PRESTON PRIMARY CARE TRUST
Pharmacy First
A Minor Ailments Scheme through Community Pharmacists
Index
Page
Background
2
Service Specification
4
Appendix 1 Preston PCT GP Practices Contact Numbers
9
Appendix 2 Pharmacy First Formulary
10
Appendix 3 Circumstances in which Pharmacy First medicine should
not be supplied
11
Appendix 4 Pharmacy First: Consultation Form
13
Appendix 5 Pharmacist Rapid Referral Form
15
Appendix 6 Chorley & South Ribble PCT
GP practice contact numbers
17
Appendix 7 Pharmacies Participating in Scheme
18
Appendix 8 Pharmacy First Patient Passport & Information Leaflet 19
Appendix 9 Pharmacy First Consultation Decision Pathway
23
Appendix 10 Pharmacy First Minor Ailment Protocols
24
Appendix 11 Generic list of competencies for community pharmacies
involved in providing a minor ailment service
51
Appendix 12 Pharmacy First Locum Guide
54
Appendix 13 Pharmacy First Common Questions
56
Appendix 14 Pharmacy First Model Receptionist Protocol
57
Appendix 15 Clinical Governance Implications for pharmacies
providing a Minor Ailment Service
58
Appendix 16 List of publications for Patient Information Leaflets
59
1
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PRESTON PRIMARY CARE TRUST
Pharmacy First
A Minor Ailments Scheme through Community Pharmacists
Background
1.
Introduction
1.1
A significant amount of a GPs workload is spent dealing with minor ailments.
A ‘minor ailment’ means different things to different people. Some patients
need a formal GP appointment to be reassured that the symptoms are not
serious whilst many other patients require convenient and instant access to
suitable over the counter medicines. Several community pharmacy based
schemes around the country have allowed this to happen with great success
thereby relieving pressure on GP appointment times.
2.
Better Management of Minor Ailments
2.1
GPs spend a significant proportion of their working day dealing with minor
ailments. For some patients this is entirely appropriate, but for many others, it
is an inconvenient and inefficient way of getting help to look after themselves.
Many emergency appointments are taken up by people with minor ailments.
2.2
The aim of this scheme is to allow appropriate patients to be referred or to self
refer to their local community pharmacy. The community pharmacist will be
able to treat a number of specified minor conditions and supply medicines
from an agreed local formulary at NHS expense. No payment need be made if
the patient is exempt from prescription charges. Those patients who pay
prescription charges will be able to choose either to pay the prescription
charge due, or purchase the medication at the normal ‘over the counter’ price.
2.3
The minor ailments have been selected because of their prevalence, the
availability of pharmacy medicines for their treatment and the willingness of
GPs to see their management transferred to pharmacies.
2.4
The scheme was subjected to phased introduction across Preston PCT, which
commenced in those areas of Preston with high levels of deprivation.
2.5.
Moving minor ailment management into community pharmacy will relieve
pressure on the GP urgent appointment system. By directing patients with
minor illnesses to community pharmacies, GPs will potentially have more
consultation time available for patients with more serious or chronic
complaints. Relieving capacity and demand pressures will help with
recruitment and retention initiatives particularly in practices serving areas of
high deprivation. The scheme will also help to achieve and sustain improved
access to primary care by helping patients to be seen within 48 hours by a GP
or another primary health care professional.
2
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2.6
Implementation of the scheme will support the delivery of the NHS plan
specifically in relation to reshaping care around patients and making better use
of the skills of pharmacists. Widening the availability of medicines over the
counter was also identified as a modernisation initiative in the document
published by the Department of Health ‘Pharmacy in the Future.’
There are many benefits for patients;




Waiting times are reduced
Access to advice is improved
There is an alternative to a GP consultation
No anxiety about 'bothering the doctor'
For the Practice and the PCT
 Inappropriate consultations are reduced
 More time for tasks that really need medical input
 It will be easier to achieve access targets
For the Pharmacist
 Opportunity to work more closely with the primary healthcare team
 Making better use of professional skills
3.
Outline Implementation
3.1
A minor ailments scheme known as “Pharmacy First” has been introduced
across the whole of Preston PCT.
3.2
It has been introduced in three phases;
 All community pharmacies in Preston PCT have participated in the scheme
since the launch of phase 1 in March 2004.
 All participating pharmacies undertook an accredited training course prior
to the launch of phase 1.
 Pharmacists will work within written protocols for each specified minor
ailment. These protocols will have been developed and approved by the
PCT Medicines Management Sub Committee.
 Patients managed within these protocols will be given advice and may be
supplied with the designated medication identified. Some patients may
require referral.
 Patients registered with the GP practices identified in appendix 1 are
eligible to participate in the scheme.
3
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Pharmacy First
Service Specification
1
Introduction
1.1
Patients wishing to use the service must be registered with a participating GP
surgery. See appendix 1.
1.2
The service can only be provided for patients registered with a participating
GP surgery and presenting with symptoms of a minor ailment listed in
appendix 2.
1.3
Only the products listed against the specific minor ailment as indicated in
appendix 2 can be provided as part of the scheme. The licensed medicines
available within the scheme must not be supplied out with the licensed
indication for the medicine.
1.4
Eligible patients will only be provided with medicines to manage the minor
ailment if, in the professional opinion of the pharmacist, the medicine required
is not contraindicated and that the treatment provided is in accordance with the
minor ailment protocol.
1.5
Only pharmacies accredited by Preston Primary Care Trust will be included in
the scheme. See appendix 7.
1.6
Patients under the care of GP practices as identified in appendix 1 will register
onto the scheme when they visit an accredited pharmacy as a result of
symptoms associated with one of the minor ailments listed in appendix 2. The
patient will be encouraged to use the pharmacy that normally dispenses their
prescriptions. Once registered the patient should normally use that same
pharmacy for further consultations arising from symptoms associated with one
of the minor ailments listed in appendix 2. See 1.12 for arrangements
pertaining to patients registered with GP practices in Chorley & South Ribble
PCT.
1.7
Registration will take the form of the provision by the pharmacy of a
Pharmacy First Passport (appendix 8) completed with details of the patient,
condition treated and medication supplied under the scheme.
1.8
Patients are required to present the Pharmacy First Passport at all subsequent
pharmacy consultations under the scheme. Ideally this should be at the
pharmacy that originally issued the Pharmacy First Passport. However
presentation of the passport in association with a minor ailment consultation at
another participation pharmacy in Preston PCT is acceptable.
4
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1.9
The top copy of the consultation form (Appendix 4) will be sent to the PCT
for audit and reimbursement. The second copy should be retained at the
premises of the pharmacy for at least two years.
1.10
A copy of the patient consultation form (appendix 4) may be faxed to the
patient’s GP for information if so requested by the GP.
1.11
Patients are at liberty to decline to participate in the scheme.
1.12
Patients registered with GP practices in Chorley & South Ribble PCT
(Appendix 6) may receive treatment for the conditions and with the medicines
listed under the Preston scheme following a consultation in a pharmacy
within Preston PCT. Documentation and reimbursement requirements are
identical to that of all other patients managed under the Preston PCT scheme.
2.
Referral into scheme and registration
2.1
Patients presenting at a participating GP surgery or the primary care GP
deputising service with one of the minor ailments listed in appendix 2 may be
advised of the scheme and how to access it through their local pharmacy.
Surgeries should note that patients who are not exempt from prescription
charges will be required to pay for any medication supplied.
2.2
Patients presenting at a pharmacy by self-referral.
2.3
Pharmacists will only accept a patient into the scheme providing they can
establish that the patient is registered with a participating GP practice. This
can be achieved by:
 Evidence produced by the patient of registration with a participating
GP practice e.g. repeat prescription tear-off slip.
 Pharmacy PMR record showing evidence of a prescription dispensed
in the last 6 months.
2.4
Once it has been established that the patient is included on the list of a
participating GP practice, the patient must register with the pharmacy in order
to participate in the scheme and be provided with a Pharmacy First Passport.
The patient is required to sign the consultation form (appendix 4) following
every pharmacy consultation.
2.5
If a patient or pharmacist cannot confirm registration with a participating GP
practice, the patient cannot access the scheme at that time. The patient should
be advised of alternative methods of accessing care.
5
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3.
Key points for participating pharmacies
3.1
Core competencies and Clinical Governance issues required of community
pharmacists participating in a minor ailments scheme are identified in
appendices 11 and 15
3.2
Once confirmation of patient registration with a participating GP practice has
been established, the Pharmacist or suitably trained member of the pharmacy
staff should then carry out a professional consultation with reference to the
appropriate minor ailment protocol (appendix 10) which should involve:




