SPECIFICATION FOR MINOR AILMENTS SERVICE PROVIDED
BY COMMUNITY PHARMACISTS IN NHS SOUTH EAST ESSEX
1ST October 2008 to 31st March 2009
A local enhanced service between _____________________________
_________________________(Name & Address of Pharmacy) and NHS South East
Essex
1.Introduction
The overall aim of this project is to identify effective ways of promoting self-care for
minor ailments and reducing demand on both general practice and the NHS drug
budget. Evidence shows that the average cost of medicines supplied through the
minor ailments service is less than that prescribed by the average GP.
Working in conjunction with Primary Care colleagues, the service aims to
appropriately manage demand for primary care services within the context of a
resource constrained healthcare system and to better utilise the skills of
Community Pharmacists in the delivery of services.
2. Eligibility
This scheme is available to patient’s who are currently registered with a GP,
who practices within the PCT area and who have identified that they are
suffering from one of the listed minor ailments.
3. Delivering a Minor Ailments service
Delivery of the service must be in accordance with the Minor Ailments Service
treatment protocols and pharmacy operational procedures. (Appendix B &C)

The Primary Care Contractor (Pharmacist) should hold a consultation
with the patient in a private area, ensuring that colleagues or other
patients cannot overhear the conversation.

The pharmacist must ensure that the appropriate advice is given at the time
of the consultation.

The pharmacist should complete the voucher and ensure that the patient
signs the declaration on the voucher and must ensure that a copy of this
document is provided to the patients registered GP to be included in their
life long medical record.

If the pharmacist considers that the patient would be more appropriately
seen by their usual GP, the GP Rapid Referral Form should be completed
MAS
and faxed to their GP practice to arrange for an appointment. The PCT
reserves the right not to pay for this aspect of the service, as pharmacists
are obliged to signpost patients to appropriate healthcare professionals,
under the current pharmacy contract.

If the pharmacist has confirmed that the patient has one of the listed minor
ailments, he/she should provide the appropriate medicine(s) from the
Minor Ailments formulary.

The patient should be given the opportunity to complete the patient survey,
which should then be returned to the PCT.

For all Head lice and threadworm consultations, whole families can be
included on the same form (voucher).

