgram in
5ml (5s)
GASTROINTESTINAL
Supply as a full course to
appropriately treat the
presenting condition.
Gaviscon Advance tablets (12s)
Omeprazole 20mg capsules (28s)
Peptac liquid 500ml
Ranitidine 150/300mg
DRUG
Glycerol
suppositories
Anti-spasmodic
Faecal impaction
Loperamide
Metoclopramide
Oral rehydration
sachets
Micro enema
Prochlorperazine
COMMENT
PREPARATIONS STOCKED IN
DORSET TREATMENT CENTRES
Included for immediate
symptom relief.
Supply as a full course to
appropriately treat the
presenting condition.
Included for immediate
symptom relief.
PREPARATIONS FOR FP10
PRESCRIBING ONLY (Not
stocked in LTC)
Glycerin 4g adult suppositories (12s)
Hyoscine-N-butylbromide injection
20mg in 1ml
Hyoscine-N-butylbromide
10mg tablets
Polyethylene glycol 3350 and
electrolytes sachets (8s)
Paediatric polyethylene glycol 3350
and electrolytes (6s)
Loperamide 2mg capsules (8s)
Supply as a full course to
appropriately treat the
presenting condition.
Included as there is no
parenteral formulation of
domperidone.
Supply as a full course to
appropriately treat the
presenting condition.
Included for immediate
symptom relief.
Metoclopramide 10mg in 2ml injection
(10)
Metoclopramide 10mg tablets (28s)
Dioralyte natural (6s)
Sodium citrate 450mcg in 5ml micro
enema
Supply as a full course to
appropriately treat the
presenting condition.
Prochlorperazine 3mg buccal tablets
(8s)
Prochlorperazine 12.5mg in 1ml
injection (10s)
PSYCHIATRIC EMERGENCIES
Diazepam
Haloperidol
Procyclidine
Levonorgestrel
1500
Supply as a full course to
Diazepam 2mg tablets (6s)
appropriately treat the
Diazepam rectal tube 5mg (5s)
presenting condition. Smaller
Diazepam rectal tube 2.5mg (5s)
quantities may be more
appropriate. An appropriate
rectal formulation to be
included.
Supply as a full course to
Haloperidol 5mg in 1ml injection (10s)
appropriately treat the
presenting condition. May also
be used for the treatment of
severe nausea and vomiting.
Supply as a full course to
Procyclidine 10mg in 2ml injection
appropriately treat the
(5s)
presenting condition.
OBSTETRIC AND GYNAECOLOGY
Diazepam 2mg in 5ml syrup
Do not prescribe the OTC
product ‘Levonelle One Step’
Ulipristal acetate (Ella One)
tablets
Levonelle 1500 tablet (1s)
Haloperidol 500mcg capsules
on FP10. This is significantly
more expensive than the POM
medicine.
OPHTHALMIC
Fluorescein
Examination of eye
Fluorescein ophthalmic strips
PALLIATIVE CARE DRUGS
Morphine
(Diamorphine∞)
Cyclizine
Dexamethasone
Hyoscine
Levomepromazin
e
Midazolam
(See above ‘Analgesia’ for
Morphine/Diamorphine)
(See above ‘Analgesia’)
(See above ‘Analgesia’)
Cyclizine 50mg in 1ml Injection (5s)
Quantities supplied should be
enough to allow appropriate
symptom relief until formal
review by palliative care team
or GP.
Selected community
pharmacies carry a full stock
of formulary palliative care
drugs. Contact
Communications Centre for
further details
Dexamethasone 4mg/ml 2ml injection
Dexamethasone 500mcg
tablets (10s)
Hyoscine hydrobromide 400mcg in
1ml injection (10s) (see also
gastrointestinal)
Levomepromazine 25mg
tablets
Levomepromazine injection
25mg in 1ml (10s)
Midazolam 10mg in 2ml injection
(10s)
Fentanyl
Oxycodone
Fentanyl patches
Oxycodone injection,
immediate release capsules,
sustained release tablets, oral
solution
ANTIMICROBIALS
Antimicrobial formulary choices are those indicated in the Health Protection Agency’s guidance for primary care prescribing.