Patient assessment
Provision of advice
Supply of appropriate medication from the agreed formulary
Provision of Pharmacy First Passport on initial registration and
a replacement when the original passport record section is full. All
fully completed passports should be sent to the PCT at month end
along with completed consultation forms.
 Completion of ‘Pharmacy First’ consultation form. See appendix 4.
3.3
The patient must sign the consultation form if he/she wishes treatment within
the scope of the scheme. This should occur each time the patient accesses the
scheme.
3.4
The top copy of each consultation form will be sent to the PCT for audit and
reimbursement at month end.
3.5
The second copy of the consultation form will be retained at the premises of
the pharmacy for at least two years.
3.6
A copy of the consultation form may also be sent to the GP for information if
so requested.
3.7
The pharmacist should ensure that the patient is eligible for treatment within
the scope of the scheme.
3.8
The pharmacist must ensure that the appropriate medication from the
formulary (appendix 2) is supplied and that the patient is advised how to
take/use the medication and is provided with a PIL if appropriate.
3.9
The pharmacist should ensure the patient has completed and signed the
declaration of exemption of prescription charges on the back of the ‘Pharmacy
First’ consultation form (appendix 4).
3.10
Patients who present with a minor ailment outside the scope of the scheme or
for whom the listed formulary product/s is/are not appropriate or contraindicated, should be advised of alternative methods of accessing care (e.g.
OTC sale, routine GP appointment)
6
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3.11
If the patient presents with symptoms causing serious concern to the
pharmacist e.g. symptoms of meningitis, the pharmacist must use the rapid
referral form (Appendix 5) which allows patients to see their GP as soon as
possible.
3.12
Only the medicines listed in appendix 2 in the quantities stated can be issued
to an eligible patient following a consultation. Further supplies of this
medication following a subsequent professional consultation should only be
supplied if, in the opinion of the pharmacist, it is considered appropriate. A
patient presenting at the pharmacy more than twice over a short period of time
with the same minor ailment symptoms should not normally be considered for
further provision of treatment under the scheme.
3.13
If a pharmacist has any doubt over the appropriateness of the supply of a
‘Pharmacy First’ formulary medication (see appendix 3) then supply should be
withheld. The pharmacist must use their professional judgement to decide
whether rapid referral of the patient to a GP is appropriate or advise the patient
to see their GP in a normal way. Routine referral should occur if a patient
repeatedly presents with the same condition or the pharmacist suspects the
patient is abusing the system.
3.14
The pharmacist should endeavour to keep the consultation process as
confidential as possible and as such a private consultation area would be
desirable to achieve this.
3.15
The pharmacy consultation decision pathway is outlined in appendix 9.
3.16
Additional support provided for pharmacists and their staff can be found in
appendix 12 –(Locum Guide) and appendix 13 – (Common Questions)
4.
Key points for participating Surgeries
4.1
All patients requesting GP consultation for symptoms in keeping with one of
the minor ailments listed in appendix 2 should be considered for inclusion and,
if appropriate, directed as to how to access the scheme and provided with an
information leaflet (appendix 16).
4.2
Patients presenting in person to the GP surgery should be provided with the
patient information leaflet stamped by the practice and advised to use the
pharmacy where they normally obtain their prescriptions. Patients resident in
Chorley & South Ribble PCT but registered with a Preston PCT GP practice
may normally have their prescriptions dispensed at a pharmacy in Chorley &
South Ribble PCT. They should use that pharmacy to access treatment under
the minor ailments scheme operational across Chorley & South Ribble PCT.
4.3
Surgeries should liase with pharmacists to allow the rapid referral procedure
from the pharmacy to the GP to operate effectively (appendix 5).
4.4
GP surgeries should endeavour to advertise the scheme using posters and
leaflets provided by Preston PCT.
7
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4.5
If GP surgeries request a copy of the pharmacy consultation form they should
record the medication supplied by the pharmacist on the GP electronic patient
record or in the patient notes stating the name of the pharmacy providing the
service.
4.6
Practices may find the model Receptionist Protocol (appendix 14) helpful in
supporting the scheme.
5.
5.1
Service funding
The Pharmacy payment structure paid by the Preston PCT will consist of:
 Consultation fee £3.00
 Medication cost based on the drug tariff price or Chemist and Druggist
cost price plus VAT (currently 17.5%).
6.
Claims for payments
6.1
Claims for payment should be made by the 5th working day of the following
month by submission to the PCT of the top copy of each consultation form.
Late submission may delay payments. The monthly claim summary form
introduced at the launch of the scheme is no longer required although
pharmacies may wish to complete this form for their own internal records.
6.2
The pharmacy should retain the second copy of the ‘Pharmacy First’
consultation form at the pharmacy premises for at least two years and as such
should allow Preston PCT access to these documents as and when required.
Breach of this may result in termination of the service.
6.3
Payments will be made at the end of the 2nd month following that to which
the payment relates and can be identified from the pharmacy contractors PPA
statement.
6.4
Incomplete consultation forms will be deemed invalid and as such will be
returned to the contractor for resubmission, which will delay payments.
6.5
Where a formulary item supplied is not done so in accordance with the minor
ailments protocols, no reimbursement for the formulary item supplied will
occur and no consultation fee will be paid.
7.
Termination of service
7.1
The pharmacy contractor or Preston PCT may terminate this agreement by
providing written notice of their intention to do so. A period of 28 days should
be
given
as
notice.
8
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Appendix 1
PRESTON PCT MINOR AILMENTS SCHEME - GP'S ADDRESSES
GP
Practice Manager
Telephone
Fax
Address 1
Address 2
Postcode
Baroudi G
Chakrabarti HP
Chesworth RJH & Ptnrs
Conway HP
Craig M & Partners
Das BT
Fletcher DJ & Ptnrs
Forrester & Partners
Ghori SS
Hann JC & Partners
Jandu MS & Partners
Jha JN
Khan QO & Partners
Kumar B
Mawson AC & Partners
Naik RK
Nath K
O'Donnell EI & Ptnrs
Patel DC & Partners
Pavey K & Partners
Pritchett AHJ & Ptnrs
Robb GA & Partners
Rossall CJ
Shahid SZ
Shaw S
Singh B
Singh H & Partners
Smith EM & Partners
Thanda KM
Webster M
Pat Baroudi
Pam Allen
Harry Williamson
Louise Fowler
Sangeeta Chikhalikar
Karen Baron
Alison Ashworth
Helen Stammers
Margaret Ghori
Ann Fadden
Cathy Jandu
Asha Jha
Glenda Sandham
Val Wiles
Pam Grogan
Carol Molyneux
Louise Fowler
Louise Fowler
Anne Fairclough
Lynda Williams
Gill Fraser
Joanne Nicholas
Rossall CJ
Patricia Bracken
Kath Wild
Sharon Riley
Wendy Sutton
Gwen Davy
Kath Wild
Jane Mills
01772 792864
01772 884308
01772 716033
01772 726389
01772 723222
01772 726588
01772 792512
01772 783021
01772 729756
01772 258474
01772 726186
01772 254546
01772 252414
01772 252409
01772 655533
01772 863033
01772 726169
01772 726500
01772 717261
01772 783271
01772 401730
01772 253554
01772 655599
01772 555733
01772 401760
01772 821069
01772 254484
01772 252077
01772 401931
01772 254173
01772 705251
01772 887735
01772 715445
01772 768138
01772 726619
01772 726613
01772 693521
01772 785809
01772 760862
01772 884200
01772 768823
01772 254984
01772 254101
01772 885509
01772 653414
01772 865492
01772 768138
01772 768138
01772 769733
01772 782836
01772 401731
01772 256679
01772 909080
01772 885406
01772 401950
01772 556778
01772 881835
01772 885451
01772 886567
01772 563669
Ribble Village Surgery
110 Deepdale Rd
Lytham Road Surgery
Ashton Health Centre
Docland Medical Centre
34-35 Ashton St
Ribbleton Medical Centre
Berry Lane Medical Centre
104 Woodplumpton Rd
Park View Surgery
Briarwood Medical Centre
310 St George's Rd
57 – 59 Meadow St
St Paul's Surgery
The Health Care Centre
The Surgery
Ashton Health Centre
The Park Medical Practice
Broadway Surgery
Stonebridge Surgery
The New Hall Lane Practice
The Surgery
The Health Centre
228-232 Deepdale Rd
The Geoffrey St Surgery
98 Deepdale Rd
Fishergate Hill Surgery
Moor Park Surgery
Avenham Lane Practice
49 Frenchwood Ave
200 Miller Road, Preston
Preston
2a Lytham Road, Fulwood,Preston
Pedders Lane, Ashton, Preston
Blanche Street, Preston
Preston
243 Ribbleton Avenue, Preston
Berry Lane, Longridge, Preston
Fulwood, Preston
23 Ribblesdale Place, Preston
514 Blackpool Rd, Ashton, Preston
Deepdale, Preston
Preston
36-38 East St, Preston
Flintoff Way, Preston
17-19 Beech Drive, Fulwood
Pedders Lane, Ashton, Preston
Peddars Lane, Ashton, Preston
2 Broadway, Fulwood, Preston
Preston Road, Longridge, Preston
Geoffrey Street Health Centre Geoffrey St, Preston
63-65 Garstang Rd, Preston
Flintoff Way, Preston
Deepdale, Preston
Geoffrey Street Health Centre Geoffrey St, Preston
Deepdale, Preston
50 Fishergate Hill, Preston
49 Garstang Road, Preston
Avenham Lane H C, Avenham Lane, Preston
Frenchwood,Preston
PR2 6NH
PR1 5AR
PR2 8JE
PR2 1HR
PR2 2RL
PR2 2PP
PR2 6RD
PR3 3JT
PR2 2LR
PR1 3NA
PR2 1HY
PR1 6NR
PR1 1TS
PR1 1UU
PR1 5AF
PR2 3NB
PR2 1HR
PR2 1HR
PR2 9TH
PR3 3AP
PR1 5NE
PR1 1LB
PR1 5AF
PR1 6QB
PR1 5NE
PR1 5AR
PR1 8DN
PR1 1LB
PR1 3RG
PR1 4ND
Preston Primary Care
Centre
Jim Braithwaite
01772 788058
01772 713016
Royal Preston Hospital
Sharoe Green Lane, Fulwood, Preston
PR2 9HT
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9
Appendix 2
Pharmacy First – Formulary
MINOR
AILMENT
Athletes foot
Constipation
Cold sores
Cough, cold and Flu like
symptoms including
Fever
Cystitis
Diarrhoea
Earache
Eczema
Hay fever (Allergic
Rhinitis)
Headache
Head Lice
Indigestion
Mouth ulcers
Nappy rash
Scabies
Sore Throat
Teething
Threadworm
Oral thrush
Vaginal thrush
Verrucas
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MEDICINE
Clotrimazole cream 20g, Miconazole Cream 30g
Ispaghula Sachets (10), Lactulose Soln. (300mL), Senna Tabs (20)
Aciclovir 5% Cream 2g,
Ibuprofen 200mg Tabs (24), Paracetamol 500mg Tabs (32)
Ibuprofen Suspension 100mg/5mL (100mL)
Paracetamol Suspension 120mg/5mL (100mL/200mL)
Paracetamol Suspension 250mg/5mL (100mL), Menthol and
Eucalyptus Inhalation (100mL), Pholcodine Linctus adult (200mL)
and paediatric (90/100mL), Pseudoephedrine Linctus (100mL) or
Tabs (24)
Xylometazoline adult and paediatric Nasal Drops (10mL), Normal
Saline Nose Drops (10mL).
Potassium Citrate Mixture (200mL), Paracetamol 500mgTabs (32)
Dioralyte (6 Sachets)
Ibuprofen 200mg Tabs (24), Paracetamol 500mg Tabs (32)
Ibuprofen Suspension 100mg/5mL (100mL)
Paracetamol Suspension 120mg/5mL (100mL/200mL)
Paracetamol suspension 250mg/5mL (100mL) Pseudoephedrine
Linctus (100mL) or Tabs (24)
Emulsifying Ointment (500g), Aqueous Cream (500g),
Hydrocortisone Cream 1% (15g)
Chlorphenamine 4mg Tablets (30), Chlorphenamine 2mg/5mL Syrup
(150mL), Sodium Cromoglycate 2% Eye Drops (10mL), Cetirizine
10mg Tablets (30). Cetirizine Oral Soln 5mg/5mL (150mL)
Ibuprofen 200mg Tabs (24), Paracetamol 500mg Tabs(32)
Ibuprofen Suspension 100mg/5mL (100mL)
Paracetamol Suspension 120mg/5mL (100mL/200mL)
Paracetamol Suspension 250mg/5mL (100mL)
Phenothrin 0.2% Lotion (50mL x 1 or 2 bottles)
Malathion 0.5% Aqueous Liquid or Lotion (50mL x 1 or 2 bottles)
Gaviscon Liquid (150mL)
Hydrocortisone Lozenges (20)
Bonjela Gel (15g)
Sudocrem Cream (60g)
Permethrin Dermal Cream (30g), Malathion 0.5% Aqueous Liquid
(50mL), Chlorphenamine 4mg Tablets (30), Chlorphenamine
2mg/5mL Syrup (150mL), Cetirizine 10mg Tablets (7). Cetirizine
Oral Soln 5mg/5mL (75mL)
AAA Spray (60 sprays), Difflam Spray (30mL), Ibuprofen 200mg
Tabs (24), Paracetamol 500mg Tabs (32)
Ibuprofen Suspension 100mg/5mL (100mL)
Paracetamol Suspension 120mg/5mL (100mL/200mL)
Paracetamol Suspension 250mg/5mL (100mL)
Aspirin Sol Tabs 300mg (24)
Bonjela Gel (15g)
Mebendazole 100mg Tabs (1) x 2
Miconazole Oral Gel (15g)
Clotrimazole 500mg Pessary (1), or 1% Cream (20g) or
Clotrimazole Combi Pack (1)
Cuplex Gel 5g
10
Appendix 3
Circumstances in which a Pharmacy First medicine should not be supplied

Patients presents with symptoms not indicative of any of the minor ailments included in the
scheme.