If the Pharmacist suspects that a patient and/or parent is abusing the
service they should alert the Community Pharmacy & Medicines
Management team.
4. Pricing for Service
This enhanced service is priced as follows:
The pharmacy will be paid £4.00 for each consultation and reimbursement of
medicine supplied at drug tariff /cost price plus VAT
Payment will be released on submission of the Community Pharmacists’
Minor Ailments Service Reconciliation and claim form.
5. Monitoring Arrangements
The Pharmacy is required to undertake an annual survey and report findings
to the PCT. (Patient Survey, Appendix E)
Monitoring of the scheme may be undertaken by the PCT at any time and will
be included as part of the Community Pharmacy Contract visits.
6. Protecting Patient Confidentiality
Caldicott Guardianship is based upon being thoughtful about the way in which
patient information is handled, protecting data, using it appropriately and
minimising or eliminating the risk of inappropriate disclosure.
7.Tax Liabilities
Pharmacists providing the minor ailments service shall have the status of a
self-employed person, hence will be responsible for all income tax and
national insurance liabilities in respect of his/her fees.
MAS
8.Termination of contract
NHS South East Essex reserve the right to terminate or suspend this
agreement forthwith, if there are reasonable grounds for concern including but
not limited to malpractice, negligence or fraud on the part of the pharmacy.
9.Further information
Please note that once this agreement has been signed it should be sent
to the Primary Care Commissioning Team. All further correspondence
(vouchers, payments etc) should be with the Community Pharmacy and
Medicines Management Team.
Community Pharmacy and Medicines Management Team
NHS South East Essex.
01702 224608
Please sign and date below to confirm acceptance of this LES for 2008/09:
Signature……………………………………………. Date:……………………….
Name:………………………………………………..
Pharmacy Stamp:
Please return a signed copy of this agreement to:
Primary Care Commissioning Team
Harcourt House, Harcourt Avenue, Southend-on-Sea, Essex, SS2 6HE,
MAS
APPENDIX A
MAS
Appendix B
Minor Ailments Treatment Protocols & Formulary
(23 Ailments)
Ailment & Definition
Symptoms
(some or all)
When to refer to
GP
Medicines
Advice to
patient
Age
Limits
Athletes Foot
Fungal infection of the skin
Sore, Itchy &
broken skin
between the
toes and on the
sole of the foot.
Toenails are black or
discoloured
Clotrimazole 1% cream 20g
Miconazole 2% + Hydrocortisone
1% cream 15g
Wash & dry feet
thoroughly,
especially between
the toes.
Refer to
PILs
Infection has started
to spread under the
nails or to other parts
of the body
Clean wool or
cotton socks will
allow the skin to
breathe & can
reduce the
moisture that is
kept in contact with
the skin
Continue using the
cream for two
weeks after the
infection appears to
have cleared
Broken, bleeding
or exuding skin
Bites & Stings
Insect bites or stings
Cold Sores
Viral infection
Herpes labialis caused by
the Herpes Simplex virus
Constipation
Increased difficulty &
reduced frequency of bowel
evacuation compared to
normal
MAS
Sores on lips or
around mouth
Tingling/irritation
2-3 days before
the appearance
of sores
Red inflamed
skin
Discomfort
Pharmacists
should use their
professional
judgement
Patients with atopic
eczema
Chlorpenamine 4mg/10ml
Chlorphenamine 4mg tablets
Calamine lotion 100ml
Hydrocortisone 1% cream 15g
(HC45)
Aciclovir 5% cream 2g
Senna tablets
20
Lactulose Liquid 500ml
Fybogel sachets 10
>2 years
>10years
Refer to
PILS
Lifestyle advice
>6 years
>2 years
>6 years
Conjunctivitis