The following preparations are stocked in the treatment centres and on vehicles:
Aciclovir 800mg tablets Overlabelled Pack
Amoxicillin 125mg in 5ml Suspension
Amoxicillin 250mg Capsules Overlabelled Pack
Amoxicillin 250mg in 5ml Suspension Overlabelled Pack
Amoxicillin 500mg Capsules Overlabelled Pack
Benzylpenicillin Sodium Injection 600mg
Ciprofloxacin 500mg Overlabelled pack
Chloramphenicol 1% eye ointment Overlabelled Pack
Clarithromycin 125mg in 5ml Suspension Overlabelled Pack
Clarithromycin 250mg Tablets Overlabelled Pack
Co-amoxiclav 125/31 Suspension Overlabelled Pack
Co-amoxiclav 250/125 mg Tablets Overlabelled Pack
Co-amoxiclav 250/62 Suspension Overlabelled Pack
Co-amoxiclav 500/125 mg Tablets Overlabelled Pack
Doxycycline 100mg Capsules Overlabelled Pack
Flucloxacillin 125mg in 5ml Suspension Overlabelled Pack
Flucloxacillin 250mg Capsules Overlabelled Pack
Flucloxacillin 250mg in 5ml Suspension Overlabelled Pack
Flucloxacillin 500mg Capsules Overlabelled Pack
Locorten-Vioform ear drops 7.5ml Overlabelled Pack
Metronidazole 200mg Tablets Overlabelled Pack
Metronidazole 400mg Tablets Overlabelled Pack
Nitrofurantoin 50mg Capsule Overlabelled Pack
Penicillin V 125mg in 5ml Suspension Overlabelled Pack
Penicillin V 250mg in 5ml Suspension Overlabelled Pack
Penicillin V 250mg Tablets Overlabelled Pack
Trimethoprim 200mg Tablets Overlabelled Pack (6s)
Trimethoprim 200mg Tablets Overlabelled Pack (14s)
Trimethoprim 50mg in 5ml Suspension Overlabelled Pack
Other available presentations of these drugs may be prescribed on
FP10 eg Chloramphenicol 0.5% eye drops (if not stocked as no
refrigerated storage facilities).
Prescribers are reminded of the recommendations of the Standing Medical Advisory Committee (SMAC) report, ‘Four things
you can do to make a difference’:




No prescribing of antibiotics for simple coughs and colds
No prescribing of antibiotics for viral sore throats
Limit prescribing for uncomplicated cystitis to three days in otherwise fit women
Limit prescribing of antibiotic agents over the telephone to exceptional cases
Non-prescription pads are available in all treatment centres.
See current BNF and Children’s BNF for dosage of antibiotics.
ADDITIONAL PRODUCTS
Sodium chloride
0.9% injection
Water for
injection
Diluent
Diluent
Sodium chloride 0.9% injection 10ml
ampoule (50s)
Water for injection 10ml ampoules (50s)
Pregnancy
testing kit
Instillagel
Oral syringes
Urine testing
sticks
Blood glucose
testing strips
Do not prescribe on FP10.
Immediate use only.
Do not prescribe on FP10.
Immediate use only.
Do not prescribe on FP10. If
indicated by dose then
pharmacists will supply
automatically.
Do not prescribe on FP10. For
use where diagnosis cannot
safely wait e.g to identify
patients with urgent treatment
needs or who should be
admitted to hospital.
Do not prescribe on FP10. For
use where diagnosis cannot
safely wait e.g to identify
patients with urgent treatment
needs or who should be
admitted to hospital.
Clearview HCG pregnancy test
Do not prescribe
Instillagel 2% (11ml) gel
Oral syringes
Multistix 8SG test strips
Do not prescribe
reagent strips
Do not prescribe