Patient or parent cannot demonstrate that the patient is on the list of a participating
GP practice.(PMRs, repeat prescription tear off slip, Pharmacy First Passport)

The patient normally pays a prescription charge. (these patients whilst not excluded from the
scheme, may choose to purchase OTC medicines rather than pay the prescription charge for a
medicine supplied under the Pharmacy First scheme)

Patient or parent unwilling to complete Pharmacy First documentation

Pharmacy First medicine is contraindicated

Recent supply of the Pharmacy First medicine

Lost medicine

Patient or parent unwilling to accept medication or quantity of medication available
from within the Pharmacy First Formulary

Medicine requested ‘just in case’

Medicine requested to take abroad

Medicine requested in lieu of uncollected repeat prescription

Medicine requested to stock up medicine cabinet
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11
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12
Preston Primary Care Trust
Pharmacy First: Consultation Form
Date of Consultation……………………………..
Date of Birth………………………………………
GP Practice* (Senior Partner Name)
……………………………………………………..
*Specify PCT if not Preston……………………………..
1. Patient Details.
Patient Name…………………………………………….……
Patient address……………………………………………….
…..………………………………………………………………
…….…………………………………….………………………
2. Referral Method
 GP Surgery.
 Pharmacist
 Patient self referral
 Out of Hours
 Other
3. Minor Ailment






Athletes Foot
Constipation
Cold Sores
Cough,Cold, Flu–like symptoms, Fever
Cystitis (in women)






Diarrhoea
Earache
Eczema
Hay Fever (Allergic Rhinitis)
Headache






Head Lice
Indigestion
Mouth Ulcers
Nappy Rash
Oral Thrush






Scabies
Sore Throat
Teething
Threadworm
Vaginal Thrush
Verrucas
4. Formulary Item Supplied



























AAA Spray x1
Aciclovir 5% cream (2g)
Aqueous cream (500g)
Aspirin Sol tabs 300mg (32)
Bonjela gel (15g)
Cetirizine 10mg tabs (30)
Cetirizine oral solution 5mg/5ml (150ml)
Chlorphenamine 2mg/5mL syrup (150mL)
Chlorphenamine 4mg tabs (30)
Clotrimazole 500mg pessary x 1
Clotrimazole combi pack x 1
Clotrimazole cream 20g
Cuplex gel 5g
Difflam spray (30mL)
Dioralyte sachets (6 sachets)
Emulsifying ointment (500g)
Gaviscon liquid (150mL)
Hydrocortisone cream 1% (15g)
Hydrocortisone lozenges (20)
Ibuprofen 200mg tabs (24)
Ibuprofen suspension 100mg/5mL (100mL)
Ispaghula sachets (10)
Lactulose soln (300mL)



























Malathion 0.5% Aqueous liquid(50mL)
Malathion 0.5% lotion (50mL)
Mebendazole 100mg tabs (1)x2
Menthol and Eucalyptus inhalation (100mL)
Miconazole cream (30g)
Miconazole oral gel (15g)
Normal saline nose drops (10mL)
Paracetamol 500mg tabs (32)
Paracetamol suspension 120mg/5mL (100mL)
Paracetamol suspension 120mg/5mL (200mL)
Paracetamol suspension 250mg/5mL (100mL)
Permethrin dermal cream (30g)
Phenothrin 0.5% liquid (50ml)
Phenothrin 0.2% lotion (50mL)
Pholcodine linctus adult (200mL)
Pholcodine Paediatric linctus (90/100mL)
Potassium citrate mixture (200mL)
Pseudoephedrine linctus (100mL)
Pseudoephedrine tablets 60mg (24)
Senna tabs (20)
Sodium cromoglycate 2% eye drops (10mL)
Sudocrem cream (60g)
Xylometolazone adult nasal drops (10mL)
Xylometolazone paediatric nasal drops (10mL)
Pharmacist Signature………………………….
Pharmacy Stamp
Date…………
Please ensure exemption declaration overleaf is signed
D:\116104921.doc
13
DECLARATION OF EXEMPTION
To be completed by the patient or the patient’s representative.
The patient doesn’t have to pay because he/she:












A
B
C
D
E
F
G
L
H
K
M
N
is under 16 years of age
Pharmacy use only
is 16, 17 or 18 and in full-time education
is 60 years of age or over
has a current maternity exemption certificate
has a current medical exemption certificate
Evidence not seen
has a current prescription pre-payment certificate
has a War Pension exemption certificate
is named on a current HC2 charges certificate
*gets Income Support
*gets Income-based Jobseeker’s Allowance
*is named on a Working Families’ Tax Credit NHS Exemption Certificate
*is named on a Disabled Person’s Tax Credit NHS Exemption Certificate
*Name:
Date of birth:
NI no:
* for boxes H, K, M and N. print the name of the person getting benefit or Credit. This may be you or
your partner. Checks may be made with the Department for Work and Pensions (previously DSS) or
the Inland Revenue.
 I am the patient.
 I am the patient’s representative
Declaration: I declare that the information I have given is correct and understand that if it is not, action
may be taken against me. For the purposes of audit and for verifying entitlement to exemption from
prescription charges (where appropriate) I consent to the disclosure of relevant information about
myself/the patient, including to and by the Inland Revenue and the local Primary Care Trust. I
understand that this information may be communicated to my GP or healthcare professionals directly
involved in my care. I have been counselled on the use of the medicine supplied and understand the
advice given by the pharmacist.
To the Patient – Please complete either declaration (1) or (2) below:1.
I have received the above medicine(s) indicated on this form and am exempt from charges for
the reason specified above.
Signed (Patient)…………………………………Date………………………………..
2.
I have received the above medicine(s) indicated on this form, I am not exempt from
prescriptions charges and I have paid £…………….
Signed (Patient)………………………………….Date……………………………….
Print name and address (if different from overleaf):
………………………………………………………………………………………….
………………………………………………………………………………………….
…………………………………………………….Postcode…………………………..
IMPORTANT – Your Pharmacist is providing treatment and/or advice under the Minor Ailments Scheme
in line with the symptoms you have described. If your symptoms persist you should seek further advice
from your doctor. Use the information given in your ‘Pharmacy First’ passport provided by the pharmacist
to advise your doctor which pharmacy you have attended and what advice and treatment you have already
received.
D:\116104921.doc
14
Appendix 5.
Care in the Pharmacy
Pharmacy First
Minor Ailments Scheme
Pharmacist Rapid Referral form
Patient Name:
Patient Address:
GP Name:
Please make an appointment ASAP for this patient.
Comments:
Pharmacists Name, Address and Telephone Number:
Date and Time:
Please Fax this form to GP surgery or give to the patient to take to surgery.
D:\116104921.doc
15
D:\116104921.doc
16
Appendix 6
CHORLEY AND SOUTH RIBBLE PCT MINOR AILMENTS SCHEME – GP’S ADRESSES
PRACTICE
SURGERY NAME
STREET
REGION
POSTCODE
PRACTICE MANAGER
TELEPHONE
No
FAX No
DR A B PHILLIPS & PARTNERS
RIVERSIDE MEDICAL CENTRE
194 VICTORIA ROAD
WALTON LE DALE
PR5 4AY
JAYNE SAYNER
01772 556703 01772 880861
DR A K TANDON
THE BEECHES MEDICAL CENTRE
LIVERPOOL ROAD
LONGTON
PR4 5AB
BARRBARA NORRIS
01772 613123 01772 616311
DR A SERVICE & PARTERS
WHITTLE SURGERY
199 PRESTON ROAD
WHITTLE LE WOODS PR6 7PS
SALLY COOKE
01257 262383 01257 261019
DR D R BALL & PARTNERS
ROSLEA SURGERY
51 STATION ROAD
BAMBER BRIDGE
PR5 6PE
MARGARET/VAL CALLAGHAN
01772 335128 01772 492248
DR D W YOUNG & PARTNERS
THE RYAN MEDICAL CENTRE
St MARY'S ROAD
BAMBER BRIDGE
PR5 6TE
JULIE HOWARTH
01772 335136 01772 626701
DR E M H DAWOUD & PARTNER 652 PRESTON ROAD
CLAYTON LE WOODS
CHORLEY
PR6 7EH
LORRAINE PARKINSON
01772 323021 01772 620078
DR G G K WIJETHILEKE
MEDICARE UNIT
1 CROSTON ROAD
LOSTOCK HALL
PR5 5RS
JANET GALLAGHER
01772 330724 01772 620160
DR G W AHAD
STATION SURGERY
8 GOLDEN HILL LANE
LEYLAND
PR25 3NP
CAROL DONNAN
01772 622505 01772 457718
DR H D SULE & PARTNER
MOSS SIDE MEDICAL CENTRE
16 MOSS SIDE WAY
LEYLAND
PR26 7XL
JANET McGRATH
01772 623954 01772 622897
DR I H JONES
THE HEALTH CENTRE
COLLISON AVENUE
CHORLEY
PR7 2TH
JAYNE PRESTON
01257 268955 01257 241870
DR J PARKER & PARTNERS
WORDEN MEDICAL CENTRE
WEST PADDOCK
LEYLAND
PR25 1HW
TRACY WILLIAMS
01772 423555 01772 623878
DR K BROWN & PARTNERS
ACRESWOOD SURGERY
5 ACRESWOOD CLOSE
COPPULL
PR7 5EJ
LYNDA KEELEY
01257 793578 01257 794005
DR K K GARG & PARTNER
CROSTON MEDICAL CENTRE
30 BROOKFIELD
CROSTON
PR26 9HY
GLENNYS PARR
01772 600081 01772 601612
DR K MASHAYEKHY
VILLAGE SURGERY
WILLIAM STREET
LOSTOCK HALL
PR5 5RZ
BEVERLEY MASHAYEKHY
01772 697666 01772 697888
DR K PATEL & PARTNERS
CENTRAL PARK SURGERY
BALFOUR STREET
LEYLAND
PR25 2TD
ANNE-MARIE MILLER
01772 623110 01772 623885
DR LYONS & PARTNER
THE HEALTH CENTRE
COLLISON AVENUE
CHORLEY
PR7 2TH
JACCI ROWLEY
01772 644186 01257 232285
DR M FRANCE & PARTNERS
WITHNELL HEALTH CENTRE
RAILWAY ROAD
WITHNELL
PR6 8UA
MARYLIN CLOWES
01254 830311 01254 832337
DR M S J GALE & PARTNER
THE HEALTH CENTRE
COLLISON AVENUE
CHORLEY
PR7 2TH
PAT STRINGER
01257 262104 01257 232285
DR N S McCRAITH & PARTNERS St MARY'S HEALTH CENTRE
COP LANE
PENWORTHAM
PR1 0SR
GWEN ADAMS
01772 744404 01772 752967
DR O A ELHALHULI
22-24 BABYLON LANE
ADLINGTON
PR6 9NW
JUNE FERNANDE
01257 482076 01257 474770
DR P A MUMFORD & PARTNERS GRANVILLE HOUSE MEDICAL CENTRE GRANVILLE STREET
ADLINGTON
PR6 9PY
LINDA KERSHAW
01257 481966 01257 474655
DR P BAMFORD & PARTNER
THE HEALTH CENTRE
COLLISON AVENUE
CHORLEY
PR7 2TH
SUSAN HARTLEY
01772 644184 01257 235585
DR P R CURTIS & PARTNERS
SANDY LANE SURGERY
SANDY LANE
LEYLAND
PR25 2EB
CHRISTINE KERBER
01772 909917 01772 909911
DR Q AHMAD
CROSTON VILLAGE SURGERY
OUT LANE
CROSTON
PR26 9HJ
DIANA HEATON
01772 600722 01772 600448
DR R A EVISON & PARTNERS
REGENT HOUSE SURGERY
21 REGENT ROAD
CHORLEY
PR7 2DH
SUE JEZZARD
01257 264842 01257 231387
DR R DASGUPTA & PARTNER
KINGSFOLD MEDICAL CENTRE
WOODCROFT CLOSE
PENWORTHAM
PR1 9BX
WENDY BATE
01772 746492 01772 909141
DR R J C BENNETT & PARTNER THE SURGERY
20 DOCTORS LANE
ECCLESTON
PR7 5RA
01257 451221 01257 450911
DR R K PRASAD & PARTNER
LOSTOCK HALL MEDICAL CENTRE
410 LEYLAND ROAD
LOSTOCK HALL
PR5 5SA
ANNE SINGLETON
PAT COOK PRACTICE ADMINISTRATOR
DR S D MOSS & PARTNERS
LONGTON HEALTH CENTRE
LIVERPOOL ROAD
LONGTON
PR4 5HA
KATH SWAIN
01772 615429 01772 611094
DR S E LEWIS & PARTNER
VILLAGE SURGERY
2 CHURCHSIDE
NEW LONGTON
PR4 4LU
KAREN RIMMER
01772 613804 01772 617812
DR S N HILTON & PARTNER
CUNLIFFE MEDICAL CENTRE
41 CUNLIFFE STREET
CHORLEY
PR7 2BA
SHIELA ECKERSLEY
01257 267127 01257 234665
DR S R LORD & PARTNER
EUXTON MEDICAL CENTRE
St MARY'S GATE
EUXTON
PR7 6AH
CHRISTINE MEREDITH
01257 267402 01257 271501
DR T LEELAKUMARI
STATION SURGERY
ADLINGTON MEDICAL CENTRE
01772 518080 01772 518086
8 GOLDEN HILL LANE
LEYLAND
PR25 3NP
GLENNYS PARR
01772 622808 Fax not working at present
DR T P O'CONNOR & PARTNERS St FILLIANS MEDICAL CENTRE
2 LIVERPOOL ROAD
PENWORTHAM
PR1 0AD
LESLEY DICKINSON
01772 745427 01772 752562
DR THORNLEY PCT LOCUM
EAVES LANE SURGERY
311 EAVES LANE
CHORLEY
PR6 0DR
GILLIE BUCK
01257 272904 01257 266821
DR V K KHANNA & PARTNER
CLAYTON BROOK SURGERY
62 TUNLEY HOLME
BAMBER BRIDGE
PR5 8ES
JANICE FISHWICK
01772 313950 01772 620467
DR W R ALMOND & PARTNERS
LIBRARY HOUSE SURGERY
AVONDALE ROAD
CHORLEY
PR7 2AD
JENNY PARRY
01257 262081 01257 232114
D:\116104921.doc
17
Appendix 7
Pharmacy Name
Alliance Pharmacy.
Alliance Pharmacy.
Asda Pharmacy
Ashton Pharmacy
Avenham Pharmacy.
Boots The Chemist
Boots The Chemist
Boots The Chemist
Broadway Pharmacy
D.D.L Davies
Frenchwood Pharmacy
Gamull Pharmacy
Goosnargh Pharmacy
Ingol Pharmacy
Kadri Pharmacy
Knights Pharmacy
Lloyds Pharmacy
Lloyds Pharmacy
Lloyds Pharmacy
Lloyds Pharmacy
Lloyds Pharmacy
Lloyds Pharmacy Ltd
Lloyds Pharmacy Ltd
Lloyds Pharmacy Ltd
Moor Park Pharmacy
Morrisons Pharmacy
Pomfrets Chemist
Ribbleton Pharmacy
Rowland’s Pharmacy
Sainsburys Pharmacy
Sharoe Green Pharmacy
Smithson’s Pharmacy
Stonebridge Pharmacy
Superdrug Pharmacy
D:\116104921.doc
Preston PCT Pharmacies Participating in the Pharmacy First Scheme
Address
Unit 5, Kwik Save Development, Ribble Village Local Centre, 198 Miller Rd, PR2 6NH
76, Pedders Lane, Ashton, Preston, PR2 1HN
Asda Superstore, Eastway, Fulwood, Preston, PR2 5SP
33 Ashton Street, Preston, PR2 2PP
42, Avenham Lane, Preston, PR1 3TS
Unit C2, Deepdale Retail Park, Blackpool Rd, Preston, PR1 6QY
10 - 13 Fishergate, Preston, PR1 3QA
440 Blackpool Road, Ashton on Ribble, Preston, PR2 2LP
331 Garstang Road, Preston, PR2 4UP
59-61 Plungington Road, Preston, PR1 7EN
1 Ruskin Street,Preston, PR1 4NA
Ribbleton Medical Centre, 245 Ribbleton Avenue, Preston, PR2 6RD
6, Church Lane, Goosnargh, PR3 2BE
86, Village Green Lane, Ingol, Preston, PR2 7DS
87-89 Meadow Street, Preston, PR1 1TS
14 Elswick Road, Larches Estates, Ashton Preston, PR2 1NT
112 Deepdale Road, Preston, PR1 5AR
3,Lytham Road, Fulwood, Preston, PR2 2JE
258, New Hall Lane, Preston, PR1 4ST
Geoffrey Street Health Centre, Geoffrey Street, Preston, PR1 5NE
234-236 Deepdale Road, Preston, PR1 6QB
40 Berry Lane, Longridge, Longridge, Preston, PR3 3JJ
78-80 Lancaster Road, Fulwood, Preston, PR1 1DD
Longsands Lane, Preston, PR2 9PS
32, Garstang Road, Preston, PR1 1NA
Wm Morrison Supermarket, Mariners Way, Ashton on Ribble, Preston, PR2 2YN.
22 Lancaster Road, Preston, PR1 1DA
182 Ribbleton Avenue, Ribbleton, Preston, PR2 6QN
Blanche Street, Preston, PR2 2RC
Sainsburys Store, Flintoff Way, Off Deepdale Road, Preston, PR1 6PJ
Unit 9, Booths Shopping Complex, Sharoe Green Lane, Fulwood, Preston, PR2 9HD
51 Fishergate Hill, Preston, PR1 8DN
Units 2&3, Stonebridge Pde, Preston Rd, Longridge, Preston, PR3 3AN
43 Friargate, St.Georges's Centre, Preston, PR1 2NQ
Telephone
01772 654139
01772 726149
01772 703174
01772 726383
01772 259915
01772 792265
01772 254517
01772 726602
01772 717574
01772 556030
01772 491185
01772 796142
01772 865238
01772 726955
01772 823751
01772 728111
01772 254937
01772 718022
01772 493257
01772 493224
01772 493234
01772 782643
01772 250486
01772 653031
01772 555150
01772 732925
01772 252468
01772 796131
01772 721893
01772 651374
01772 712244
01772 252033
01772 784700
01772 253752
Fax
01772 654139
01772 726149
01772 703174
01772 426383
01772 259915
01772 703813
01772 880079
01772 768613
01772 717574
01772 562067
01772 252469
01772 796518
01772 865238
01772 726955
01772 467467
01772 728111
01772 203205
01772 716083
01772 493258
01772 493224
01772 493235
01772 782643
01772 250486
01772 653031
01772 555150
01772 732925
01772 562116
01772 702145
01772 736489
01772 651374
01772 712288
01772 251020
01772 784700
01772 253752
18
Appendix 8
19
20
21
22
Appendix 9
PHARMACY FIRST CONSULTATION DECISION
PATHWAY
PATIENT ADVICE
Is the patient presenting with symptoms that may
be related to any of the minor ailments included
in the ‘Pharmacy First’ Scheme?
Suggest (as appropriate)