Acute inflammation of the
Conjunctiva. This is due to
bacterial contamination.
A sticky/purulent
discharge,
which can make
the eye difficult
to open in the
morning. The
eye may feel
“gritty” and
“irritated”.
Reports of pain within
the eye.
Children < 2 yrs
Contact lens
(appropriate advise)
Foreign body in the
eye.
Eye injury
Patient feels unwell
Glaucoma
Loss of sight, Blurred
vision.
Dry eye syndrome
Brochlor 0.5% eye drops.
Acute bacterial conjunctivitis in
adults, elderly and children over 2
years apply one drop into the
affected eye every 2 hours for 48
hours and 4 hourly thereafter.
Course of treatment is five days.
Try not to touch the
eye or lashes with
nozzle of container.
>2 years
Wash hands before
and after touching
eyes and avoid
sharing towels,
face clothes, etc.
Dispose of any eye
cosmetics that may
be contaminated.
Do not rub eyes
Store
Chloramphenicol
eye drops in the
fridge (2oc-8oc) and
protect from
sunlight.
Once opened the
treatment should
be discarded after
5 days.
Do not share
containers if more
than one member
of the family is
affected.
Broken/bleeding
skin
Patients with chronic
diarrhoea problems
Children under
2 years
Persists for over 48
hours
Dry Skin
Diarrhoea
Increased frequency &
fluidity of defecation
Aqueous cream 500g
Dioralyte Sachets
Loperamide 2mg capsules
>2 years
>12years
Discharge
Severe headache &
temperature
Suspected infection
Young children
Otex ear drops
Sodium Bicarbonate Ear drops
Refer to
PiLs
Pregnant or
breastfeeding
Women
Derbac M 50ml, 100ml
Lyclear rinse 59ml, 118ml
Patients taking
medicines that cause
diarrhoea
Ear Wax
Build up of yellowish/brown
residue in outer ear
Headlice
Lice are cream or grey &
about 2-4mm long
Eggs are attached to the hair
shaft close to the scalp
Itchiness of
scalp
Detection of live
lice
Treatment failures
Very young babies
MAS
Alcoholic lotions are suitable for
people with normal healthy skin
Aqueous lotions are the treatment
choice for asthmatics or patients
with eczema
Treat all infected
members of
household
>6 months
>6 months
Hay fever
Seasonal allergy to plant
pollen
Sneezing
Nasal blockage
Rhinorrhoea
Itchy nose,
throat & eyes
Heavy wheezing
Breathlessness
Asthma sufferers who
are finding it difficult
to breathe despite
using their inhaler
Chlorphenamine 4mg/10ml
Chlorphenamine 4mg tablets
Loratidine 10mg tablets
Sodium Cromoglicate
eye drops 10ml
Beclomethasone aq.nasal spray
(appropriate advice should be
given to asthmatic patients on
inhaled corticosteriods)
Haemorrhoids
Swollen veins rather like
varicose veins which
protrude into the anal canal
Itching, burning
pain, swelling &
discomfort in the
perianal or anal
area
Bleeding
Associated
abdominal
pain/vomiting
Change in bowel
habit
Duration of longer
than 3 weeks
Anusol ointment 23g
Anusol suppositories
Headache
Pain is a subjective
experience; the nature &
location may vary
considerably.
Fever or pain
associated with
upper
respiratory tract
infections
Children under the
age of 6 months
Paracetamol 500mg
Ibuprofen 200mg tablets 24
Dyspepsia/Heartburn
A collection of symptoms
Stomach
discomfort
Flatulence
Feeling of
fullness
Infant teething
Pain & redness of gums in
infants from 6 to30 months
old
Excess
salivation &
dribbling
Restlessness
Pain &
discomfort
Chews hard
objects
Single ulcer
Occurs in any
area of the
mouth
No systemic
symptoms
No history of
previous
episodes
Mouth Ulcers
Recurrent aphthous
stomatitis
Nasal Congestion
Blocked nose associated
with colds & upper
respiratory tract infections
Nappy Rash
Napkin dermatitis appearing
as an erythematous rash on
the buttock area
MAS
Congestion
where seasonal