OTC Sale.

Routine GP appointment.

Urgent doctor’s appointment
NO
YES
NO
Is the patient registered with a participating GP
practice?
YES
Suggest (as appropriate)

OTC Sale.

Routine GP appointment.
Is the patient exempt from paying a prescription
charge?
YES

NO

Urgent doctor’s appointment
Pharmacy First supply
Has the patient already registered with the
scheme and has been previously supplied with
a Pharmacy First Passport?
YES
Has the patient presented the Passport at the
pharmacy?
NO
NO

Request patient to return with Pharmacy
First Passport.
YES
Is there any reason why any a Formulary
medicine identified in the Minor Ailment
Protocol should not be supplied following
reference to the Passport?
YES
Suggest (as appropriate)

OTC Sale.

Routine GP appointment.

Urgent doctor’s appointment
NO
Is the patient excluded from treatment from
within the scheme according to Pharmacy First
Minor Ailment Protocol?
YES
Suggest (as appropriate)

OTC Sale.

Routine GP appointment.

Urgent doctor’s appointment
NO
YES
Is the particular medication to be supplied from
the Pharmacy First Formulary normally routinely
prescribed for the patient on repeat prescription
by their doctor (See PMR’s)?

Request patient to order routine repeat
prescription.
NO
Does the patient refuse the appropriate medicine
as identified in the Pharmacy First Formulary?
YES
Suggest (as appropriate)

OTC Sale.

Routine GP appointment.

Urgent doctor’s appointment
NO
Document refusal by the patient.
YES
NO
Supply if appropriate medicine from Pharmacy First Formulary.
Counsel patient on appropriate management of symptoms and the use
of medicines if supplied. Provide PIL if appropriate.
Issue or update Pharmacy First passport – instruct patient of
importance of producing passport for any future consultations with
any pharmacy across the PCT.
Complete documentation with patient. and collect prescription charge
if appropriate.,
Explain that the consultation document may be shared with Preston
PCT for audit and may be provided to the patient’s GP.
Suggest (as appropriate)

OTC Sale.

Routine GP appointment.

Urgent doctor’s appointment
23
Appendix 10
Minor Ailment Protocols
24
Allergic Rhinitis (including hayfever) Protocol
Definition
Symptoms
Common allergens
Advice
Pharmacy First Formulary
When to refer
Review Date
 Allergic hypersensitivity reaction of the nose with or without conjunctiva of the eyes caused by pollen or other allergen
 Rhinorrhoea (nasal discharge)
 sneezing,
 nasal congestion
 nasal itching
 red, watery and/or itchy eyes
 Pollen, house dust mite droppings, pet hairs, mould spores
Hay fever
 Remain indoors with windows closed esp. mid-morning and early evening
 Avoid fields, newly mown grass, fruit picking and touching outdoor animals
 Wear close fitting sunglasses
 Choose an air-conditioned car
 Follow pollen counts (e.g. www.bbc.co.uk/weather)
Perennial rhinitis
 Dust using sprays and vacuum twice weekly
 Wash all bedding at 60oC weekly
 Cover pillows and mattresses with plastic (use non-allergenic pillows)
 Remove anything that collect dust from the bedroom e.g. rugs, stuffed toys, open cupboards
 Treat furniture and carpets with ascaricides (e.g. benzyl benzoate) to control dust mites and fungicide
 Pets should be kept out of the bedroom (or house if possible)
 Use vacuum cleaners with high-efficiency particulate air cleaner (HEPA) filters
 Chlorpheniramine Tabs 4mg (30)
 Chlorpheniramine Syrup 2mg/5ml (150ml)
 Cetirizine 10mg tablets (30)
 Cetirizine Oral Solution 5mg/5ml (150ml)
 Sodium cromoglycate 2% eye drops (10ml)
Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations
and/or the BNF/Mims.
 Children under 12 years old
 Pregnant and breastfeeding women
 Symptoms unresponsive to treatment
 Severe persistent symptoms (provide initial treatment)
 Patient is wheezing and/or short of breath
 Rhinitis accompanied by:
 Earache or facial pain (sinusitis/otitis media)
 Purulent (green/yellow) discharge from the eyes
April 2006
25
Athlete’s Foot Protocol
Definition

Fungal infection of the feet, which is otherwise known as Tinea pedis.
Description of symptoms





The fungus is most often confined to the skin between the toes but it can also affect other nearby areas of the foot.
The most common symptom is a persistent itching of the skin.
As the infection progresses, the centre of the infection becomes inflamed and sensitive to the touch.
Gradually, the edges of the infected area become milky white and the skin begins to peel.
In some patients the area becomes very sore and cracks develop in the skin, making the patient susceptible to secondary
bacterial infection.
Pharmacy First Formulary

Miconazole cream (30g)

Clotrimazole cream (20g)
Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations and/or
the BNF/Mims.
Other advice to be given







Continue using the cream for two weeks after the infection appears to have cleared to eradicate all remaining fungal spores.
Anti-fungal sprays and powder may be purchased for direct application to shoes and hosiery.
Wash and dry feet thoroughly, especially between the toes.
Wearing clean wool or cotton socks allows the skin to breath.
Athlete’s foot is more common in people that wear artificial soles and especially trainers and sports shoes.
It can help to expose feet to the air where possible.
Avoid walking barefoot in public areas.
When to refer