allergy has been
excluded
Visual disturbance
Vomiting
Photophobia
Slurred speech
Temporal arteritis
(Patient usually
>60years with pain in
one temple only
Severe sinusitis
Recent head injury
Suspected meningitis
Chest pains
Patients over 40
experiencing first
episode
Bleeding PR
Unexplained weight
loss
Vomiting significant
amounts of blood
Child with fever
GIT disorders
or rash
Sores that bleed
easily
Broken/Bleeding Skin
>2 years
>12 years
Do not stroke pets
that have been
outside
>12 years
>12 years
>18 years
Check pollen count
daily
Wear sunglasses
Lifestyle advice
>18 years
Long term
treatment with
analgesics
particularly those
containing codeine
may give rise to
rebound
headaches
PiLs
Bonjela teething gel
Paracetamol 120mg/5ml
Ibuprofen 100mg/5ml susp
Cool teething rings
>6months
>6 months
>6months
Bonjela teething gel
Adcortyl in Orabase
Limit spicy foods,
hot fluids and
carbonated drinks
Refer to
PILS
Gaviscon Extra tablets
Peptac Liquid 500ml
Ranitidine 75mg tablets
Non painful lesions
including lumps,
thickening red or
white patches
Ulcers that have
persisted for >3
weeks
Diabetes
Hyperthyroidism
Recurrent nose
bleeds
Stop smoking if
appropriate
Avoid crisps(sharp
foods)
Rinse mouth with
salt water solution
Sodium Chloride nasal drops
Pseudoephedrine 30mg/5ml (no
Hx of  BP)
Menthol & Eucalyptus inhalation
Sudocrem ointment
Metanium ointment
Should not be used
for more than 7
days to prevent
rebound
> 2 years
> 2 years
Refer to
PILs
Spots/Acne
Commonly occurs in
teenage years
Sore Throat
Painful throat often
accompanied by viral
symptoms
Temperature
Threadworm
Pain on
swallowing
Fever
Headache
Malaise
Swollen tender
neck glands
Enlarged tonsils
Presence of
exudates
Fever
associated with
upper
respiratory tract
infections
Post
immunisation
temperature
Perianal itching
Failed medication
Severe acne
Suspected druginduced acne e.g.
Lithium, phenytoin
Benzoyl Peroxide
2.5%, 5% or 10% cream or gel.
No improvement after
5-7 days
Paracetamol 120mg/5ml
Paracetamol 250mg/5ml
Ibuprofen 100mg/5ml
Aspirin 300mg Soluble 32(gargle)
Soluble Paracetamol
500mg(gargle)
>13 years
>12 years
Patient on other
medication e.g.
Carbimazole,
Methotrexate, oral
steroids
Patients especially
children presenting
with severe
symptoms
A second request
within 4 weeks
Babies under 3
months
Pregnant women
Reduce or stop
smoking
Paracetamol 120mg/5ml
Paracetamol 250mg/5ml
Ibuprofen 100mg/5ml
Mebendazole 100mg (2)
Repeat in 14 days
to prevent reinfection
> 2 years
General advice on
hygiene/sharing
Vaginal Thrush
Fungal infection of the lower
female genital tract
Warts and Verrucae
Vaginal
discharge
Soreness
Itching
Raised lesion
with a
toughened
surface.
Plantar warts
(verrucae) are
weight bearing
and are found
on the sole or
heel of the foot.
First time sufferer
No response to
medication
Blood in discharge
Diabetic
Pregnancy
Under 16 or over 60
years of age
Clotrimazole 2 % cream
Clotrimazole 500mg pessaries
Flucoconazole 150mg (1)
Bleeding
Anogenital
Facial
Diabetic Patients
Itching
Duofilm Paint
Verrugon Ointment
Medicines Management & Community Pharmacy
Revised September 2008
References: Symptoms in the Pharmacy by Alison Blenkinsopp et al
MAS
Avoid highly
perfumed soaps,
bubble bath etc if
prone to thrush
>16 years,
<60years
Avoid tight fitting
underwear
Treatment could be
needed for up to 3
months.
If symptoms persist
for longer, removal
by liquid nitrogen
may be required.
Application advice:
avoid healthy skin,
petroleum jelly
could be used as a
barrier
Refer to
PILs.
Appendix C
Pharmacy Operational Procedures
Only medicines listed on the Minor Ailments formulary can be supplied.