Treatment failures. The diagnosis may need to be confirmed with a lab test.
If the infection spreads to the toenails. Here it causes the nail to become thick, discoloured and crumbly.
If the fungal infection spreads to other areas of the body.
If the condition is complicated with a secondary bacterial infection which takes advantage of the damaged skin. Any
patient presenting with symptoms of cellulitis (e.g. spreading redness, pain and tenderness) should be referred immediately.
Review Date
April 2006
26
Cold Sores Protocol
Definition



Cold sores are very common caused by the herpes simplex virus
They are characterised by fluid blisters which appear on red swollen areas of the skin or on the mucous membranes.
The blisters heal without scarring but tend to reoccur.
Precipitating factors


The virus can only be transmitted by close personal contact such as kissing.
Most people will have come into contact at an early age but generally do not show symptoms until after puberty usually when the immune
system becomes comprised eg due to a heavy cold.
Advice to be given



Early recognition of symptoms may be a tingling sensation after which scabs appear and typically fall off after 8 to 10 days.
Treatment should begin as soon as possible.
In children, the virus can infect the mouth and throat and can be accompanied by fever, aches and pains.
Cold sores should not be touched as this can spread infection therefore hands should be washed before and after each application of
the cream.
Pharmacy First Formulary
 Aciclovir 5% cream (2g)
Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations and/or
the BNF/Mims.
Side effects


Transient stinging or burning, occasional erythema, itching or drying of the skin.
Avoid contact with eyes and mucous membranes.
When to refer




Patient is immunocompromised eg AIDS
Infection of mucous membranes, eye or vagina
Pregnancy
Children under 12 should be referred automatically if intra oral and not just the lips.
Review Date
April 2006
27
Constipation Protocol
Definition
Precipitating factors
Pharmacy First Formulary
Advice to be given
When to refer
Review Date
 Constipation can be a reduced frequency of stools compared to the patient’s normal bowel habits, difficulty in passing stools or a sense of
incomplete emptying after a bowel movement.








Diet (poor or low-fibre diet)
Inadequate fluid intake
Lack of physical activity
Other medication – if appropriate, medication may need to be reviewed.
Regularly suppressing the urge to defecate
Stress and travel
Certain conditions and diseases (e.g. IBS, pregnancy, hypothyroid or neurological diseases)
Immediate relief
 Senna tablets (20) – for acute simple constipation.
 Medium-term treatment
 Ispaghula sachets (10) – useful where dietary intake of bulk is low.
 Lactulose solution (300mL) – valuable when the major problem is the passing of hard, painful stools.
Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations and/or
the BNF/Mims.
Regular doses of laxative are rarely required.
Give advice on changes that can help prevent re-occurrence
 Increase dietary fibre (e.g. fruits, vegetables and whole grains)
 Increase fluid intake
 Increase physical activity
 If the constipation persists beyond one week.
 If an infant or child has not had a bowel movement in 3 days OR any infant younger than 2 months.
 Nausea and vomiting are also present.
 Sharp or severe abdominal pain, especially if also bloated.
 Sudden constipation with abdominal cramps and an inability to pass gas or stool.
 Unexplained weight loss.
 Blood in the stool.
 Rectal pain.
 Constipation alternating with diarrhoea.
 If patient is regularly requesting laxatives.
April 2006
28
29
Cough, Cold and Flu-like Illnesses (Viral URT infections )
including Fever Protocol

Cough, Cold and Flu-like Illness (Viral URT infections) including Fever




Very Common. Children are more at risk to developing upper respiratory tract infections.
There are over 1000 types of cold virus1.
Cold symptoms include - cough (dry or productive), mild fever, runny or blocked nasal cavity, sneezing and watery eyes, sore throat
Flu-like symptoms include - feeling hot or cold or shivering, high temperature, headache, muscle and bone aches, dry cough. Runny nose
and sneezing may also occur
A cough is the body’s way of removing mucus or dust from the lungs 2.
A productive cough (chesty cough) is associated with phlegm or mucus, may be accompanied by earache and can occur if there is a chest or
ear infection possibly of viral origin.
A dry cough is a tickly feeling in the back of the throat that is not associated with production of mucus.
Cold and Flu symptoms are similar but Flu is more severe and last longer
General feeling of being unwell.
Infection.
Drug therapy on rare occasions ( ACE inhibitors may induce cough).
Give palliative treatment for symptoms.
Rest and avoid strenuous exercise if symptoms are severe.
Drink plenty of non-alcoholic fluids particularly hot water with honey and lemon have a soothing effect
In patients aged 65years and over, those with chronic illnesses such as asthma, emphysema, heart disease, kidney disease and diabetes or
those living in residential care should be advised to on the benefits of annual influenza vaccination each October/November.
Normal body temperature is 37oC
Fever is a natural defence mechanism to infection
Advice on the appropriate dose of medicine supplied for children and the maximum daily dose of Paracetamol if supplied
Smoking cessation advice if appropriate
Definition
How common is it?
Description of symptoms
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Precipitating factors
Advice to be given
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Pharmacy First Formulary
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Non pharmaceutical treatment

Paracetamol tabs (32) or suspension (100mL/200mL) for analgesia or for pyrexia. Choose Paracetamol as the analgesic and/or antipyretic of
choice.
 Ibuprofen tablets 200mg (24) for analgesia or for pyrexia,
 Xylometazoline nasal drops (10mL) (<7 days treatment), Pseudoephedrine tabs (24) or linctus (100ml), Normal saline (0.9%) nasal drops
(10mL) or menthol and eucalyptus inhalation (100mL) as decongestants (care in patients with high BP)
 Pholcodine linctus (200mL) and Pholcodine Paediatric linctus (90mL/100mL) as suppressant for dry cough.
 Patients should be referred to the GP if repeated requests are made for Pholcodine and the GP informed.
Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations and/or
the BNF/Mims.
Hot water inhalations (for chesty / productive coughs)
30
When to refer
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Hot shower or bath before bedtime.
Keep room warm but airy, don’t wrap children up too warmly
Sponge children with lukewarm water if temperature is high
Drinking plenty of non-alcoholic fluids can help to thin the mucus with chesty cough.
Avoid smoking and smoky rooms.
Suspected meningitis – vomiting, fever, stiff neck, light aversion, drowsiness, joint pain, fitting and rash
In the very young (children under 1 year) when the child is unwell and associated with either:

High temperature (above 40oC)

Poor feeding
Abnormal breathing.
If child acts oddly i.e. changes in speaking, walking, unable to sit up, drowsy all the time
Severe earache2.
In the elderly (over 75) who are of poor health (heart or lung disease).
Persistent fever more than 4 days and cough for more than 5 days or if symptoms are worsening and not responding to adequate treatment.
Chest pain.
Worsening asthma with no self-management plan.
If there is wheezing with breathing or shortness of breath Dyspnoea/wheeze asthma (especially night cough) of longer than 2 weeks
duration3.
Blood in phlegm or phlegm/sputum is green
Unexpected loss in weight (associated with cough)
Check if patient is on drug therapy (ACE inhibitor) – advise patient to discuss with GP at next routine appointment
Temperatures regularly over 41C..
Patients recently returned from foreign travel (particularly in malarious areas).
Patients that appear to be very unwell or have symptoms that suggest an infection that may need other GP input
Any other reason which makes you professionally wary of making a supply.
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Review Date
April 2006
1
E Van der Does & R.G. Metz What should I do? Do I go to the doctors?
The NHS Home Healthcare Guide 1998
3
A. Blenkinsopp et al. Symptoms in the Pharmacy 1995
2
31
Cystitis Protocol
Description
How common is it?
Description of symptoms
Advice to be given
Pharmacy First Formulary
When to refer
Review Date
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Inflammation of the bladder lining due to infection (most commonly bacterial), irritation or damage.
Common in young women in particular.
Increase in frequency and urgency of urination. However, only small amounts of urine are excreted. Patient may feel that they are unable to
empty the bladder.
 Burning, stinging or pain on urination.
 Urine may be dark, have a strong odour, be cloudy and on occasion contain traces of blood.
 Pain in the lower back or abdomen.
 Malaise, fever, nausea and vomiting.
 The only symptoms with which elderly patients may present are confusion, weakness, falls or a general feeling of being unwell.
 Children may be irritable, have a reduced appetite, may be vomiting or may display signs of discomfort during urination.
 Drink at least eight glasses of water each day.
 Wipe bottom from front to back after going to the toilet.
 Use a hot-water bottle to alleviate abdominal pain.
 Drinking plenty of cranberry juice may prevent bacteria from adhering to the bladder wall and thus reduce the duration of the infection.
 Avoid alcohol and caffeine as these may dehydrate the patient further.
 Wear cotton underwear.
 Try to completely empty the bladder when urinating.
 If symptoms are related to sexual intercourse, advise patient to empty bladder within an hour after intercourse.
 Alkalising agents, for example, potassium citrate, sodium bicarbonate and sodium citrate may ease the discomfort of urination.
N.B.
Exercise caution when recommending sodium based agents to patients with cardiac disease or hypertension and when recommending
potassium based agent to patients who are already taking potassium-sparing diuretics, aldesterone antagonists and ACE inhibitors, as
hyperkalaemia may occur
 Paracetamol tabs (32) may ease abdominal pain
 Potassium Citrate Mixture (200ml).
Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations and/or
the BNF/Mims.
 Male patients.
 Children under 12
 Pregnant women.
 Vaginal discharge
 Diabetics.
 Blood in the urine.
 Symptoms unresolved after 2-4 days, with or without treatment using alkalising agents.
 Recurrent attacks.
 Fever or vomiting.
April 2006
32
Diarrhoea Protocol

An increase in the normal frequency of bowel movements with the passage of abnormally soft or watery faeces
Definition
Description of symptoms
Precipitating factors
Advice to be given
Pharmacy First Formulary
Non pharmaceutical treatment
When to refer
Review Date
 Sudden onset (acute diarrhoea)
 5 or more watery or loose stools
 Abdominal cramps, flatulence, weakness and malaise may be present
 Ingestion of contaminated food or water, medicines, poor personal hygiene
 Self-limiting condition
 Recommend ‘wait and see’ for the first 24 hours
 Replacement of lost fluids is normally the only treatment required.
 Oral re-hydration therapy (ORT)With Dioralyte Sachets (6)
Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations and/or
the BNF/Mims.
 Drink plenty of fluids (at least 1.5 litres daily)
 Adults and older children should avoid dairy products and fruit juice for the duration of symptoms
 Young children
 Symptoms for more than 24 hours if under 1 years old
 Symptoms for more than 2 days if under 3 years old
 Elderly (symptoms for more than 2 days if over 70 years old
 Apparently anorexic patients
 Symptoms present for more than 3 days with colic symptoms and generally unwell
 Diarrhoea accompanied by:
 Fever
 Severe vomiting
 Weight loss
 Blood or mucus in stools.
 Signs of dehydration
 Persistent change of bowel habit
 Recent travel to a foreign country
 Patient is taking/recently finished a course of antibiotics
April 2006
33
Earache Protocol
Definition
 Earache is caused by the build-up of fluid and pressure in the middle ear.
 The middle ear is drained by the Eustachian tube into the nasal passages. A cold or allergy can cause this tube to become blocked leading to
a build up of pressure in the middle ear.
 Earache is more common in young children where the Eustachian tube is smaller and more easily blocked.
Description of symptoms
 An earache can be a sharp, dull or burning pain.
 The pain may be transient or constant
 Stuffiness and there may be some hearing loss
When dealing with infants signs often include:
 Increased irritability and crying
 Pulling at the ears
 If the symptoms are caused by an infection then high temperature and flu- like symptoms may also occur
Patient History

Pharmacy First Formulary
 Paracetamol tablets (32) or suspension (100mL/200mL).
 Ibuprofen tablets 200mg (24) or suspension (100mL)
 Pseudoephedrine tabs (24) or linctus (100mL)
Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations and/or
the BNF/Mims.
Advice to be given
 Decongestants can help open the Eustachian tubes. Decongestants are for short-term use only (rebound congestion with long-term use) N.B.
Caution in hypertension & diabetes.
 Apply a cold wet washcloth to the outer ear to reduce discomfort.
 Steam could help keep mucous thin and clear the Eustachian tubes.
When taking a history it is important to ask about provoking factors such as:
 A cold
 Hay fever
 Where water might get in the ear (e.g. swimming) and sudden changes in pressure (especially children).
 Treat only when it is a simple case of earache. All infections of the ear need to be referred.
 Other infections and problems of the nose, mouth, throat and jaw can also cause pain in the ear.
34
When to refer
Review Date
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Children under 3 months old
Earache continues for more than 12 hours after taking painkiller
Symptoms have been present for longer than 3 days.
Rapid noticeable hearing loss
Constant ringing,buzzing or hissing in ears
All ear infections need to be referred. The following all suggest an ear infection.
 Presence of severe pain
 Continuous pain
 Presence of discharge from the ear
 Fever or raised temperature, nausea, vomiting, dizziness or loss of balance.
 Symptoms have been present in the previous 3 months
April 2006
35
Eczema Protocol (N.B. The terms eczema and dermatitis may be used interchangeably.)
Definition
How common is it?
Description of symptoms
The “Itch-Scratch” cycle
Goals of treatment
Pharmacy First Formulary
General Information
Three main types:
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Atopic – an inherited condition. This may occur in conjunction with asthma, hayfever or rhinitis.
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Irritant – occurs due to lack of natural oil in the skin caused by soaps, disinfectants, detergents or chemicals at work or at home.
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Allergic – mediated by an immune reaction to a substance which has made contact with the skin. The reaction occurs on subsequent exposures after the
initial exposure. Examples of allergens include cosmetics, hair dyes, nickel, chromium and some plants.

It occurs in up to 20% of children and up to 10% of adults.
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Extremely itchy, red, inflamed and/or dry skin.

New areas may weep or become crusted.
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Chronic atopic eczema may lead to thickened and scaly (lichenified) skin.

Eczematous skin is very itchy scratching temporarily relieves the itching but also releases inflammatory mediators which cause further itching and
scratching skin becomes more damaged allowing penetration of Staphylococcus aureus toxins which dry out the skin and cause more itchiness.
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Maintaining healthy skin.
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Treating damaged skin as soon as symptoms occur.

Preventing further “flare-ups”.
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Aqueous Cream (500g), Emulsifying Ointment (500g), Hydrocortisone Cream 1% (15g)
Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations and/or the
BNF/Mims.
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Emollients – moisturisers replace lost moisture in the skin, prevent further loss of moisture, help restore the “epidermal barrier”, may act as antiinflammatory agents and finally, allow smaller doses of steroids to be used without lowering their potency if used regularly and frequently. Emollients
should continue to be used during treatment with steroid creams but at a different time of day.

Topical steroids – used to treat “flare-ups” by reducing skin inflammation and itching. Overuse may lead to skin-thinning and steroid-induced rosacea on
the face. In order to avoid these side-effects there are important rules to follow:
 Apply steroids sparingly. The fingertip unit may be used as a rough guide. This is the amount of cream needed to cover the area between the first crease
of the index finger to the tip. Half a finger-tip unit of steroid cream should cover an area the size of the flat of the hand.
 As soon as a clinically-acceptable effect has been achieved, stop using the topical steroid. As a general rule, OTC steroid creams should be used for no
longer than a week. If flare-ups require treatment with a steroid cream for longer than this, it should be under medical supervision only.
Points to remember
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When to refer
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Review Date
Try to identify the cause of irritant or allergic eczema and advise the patient to avoid further contact with the substance.
Steroid creams are open to potential misuse as skin-lighteners. Be aware of this and exercise caution where appropriate.
If you are unsure of the diagnosis.
If there is little or no response to a moderately potent steroid cream after one week.
If the face, genitals or armpits are severely affected by eczema.
If a diagnosis of seborrhoeic eczema or psoriasis is suspected or confirmed.
In cases of severe eczema in children under 12 years of age or pregnant women.
If the eczema is crusty, weeping, has pustules, is unusually inflamed or has suddenly worsened. This would indicate a bacterial infection of the eczema.
If viral or fungal infections are suspected, these should also be referred to the G.P.
April 2006
36
Headache Protocol
Description
Pharmacy First Formulary
Non pharmaceutical
management
When to refer
Review Date
Tension headache
Usually bilateral, non-pulsating, does not affect normal routine. Described as tightness or squeezing around
the head
Ice-cream/ice-pick” headache
Short piercing pain usually behind one eye for periods up to several minutes, several times a day. Can be triggered by cold food.
Described as “like a flash of lighting”
Migraine
Usually unilateral, pulsating, moderate to severe in severity for periods of 4-72 hours. Patient may also have photophobia, aura (e.g.
visual disturbance) and/or nausea and vomiting. Normally affects ability to perform normal activity during headache but patients are
symptom free between attacks
Chronic daily headache
Headache often with neck stiffness for more than 4 hours a day for more than 15 days a month. Can be caused by analgesic dependence
Cluster headache
Severe sudden onset unilateral headache around the eyes, often with red, watery or swollen eye(s), droopy eyelid, stuffy or runny nose or
sweating. Normally lasts between 15-180 minutes with varying frequency
 Paracetamol 500mg tablets (32), 120mg/5ml or 250mg/5ml suspensions (100mL/200mL) (liquid preparations have rapid onset of action)
 Ibuprofen 200mg tablets (24), or 100mg/5ml suspension (100mL)
Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations
and/or the BNF/Mims.
 Stress management
 Avoiding tyramine containing food (e.g. cheese, red wine, chocolate) may be helpful for migraine sufferers
 Neck exercises may be helpful to patients who suffer from chronic daily headaches
 Eye test
 Undiagnosed migraine - Check if taking the oral contraceptive pill, cluster or chronic daily headache
 Recent head injury within the last 14 days.
 Sudden onset described as “sudden blow to the head” (subarachnoid haemorrhage)
 Headache associated with:

High temp, stiff neck, photophobia, drowsiness, vomiting, anorexia, rash, unequal pupils, symptoms of meningitis- bulging
fontanelle in babies, rash or seizures.
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Jaw pain, scalp or muscle tenderness, , general malaise esp. if over 50 years of age (cranial arteritis)
April 2006
37
Headlice Protocol
Definition
Diagnosis
Pharmacy First Formulary
General Information
Advice to be given
Non pharmaceutical treatment
When to refer
Review Date
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Infestation of scalp by live head lice
The only way to confirm an infection is by seeing a live louse.
 Hatched lice and eggs are difficult to see on the hair.
 Use a detection comb over white paper to confirm diagnosis. The combing should begin at the top of the head with the comb touching
the scalp, then draw the comb slowly through the hair to the ends.
 Lice are about 2 - 3mm long and vary from grey to brown in colour. The eggs (nits) are attached to the hair shaft close to the scalp;
they are white to grey in colour and approximately 2mm long.
 Itchiness of the scalp can occur but this usually happens several weeks after infestation.
 Phenothrin 0.2% lotion (1st choice) (50mL x 1 or 2 bottles)
 Malathion 0.5% aqueous liquid and lotion (50mL x 1 or 2 bottles)
Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations
and/or the BNF/Mims. Normally supply 50mL for each application (2 applications are required 7 days apart)
 Only treat if live lice are located.
 All infected members of the household should be treated at the same time ie within 24hours. The patient will have to confirm that live lice
have been identified in other close members of the family before product is supplied for each infected member. Each family member will have
to be registered into the scheme and be under the care of one of the participating GP practices.
 Alcoholic lotions are suitable for people with normal healthy skin.
 Aqueous lotions are the treatment choice for small children, asthmatics and patients with eczema or other skin disorders.
 In general, a course of treatment for head lice should be 2 applications of product 7 days apart to prevent lice emerging from any eggs that
survive the first application.
 Not using products properly accounts for about a third of all treatment failures.
 Head-lice repellent is on sale to the public but its effectiveness is uncertain.
 Ensure that a patient information sheet is given.
 Contact tracing – Contacts include anyone who is likely to have had head-to-head contact with the infected individual in the last month.
They should be advised to have their hair checked for live lice.
 ‘Wet combing’ is a good way to keep an eye out for the first signs of infection and it is recommended that parents wet comb their
children’s hair once a week.
 Provide a patient information leaflet
 Wet combing methods. This typically involves meticulous combing (for about 30 minutes each time) with a detection comb and hair
conditioner over the whole scalp at 4-day intervals for a minimum of 2 weeks. The evidence to show this method works is lacking. Several
products are available to the public.
 Treatment failures with Malathion and Phenothrin.
 Children under 6 months
 Pregnant or breastfeeding women.
April 2006
38
Indigestion Protocol
Definition
Dyspepsia
Upper abdominal discomfort, pain associated with food/hunger relieved by antacids, symptoms causing sleep disturbance, nausea and
bloating
Gastro-oesophageal reflux
Heartburn, acid regurgitation, epigastric pain, belching, waterbrash
Advice
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Pharmacy First Formulary
Gaviscon liquid (150mL)
Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations
and/or the BNF/Mims.
When to refer
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Review Date
Eat small regular meals, avoid eating on the go or rushing meals
Avoid foods which may aggravate symptoms e.g. spicy or fatty foods
Lifestyle management e.g. smoking cessation, alcohol consumption, weight loss
Elevating the head position during sleep for relieving nocturnal heartburn
Stress management
First symptoms of indigestion at 55 years old or over
Patients who:
 Received abdominal surgery
 Have a history of gastric ulceration
 Receiving NSAIDs or other medicines known to cause gastric irritation
 Pain in the chest indicative of another aetiology
Indigestion accompanied by:
 Unexplained weight loss
 Blood in stool (fresh blood or black and tarry stools)
 Difficulty in swallowing, food ‘sticking’ in the throat
 Lump in the throat
 Severe epigastric pain
 Persistent vomiting
Symptoms for more than 2 weeks
April 2006
39
Mouth Ulcers Protocol
Definition
Description
 A mouth ulcer is any ulcerative lesion affecting the oral mucosa.
 The term aphthous stomatitis refers to the condition of recurrent mouth ulcers.
 Minor aphthous ulcers are the most common (8 in 10 cases). Usually, there is only one ulcer but up to 5 may develop at the same time.
They are small (less than 10mm across) with a depressed round grey area surrounded by a red erythomatous edge. Each ulcer heals
spontaneously after 7-10 days without leaving a scar. They are usually not very painful.

Major aphthous ulcers (1 in 10 cases) are larger (greater than 10mm across) and usually only one or two appear at a time. Each ulcer
lasts 2 weeks to several months and then resolves leaving a scar. They can be very painful.