Pharmacists must work within guidelines and robust Standard operating Procedures (SOPs)
that have been specifically developed to support this service.

Consultations must be done by the pharmacist or designated person, (working within the SOP
drawn up by the pharmacist), in a private area.

Proxy consultations should only be done on behalf of children or care home residents and in
exceptional circumstances via telephone calls.

During consultation with the patient, complete the “symptoms reported section”.

If medicine(s) is supplied, complete the next section detailing its name and quantity.

Record the supply on the Pharmacy PMR system (audit purposes & good practice)

The pharmacist or designated person should ensure that the patient has completed and
signed the declaration of exemption of prescription charges. If the patient has to pay a
prescription charge take this money or sell the medicine to the patient if it is cheaper. If you
sell the item mark the paid box with the exact amount that the patient paid.

Complete the lower section of the voucher by adding your name, signature, pharmacy stamp
and date of supply. (All vouchers must be signed by the pharmacist)

Guidance from the RPSGB indicates that the voucher must be handled in the same way as
sales of [P] medicines; therefore the pharmacist must ensure that he/she carries out all
his/her professional responsibilities.

Handle the voucher in the same way that you would a prescription. Copies should be sent to
PCT for payment and to the surgery for patient’s notes.
Responsibility and accountability.
Pharmacists are accountable for the quality and standards of the services they provide within their
pharmacies. Clinical governance reinforces this accountability and reminds pharmacists that they are
just as accountable for the quality and standards of clinical advice given to patients and professionals
about treatment, policies and procedures as they are for the dispensing, sale and supply of
medicines (Medicines, ethics & Practice July 2008)
* The PCT reserves the right to pay one consultation fee per family for Head lice or Threadworm
treatment*
MAS
Pharmacy Stamp
Appendix D
Minor Ailments Reconciliation/Claim Form.
Medicines
Reimbursement
(Cost excluding VAT)
Aspirin 300mg soluble 32
Aciclovir 5% cream 2g
Adcortyl in Orabase
Aqueous Cream 500g
Anusol Suppositories 12
Anusol Ointment
Beclomethasone aq.spray
Bonjela teething gel
Benzoyl Peroxide 2.5% 40
Benzoyl Peroxide 5% 40g
Benzoyl Peroxide 10% 40g
Brochlor Eye Drops 0.5%
Calamine Lotion 200ml
Clotrimazole 500mg pess.
Clotrimazole 1% Crm 20g
Clotimazole 2% Crm
Chlorphenamine 4mg 30
Chlorphenamine 4mg/10ml
Derbac M liquid 50ml
Derbac M liquid 200ml
Dioralyte Sachets 6
Duofilm paint
*Fluconazole 150mg cap 1
FFybogel Sachets 10
Gaviscon Extra tablets
Hydrocortisone 1% cream
Ibuprofen 200mg tabs 24
IIbuprofen 100mg/5ml S/F
LLoperamide 2mg caps 10
LLyclear Crème Rinse 59ml
LLyclear Crème Rinse 2OP
LLactulose 500ml
LLoratidine 10mg tabs 30
Menthol & Eucalyptus 100
Mebendazole 100mg tabs2
Miconazole 2% & 15g
Hydrorocortisone1% Cream
Metanium Oint
Otex Ear drops
Paracetamol tabs 32
Paracet.500mg sol 12
Paracet 120mg/5ml 200ml
Paracet. 250mg/5ml 200ml
PPeptac/Acidex liquid 500ml
sPseudoephedrine
560mg/5ml elixir 100ml
Ranitidine 75mg tablets 6
Senna tablets 20
Simple Lintus pead
Sod.Chloride nose drops
Sod.Bicarbonate ear drops
Sod.Cromogligate 0.2%
eyedrops
Salactol Paint
Sudocrem 60g__________
Cost
per
Item
0.35
1.95
2.25
1.06
1.84
1.96
3.57
1.79
1.76
1.92
2.07
2.85
0.51
3.43
2.83
3.70
1.34
2.28
2.21
5.56
2.02
1.79
0.85*
1.29
1.62
2.33
0.71
1.89
0.99
2.38
4.32
2.66
1.95
0.70
1.17
2.73
No of
Items
Dispensed
Costs
Month claiming for: ________________________________
Signature of claimant: __________________Date: _______
Pharmacy Name & Address__________________________
___________________________________________
Preferred payment details __________________________
To be completed by NHS S.E. Essex
Are all vouchers enclosed?  Yes  No
£
Consultation Fees £4 x A
£
£
Total Amount to be
reimbursed
Verified by:…………………………….
Authorised CODE…………………………………
Signature …………………………………………
For audit purposes:
Athletes foot
Bites & Stings
Cold sores
Conjunctivitis
Constipation
Diarrhoea
Dry skin
Ear wax
Hay fever
Headache
Haemorrhoids
Head lice
Dyspepsia /heartburn
Infant teething
Mouth ulcers
2.01
4.25
0.37
1.85
0.89
1.13
£1.95
0.70
1.20
0.29
0.45
1.00
0.99
1.99
1.79
1.16
Cost of Items dispensed
(incl. VAT)
_________
_____-
TOTAL DRUG COSTS
TTOTAL DRUG COSTS+
VAT (17.5%)
Total number of consultations ________
Kemi Banjo, Prescribing & Community Pharmacy Development Pharmacist, 01702224651
MAS
Nappy Rash
Nasal congestion
Sore throat
Spots/Acne
Temperature
Threadworms
Vaginal thrush
Warts/Verrucae
Last updated September 2008
Appendix E
Minor Ailment Service Patient Survey
We would be very grateful for your view and comments about the minor ailment
scheme. Please complete the following questionnaire as fully as possible and return it
to the pharmacy, who will then send it on to the PCT.
Please note your response is anonymous and confidential and will have no affect on
your future treatment.
1. Please tell us what you think of the scheme (please tick )
Excellent
Very Good
Good
Not Very Good
Poor
2. What are the main aspects of the scheme that you liked?
I don’t have to wait and see a GP
I can treat myself sooner for a minor complaint
I can get medicine free without seeing the GP
The pharmacist will tell me if I need to see the GP
3. Were you intending to make an appointment with your GP before being
offered this service?
Yes
No
4. What do you not like about the scheme?
I can’t speak to the pharmacist in confidence
I am unsure if I have received the correct treatment
The pharmacist can’t examine me
I think this is the GPs job
Any other comments:
5. Would you use this scheme again the next time you have a minor ailment
that is covered by this scheme?
Yes
No
6. Would you recommend this scheme to someone else? Yes
If not, then why not?
MAS
No
Patient survey continued…………………….
7. Which one of these applies to you? (please tick)
The scheme saved me time
I was happy to be given advice on my condition by the pharmacist
I would be happy to go straight to the pharmacist to get some
medication without having to see the doctor first, for similar ailments
I would like this scheme to be permanent
I generally prefer to see the doctor when its about my children
8. How would you rate the quality of the service (in terms of was the pharmacist
Knowledgeable, consistent and were the relevant questions asked?)
Excellent
Very Good
Good
Not very Good
Poor
Please feel free to add any further comments, which have not been covered
by the questionnaire:
MAS