Precipitating factors
Advice to be given
Pharmacy First Formulary
Other advice to be given
When to refer
Review Date
Pinpoint aphthous ulcers (1 in 10 cases) are tiny (1-2mm across) and many occur at the same time. Some may join together to form
irregular shapes. Each ulcer may last 1 week to 2 months.
 In most cases, the ulcers develop for no apparent reason in healthy individuals.
 Single isolated traumatic ulcers are often due to catching the gum with the toothbrush or badly fitting dentures.
 More females than males are affected.
 Stress or anxiety
 Changes in hormone levels (e.g. just before their menstrual period or after the menopause).
 A lack of certain vitamins (such as vitamin B12 or folic acid) or iron may be a factor.
 There may be a genetic factor
 Aphthous ulcers are common in people with crohn’s disease, coeliac disease, HIV infection and Bechet’s disease.
 Suggest the patient limits the use of sharp foods (e.g. crisps), spicy foods, hot fluids and carbonated drinks
 Bonjela gel (15g)
 Hydrocortisone lozenges (20)
Give clear instructions on appropriate dosage based on the manufacturers recommendations and/or the BNF/Mims.
 Maintain good oral hygiene
 Antiseptic mouthwash (e.g. Chlorhexidine) may reduce the pain, prevent the ulcer from becoming infected and may also help ulcers to
heal more quickly.
 If ulcer persists for more than 3 weeks then the patient should be referred to their doctor or dentist for further investigation.
 Non painful lesions including any lump, thickening or red or white patches
 Difficulty in swallowing or chewing not associated with a sore lesion
 Any sore that bleeds easily
 If there are any other symptoms other than the mouth ulcers.
April 2006
40
Nappy Rash Protocol
Description
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
Pharmacy First Formulary
Barrier creams and ointments are used for protection against nappy rash. Their ingredients act as water-repellent substances.
 Sudocrem cream (60g)
Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations
and/or the BNF/Mims.
General advice
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When possible, leave the nappy off allowing air to get to the skin
If barrier cream is to be used only apply small amount.
Change the baby’s nappy as soon as possible after it becomes wet or soiled
Clean the nappy area thoroughly after each bowel movement, and allow it to dry
If baby has sensitive skin or nappy rash then it is a good idea to apply a small amount of barrier cream after every wash.
Avoid plastic pants as these will trap moisture. Try woollen or cotton underwear on top of the nappy, which allows the skin to breathe.
When to refer
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
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
If nappy rash is a bright shade of red, very warm or swollen. This may indicate the presence of a bacterial or fungal infection.
If rash continues for longer than a few days or becomes worse, even after allowing the skin to breathe and using a barrier cream.
In addition to the nappy rash, baby has a high temperature or seems distressed.
If rash does not match the description of typical nappy rash, skin is flaky or there are blisters.
Review Date
April 2006
Nappy rash is a red rash, or sore area, that affects skin under or around a baby’s nappy.
The main cause is a wet or dirty nappy being in contact with the skin for too long a period of time. Human waste contains ammonia byproducts which also damage baby’s skin.
41
Oral Thrush
Definition

Description of symptoms

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
Who is at special risk?
Pharmacy First Formulary
Other advice to be given
When to refer
Review Date
Oral thrush is an infection of yeast fungus, Candida albicans, in the mucous membranes of the mouth.
Presence of sore, creamy/yellow coloured patches in the mouth
The patches are slightly raised
Scraping off the spots leaves raw areas which may bleed slightly
Infants and elderly
Denture users
People whose immune system is suppressed by disease or medical treatments
 Steroids and steroid inhalers
 Immuno-suppressants or chemotherapy
 HIV infection
 Antibiotics may upset the normal balance of micro-organisms in the mouth
 Adults with uncontrolled diabetes or other metabolic disturbances
 People with poor nutrition
 Elicit drug users
 Miconazole oral gel (15g)
 A treatment course is usually 7 – 14 days so ensure a minimum of 7 days supply is given (max 2 x 15g per consultation).
Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations and/or
the BNF/Mims.
 Maintain good oral hygiene
 If possible, address the cause of the thrush
 Invest in better fitting dentures
 Adjust diabetes control
 Rinse the mouth out after using steroid inhaler
 In breast-fed infants, the mother should also use the oral gel on her nipples to prevent continuous spread to the infant. Ensure enough gel is
supplied.
 In bottle-fed infants, the teats should be discarded once the infection begins to clear because fungus may get into the teat and cannot be
easily eradicated.
 Thrush that resists treatment.
 Thrush in infants is very common but if it recurs frequently, it should raise suspicions for an underlying disorder.
 Thrush in apparently healthy adolescents and young-middle aged adults is rare and should always be viewed as a possible symptom of an
underlying medical problem
 Sudden and intense thrush
April 2006
42
Scabies Protocol
Definition

Description of symptoms

General information
Pharmacy First Formulary
Other advice
When to refer
Review Date
Scabies is an allergic irritant condition resulting from the burrowing of the human scabies mite.
Intense itching and/or rash
 Generally symmetrical on the body
 Itching is worse when the body is hot, for example, when in bed.
 It is most common for itching to begin on the hands and wrists.
 A definitive diagnosis can be made on finding burrows in the skin, usually on the hands. However, these are not often seen. Burrows are
very small (0.5cm or less) curving white lines, sometimes with a vesicle at one end
 People with impaired immune systems may show a different reaction to scabies
 The skin develops thick crusts which are highly contagious (Crusted scabies)
 Infection only spreads through direct skin-to-skin contact with another human being.
 The most common way to catch scabies is through hand-holding
 Incubation is usually 4-6 weeks in patients without previous exposure
 It is still contagious in the weeks before the symptoms appear making spread difficult to contain
 Itching may persist for 2-3 weeks after successful treatment. During this time no new lesions should develop.
 Malathion 0.5% aqueous liquid (50mL)
 Permethrin dermal cream (30g)
 Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations
and/or the BNF/Mims. Normally supply 2 units for each application. (2 applications are required 7 days apart)
 Cetirizine 10mg tablets (7) and oral solution 5mg/5mL (75mL) (for itching).
 All members of the household should be treated at the same time even in the absence of symptoms ie within 24 hours. Each family member
will have to be registered with one of the participating GP practices.
 Remember to supply a suitable quantity for each person.
 Follow instructions in the patient information leaflet
 Alternative symptomatic treatment of itching that may be purchased
 Ensure a patient information sheet is given.
 Contact tracing is the responsibility of the patient to alert anyone who may be infected.
 Children under 2 years, pregnant and lactating women should be referred to the G.P.
 Treatment failure
 Signs of bacterial infection
April 2006
43
Sore Throat Protocol
Definition

Sore Throat
How common is it?

It is estimated that 90% of pharmacy consultations for sore throats are viral in origin1. This leaves 10% to be of bacterial origin. Group A
beta-haemolytic streptococcus (GABHS) is the most common bacterial cause and can be isolated from up to 30% of patients presenting at
the GP’s2.
Description of symptoms







Sore throat and / or ear
Pain on swallowing.
Difficulty in swallowing
Fever, headache and malaise.
Laryngitis (infection of the voice box) can also cause a sore throat.
Redness of pharynx and tonsils, presence of exudate, enlarged tonsils, swollen tender neck glands.
Not all of these symptoms may be present at any one time.
Precipitating factors

Poor immune response (illness or drug related).
Advice to be given



Sore throats are usually a self-limiting illness (whether caused by viral or bacterial infection) and will resolve in 7 – 10 days
Explanation, reassurance and advice on condition are all that is required.
Avoid talking, smoking and alcohol
Pharmacy First Formulary



Non pharmaceutical treatment


Paracetamol 500mg tablets (32) and suspension (100mL/200mL)
Ibuprofen 200mg tablets (24) and suspension (100mL)
Adult and children over 16 years can gargle with Soluble Aspirin 300mg (32) dissolved in a glass of water then swallowed. Repeat every
four hours as necessary (avoid in patients with history of stomach ulcer or asthma)
 Difflam spray (30mL)
 AAA spray (1)
Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations and/or
the BNF/Mims.
Taking regular sips of warm drinks, like honey and lemon, can help to relieve the symptoms.
Sucking sugar free lozenges can help.
44
When to refer








Review Date
Patient taking other medication e.g. carbimazole, methotrexate etc that may cause neutropenia (alterations in the white blood cell counts).
Patients, especially young children, presenting with severe symptoms (not able to swallow, acute onset and high temperature over 39°C,
drooling and seems unable to swallow their saliva).
Sore throat with no improvement after 5 days.
Swallowing drinks is not possible
Difficulty in breathing
Repeated tonsil infections or abcesses
Severe Earache
Hoarseness for more than 3 weeks1.
April 2006
45
Teething Protocol
Definition
Description of symptoms
Advice to be given
OTC medication
Non pharmaceutical treatment
When to refer
Review Date
The emergence of teeth through the gums of the mouth usually begins between the 6 th and 8th month of life and all deciduous teeth are normally
in place by the time they are around three years old. Some children can go through teething much earlier or later.
Symptoms are very varied with most babies suffering little pain but some have symptoms for several weeks and can include:
 Irritability caused by the pain and discomfort of the tooth rising to the surface of the gum.
 Excess salivation and drooling.
 Gum swelling, redness and sensitivity.
 Wakefulness at night
 Refusing food/ demanding more feeding than normal
 Biting and gnawing. This helps relieve the pressure from under the gums.
 Temperature a little higher than normal
 Bowel movements slightly looser than normal
 Flushed cheeks
 Cheek rubbing and ear pulling
 Extra comforting can often be the only intervention required
 Gently wipe the baby’s face often to remove saliva to prevent rashes from developing.
 Recommend registration with an NHS dentist if the child is not already registered.
Bonjela gel (15g)
 Give the baby something cool to chew on. This can ease the pain. For example:
 Teething rings, which can be cooled in the fridge.
 A clean wet washcloth placed in the freezer for 30 minutes.
 May like to try hard foods e.g. sugar-free biscuits, frozen bread, chilled carrot sticks
 They may get some relief form eating cold foods such as: Yoghurt or applesauce.
 Rubbing the baby’s gums with a clean finger can also soothe the ache.
 If the child has a temperature over 38oC (100oF) or diarrhoea
 If symptoms and pain (if the baby is crying inconsolably) are excessive. Teething shouldn’t be excruciating
 April 2006
46
Threadworm Protocol
Definition

A parasitic worm which is caught after swallowing the eggs
Description of symptoms


Anal Pruritus mainly at night is quite often the only symptom
Sometimes worms can be seen around the anus or in the stools
How common is it?

Threadworms are extremely common. Infection can spread rapidly between family members by direct transfer of eggs.
Pharmacy First Formulary
 Mebendazole 100mg Tablets (2) (patients over 2 years old).
Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations and/or
the BNF/Mims
General Information



Non pharmaceutical measures

Use of Anthelmintics needs to be combined with hygiene measures to be prevent ova being transferred form the anus to the mouth
 Washing hands and scrubbing nails before each meal and after going to the toilet
 Bathing immediately after rising will remove eggs laid during the night
 Keeping nails short
 Prevent nail biting and thumb sucking
When to refer



Children under 2 years
Pregnant or potentially pregnant women.
Signs of bacterial infection
 Day and night time irritation
 Red and inflamed skin around the anus
 Purulent mucus discharge from the anal canal
Review Date
April 2006
All members of the family should be treated at the same time
Mebendazole should not be used in pregnancy or if potentially pregnant.
It is not advisable to breast-feed following administration of Mebendazole
47
Vaginal Thrush Protocol
Definition

Fungal infection of the lower female genital tract.
Description of symptoms

Presenting symptoms include thick, white vaginal discharge, pain or burning on urination, soreness and itching







Maintain good hygiene
Avoid highly perfumed soaps, bubble baths and vaginal deodorants if they know they are prone to thrush.
Remind the doctor that they are prone to thrush if they are prescribed antibiotics or other medication.
Try to keep the genital area cool, thrush thrives in warm moist conditions.
Wear loose fitting cotton underwear.
Partner will need treating
Symptoms may take up to 7 days to resolve, if this fails to happen then the patient should be advised to make an appointment with their
doctor.
Pessaries best used at night to aid retention
Advice to be given

Pharmacy First Formulary

Clotrimazole 500mg pessary (1), Clotrimazole 1% cream (20g), Clotrimazole combi pack (1)
Patients should be given clear instructions on appropriate dosage of the preparation supplied
based on the manufacturers recommendations and/or the BNF/Mims.
Which product



If the patient describes symptoms that are mainly external, Clotrimazole Cream should be supplied
If the patient describes symptoms that are mainly internal, Clotrimazole One should be supplied
If the patient describes symptoms that are both internal and external, Clotrimazole Combi should be supplied
When to refer









First time sufferer
Blood staining within the discharge, abnormal or irregular vaginal bleeding
Presence of sores or blisters in vaginal area
Patient is pregnant or likely to be pregnant
Patient is under 16 or over 60 years of age.
Diabetic
Unresolved symptoms 7 days after treatment
Personal history of or recent exposure to STI
Any other reason which makes you professionally wary of making the supply
Where to refer

GP, Family Planning Clinic or GUM
Review Date
April 2006
48
Verrucas Protocol
Description




Pharmacy First Formulary
 Cuplex gel (5g) – follow instructions in patient information leaflet
Patients should be given clear instructions on appropriate dosage of the preparation supplied based on the manufacturers recommendations and/or
the BNF/Mims.
Other advice



Treatment is not always necessary as many verrucas remit without any intervention but this can often take months or even years
Avoid applying keratolytic to healthy skin – can use vaseline to protect healthy skin
Avoid spreading the verruca
 Maintain scrupulous cleanliness
 Use a separate towel
 Avoid walking around in barefoot
 Cover verruca with a plaster
When to refer





Painful verrucas
Suspect skin cancer
Diabetic patient
Pregnancy
immuno-compromised – check medication
Review Date
April 2006
Verrucas or plantar warts are those found on the feet, especially the soles.
All warts are caused by various types of the human papillomavirus
A verruca typically presents as a flat skin coloured lesion with a black dot at its centre
Friction wears away the dead cells of the wart which exposes thrombosed blood vessels giving the verruca its typical appearance
49
50
Appendix 11
Generic list of competencies for community pharmacies involved in
providing a minor ailment service.
This is an example of a core competency framework which defines in generic terms
the competencies that community pharmacists have, or need to develop, to offer a
minor ailment scheme.
Competency frameworks can be used to assist in recruiting community pharmacies to
provide extended services, for performance review, and to identify training and
development needs of community pharmacy staff providing extended services.
Core Competency framework for community pharmacists providing
extended services
Adapted from:
Anon.
Community pharmacy medicines management: a resource pack for
community pharmacists. The community pharmacy medicines management project
2003. Available at www.medicinesmanagement.org.uk/.
Competence in information management
The pharmacy will:
 establish and maintain appropriate sources of information about minor ailments
and their treatment.
 operate a protocol(s) for the sale of non-prescription medicines.
 establish and maintain information on other local services relevant to the
treatment of minor ailments.
 make a written record of the minor ailment consultation.
 record the outcome of the minor ailment consultation in the PMR, as appropriate.
 correctly process documentation of the minor ailment scheme.
 provide appropriate records for audit and evaluation purposes.
Competence in communication
The pharmacy will:
 elicit key information for the treatment of minor ailments by the use of appropriate
questions.
 provide information and advice in a manner appropriate to the needs of the patient.
Competence in problem-solving
The pharmacy will:
 recognise and define actual or potential problems in the patient’s drug therapy,
life style or quality of life related to the treatment of that minor ailment.
 identify the best option for the treatment of the minor ailment based on
appropriate evidence and sound analysis, and taking account of the patient’s
wishes.
51
 when necessary refer the patient to a more appropriate source of help or
information.
 take responsibility for, and accept the outcome of, own proffered advice or
decisions for minor ailments.
Competence in working with others
The pharmacy will:
 contribute to the scheme in accordance with the law, with the RPSGB Code of
Ethics and with other relevant codes of conduct or practice, including systems for
clinical governance.
 respect and observe patient confidentiality.
 negotiate successfully with GP’s and their staff if any problems arise.
 operate across the community pharmacy: primary care interface in support of the
management of minor ailments
 behave in a manner which instils confidence of others involved in the treatment of
minor ailments, especially the patient.
 support, collaborate with, delegate to, and supervise other team members in an
appropriate manner for the treatment of minor ailments.
 use knowledge and skills effectively to help the learning of other team members
about the treatment of minor ailments
Competence in personal skills development
The pharmacy will:
 recognise personal and professional limitations in respect of minor ailments
 identify and priorities the pharmacy staffs’ learning and development needs for
minor ailments management.
 develop plans with learning objectives to meet identified needs for the treatment
of minor ailments.
 use learning and development opportunities, including those of and from workbased experience, in support of minor ailments management.
 records learning activities relevant to minor ailments management
 evaluate if learning objectives were met and identify further learning needs for
minor ailments management
 apply learning to practice of minor ailments management.
52
Competence in achieving concordance in drug therapy
The pharmacy will:
 elicit, listen to, respect and reflect the patient’s perceptions of his/her condition
and addressed his/her concerns about his/her medicines or about taking them.
 encourage the patient to ask questions about his/her condition and treatment.
 explain clearly to the patient the benefits of and rationale for his/her proposed
medicine
 identify factors which might discourage or prevent the patient from taking the
medication regimen and seek to remove or ameliorate those factors by simple
practical measures or suggestions of a clinical or no-clinical nature.
Competence in achieving a healthier lifestyle and higher quality of
life
The pharmacy will:
 help the patient to recognise any clear need for change in his/her lifestyle for
reduced risk of ill-health
 use opportunities to promote and support the patient’s healthier lifestyle.
53
Appendix 12
Pharmacy First – Minor Ailment Scheme
Locum Guide
The Pharmacy First Scheme allows participating pharmacies to supply certain
medication on a pharmacy prescription form to patients registered with a Preston
GP.
The Pharmacy may supply any of the medication listed in the formulary for those
stated conditions. The medication may only be supplied in accordance with its
OTC product licence.
Medication may not be supplied for any other condition other than those listed
even though the product is licensed for such use.
Normal Prescription Charges and Exemptions Apply
54
Please ensure that
 The patient has a Pharmacy First Passport or is issued with one
once Registration with a participating Preston GP has been confirmed.
 The consultation form is completed on BOTH sides.
 An entry is made onto the Pharmacy First Passport
 Any prescription levy is collected
 Any medication supplied is labelled in the normal way.
For further information contact
Malcolm Phillips on 01772 645586
Overview
What is it?
Who?
Where?
When?
Passports?
The scheme provides treatment for certain ailments from
pharmacies as if they were on an FP10.
Any patient registered with a participating Preston PCT
practice
See Appendix 2
A list has been
faxed to the
pharmacy
You’re in one
Any participating pharmacy
Any time the pharmacy is open. No need to see a GP first
To use the scheme the patient must have a passport, or be The yellow/blue
issued with one. It acts as a record card and lists the
book, PCT headed
medication supplied through the scheme
cards held in the
pharmacy
How?
You can supply any of the medication listed for any of the Normal
conditions. Label medication as if it were being supplied prescription
on FP10 is good practice and will ensure a record is made exemptions and
in the PMR
charges apply
When not to There are no real limits on the frequency of supply,
Don’t supply
supply
serious consideration should be given to repeat provision through the
of Pholcodine Linctus (see Cough/Cold/Flu protocol).
scheme if you
Use your professional judgement but refer to the minor
wouldn’t sell the
ailments protocols. Generally if the medication has been product!
supplied on two previous occasions in the last month,
referral may be required. Obvious exemptions include
hay fever medicines.
Paperwork?? Each patient should have a passport.
It looks like a lot
At each supply make an entry on the PMR and in the
but it’s quite
Passport.
simple. Please
ensure it is
completed or
payment will not
be made.
Complete the Patient Consultation Form (Both sides)
55
Appendix 13
Pharmacy First – Minor Ailment Scheme
Common Questions
Q. Who can use the service?
A. Any patient registered with any Preston PCT GP or Chorley & South Ribble PCT
GP. This includes children and the elderly. Children under 16 must be issued with
their own passport and the parent/guardian must sign on their behalf. The parent or
guardian should normally accompany the child on each occasion they wish to
access the scheme.
Q. What medicines can I use to treat which ailments?
A. The list of medicines and ailments will change from time to time. These are
detailed on appendix II with reference to the specific condition requiring treatment.
No other ailment is treatable through the scheme even if a suitable medicine is
available for another condition.
Q. Can patients demand the medicines available for the conditions treatable?
A. No. You are under no obligation to supply any of the products available if you feel
they are inappropriate for a particular patient or you think a referral is required.
Q How much will I be paid?
A. Payments will be £3.00 per consultation that results in the supply of a pharmacy
first medicine/s. You will be reimbursed your drug costs at the agreed price.
56
Appendix 14
Model Receptionist Protocol
This protocol is for use by all persons dealing with requests for appointments and/or
prescriptions either by the patient in person or by telephone.
For patients making an appointment by telephone or in person:
a. Patients exempt from prescription charges, where considered appropriate and
practical, may be informed that there is a new scheme in operation where patients
can be referred to a local pharmacist for advice and medicine rather than waiting for
an appointment. Normal exemptions from prescription charges will apply.
b. If the patient is present then they should be given a Pharmacy First information
leaflet to take to one of the participating pharmacies.
c. If a patient refuses transfer an appointment should be made for them with the
Doctor in the usual manner.
For Patients Self Referring at the Pharmacy
Some patients will go straight to the Pharmacy to join the Scheme. The Pharmacist is
required to be satisfied of the patient’s registration with a participating surgery. If the
patient does not have evidence with them of registration with a participating practice,
the pharmacist should not consider the patient for treatment within the scheme.
Therefore where confirmation cannot be provided, the patient will not be entitled to use
the scheme.
Referral from Pharmacy
On some occasions the Pharmacists may consider that the patient needs to be seen by a
doctor. In most cases patients should be requested to make a routine appointment with
their GP. If the patients presents at the pharmacy with similar symptom however the
Pharmacist will refer the patient back to the surgery using the urgent referral form
(appendix 5) which will be given to the patient and a copy faxed to the GP practice,
together with the advice to seek an appointment at the surgery. Sometimes if the
surgery is closed the Pharmacist may advise the patient to call the emergency number
or go straight to A & E
57
Appendix 15
Clinical Governance Implications
for pharmacies providing a Minor Ailment Service.
The pharmacist and the pharmacy staff should be clinically competent in the treatment
of the minor ailments included in the scheme. It is through continuing education and
CPD that this competency can be maintained.
As the pharmacy manager/owner may not be present at the pharmacy every day, they
must ensure that all support staff, including part-time and locum pharmacies are fully
briefed on the services being provided. Staff appraisals should be conducted regularly
to ensure personal development for the staff and adequate training should be provided
to them. An induction period for locum pharmacists would be advisable.
Pharmacist should have relevant sources of references in the pharmacy which should be
available to all appropriate staff. The pharmacy should be equipped with up to date
computerised PMR facilities. A facility to record interventions, conversations with
prescribers, carers and patients should ideally be available on the PMR. All support
staff should be familiar with the PMR and associated programmes.
Standard operating procedures related to the safe operation of the pharmacy should be
written so that support staff, particularly part-time and locum pharmacists, are aware of
the standards to which they are expected to perform. The procedures should include
error and near miss reporting.
The staff and responsible pharmacist should be able to reflect on their practice, and
continually endeavour to improve their practice. The pharmacist should regularly
perform an audit cycle on procedures to ensure robustness and enable continuous
improvement.
The practice in the pharmacy should reflect the safety, confidentiality and views of
patients.
Adapted from:
 Anon. Community pharmacy medicines management: a resource pack for
community pharmacists. The community pharmacy medicines management project
2003. Available at www.medicinesmanagement.org.uk/.
58
Appendix 16
Department of Health Publications
PO Box 777
London
SE1 6XH
Tel: 08701 555 455
Fax: 01623 724 524
Email: doh@prolog.uk.com
Text phone: 08700 102870
All of these publications are free of charge. When asking for specific guides the DOH person will
confirm availability and cost implications where necessary.
Current Publications available in conjunction with Minor Ailments Scheme
Head Lice
Influenza 2004
Pubic Lice/Scabies (Sexual Health)
The NHS self-help guide
Vaginal Thrush
Discontinued publications not being updated
Cystitis
59