Care at the Chemist
South Tyneside PCT
September 2005
Care at the Chemist
Service Specification
1. Introduction
a) This service is available to all patients registered with surgeries in South Tyneside
PCT.
b) Patients are at liberty to refuse this service.
c) The service is only available for those minor ailments using the medicines
identified as treatments in Appendix 1
d) Only Community Pharmacies that are committed to provide the service and
pharmacists who have successfully completed the appropriate training will be
included in the “Care at the Chemist” scheme with South Tyneside Primary Care
Trust.
2. Transfer of Care
a) All patients presenting with identified symptoms at a participating South Tyneside
PCT GP practice will be offered transfer into this service
b) All patients presenting at the Community Pharmacist will receive the service level
of care as laid out in this specification providing they can prove they are registered
with a participating South Tyneside GP practice.
c) All patients self referring into this service or being referred by other agencies, e.g.
NHS Direct, will receive the service level of care as laid out in this specification,
providing they can prove they are registered with a participating South Tyneside
GP practice.
3. Duties of Participating Surgeries
a) All patients requesting a consultation with their GP (either immediately or on an
appointment basis) for symptoms matching criteria identified in this service will be
offered transfer to this service
b) Patients, presenting in person and accepting transfer, may be issued with a
service information leaflet and a list of participating Pharmacies will also be
available.
c) Those patients accepting transfer by phone will be advised to take evidence of
identity to one of the participating pharmacies. In the absence of a NHS card, or
record on the pharmacy computer, the pharmacy will telephone the surgery to
confirm registration.
d) All surgeries should co-operate and liaise with Community Pharmacists to activate
rapid referral procedure when required
e) All participating GP surgeries should display official posters and provide leaflets
promoting the service.
4. Duties of participating accredited Community Pharmacists
a) Patients should only be accepted into the service if they present one of the
following



Evidence of registration with the participating GPs
The details of their GP are already available on the pharmacies computer
system
Identification combined with verbal confirmation of registration by the
surgery.
b) All participating pharmacists shall provide a professional consultation service for
patients who are registered with a participating GP when presenting with one of
the specified conditions.
c) The accredited Pharmacist or appropriate member of staff will assess the patient’s
condition (for Stop Smoking services only Pharmacist Intermediate Advisers or
Pharmacists on behalf of staff who are accredited Intermediate Advisers will be
allowed to prescribe NRT). The consultation will consist of



Patient assessment
Provision of advice
Provision of a medication from the agreed formulary appropriate to the
patients condition, if required, dispensed with a computer generated label to
ensure the pharmacy has an audit trace
d) Normal rules of patient confidentiality apply
e) The Pharmacist should ensure that the patient has completed and signed the
declaration of exemption of prescription charges on the back of the recording form
f) Implementation of the rapid referral process if symptoms meet agreed criteria
within each conditions protocol.
g) If a patient presents more than twice within any month with the same symptoms
the pharmacist should make a professional decision as to whether the patient
should be referred to their surgery or continued treatment via the Care at the
Chemist scheme is appropriate. Unless the symptoms meet the criteria for a rapid
referral the patients should be advised to make an appointment in the normal way.
5. Service funding and payment mechanism
The Pharmacy will be paid according to the following schedule for providing the
service
a) A fee of £75 will be paid for participating in the scheme.
b) A fee of £3.00 will be made for each Pharmacist Prescription form that is
completed
c) The provision of advice only will be counted in the above totals provided the
Pharmacist Prescription form is completed to indicate that advice only was given.
d) The pharmacist will be reimbursed for any medication supplied under the scheme
at the agreed cost price
e) Claims for payment for drugs supplied in a particular month should be made by the
5th working day of the following month using the Monthly Claims Summary Form
(appendix 2). Failure to do so may delay payment.
f) The Monthly claim form (appendix 2) must be accompanied by copies of the
recording forms Pharmacist Prescription Forms
g) Incomplete forms will be deemed invalid and the payment detailed in 5(e) will not
be made.
h) Payments will be made to the participating pharmacy by cheque or BACS at the
end of the month following that to which the payment relates
6.Termination of Service
a) Either party may terminate this agreement by providing written notification of their
intention to do so. A notice period of 28 days shall be given.
b) When such notice is given, the PCT reserves the right to reclaim the service fee
detailed in part 5(a) on a pro rata basis.
Please sign one copy of this SLA sheet and return it to Kathryn
Featherstone at the PCT before September 5th 2005
I agree to the terms and conditions detailed in this document.
Signed………………………………………………..
Pharmacy……………………………………………..
……………………………………………..
……………………………………………..
Date……………………
Please sign one copy of this SLA sheet and return it to Kathryn
Featherstone at the PCT before September 5th 2005
I agree to the terms and conditions detailed in this document.
Signed………………………………………………..
Pharmacy……………………………………………..
……………………………………………..
……………………………………………..
Date……………………
Appendix 1
Minor Ailments and Formularies
Cough
Definition/Criteria
Coughing arises as a defensive reflex mechanism.
Criteria for Inclusion
Dry, tickly or painful cough requiring soothing
Chesty, productive cough
Criteria for Exclusion
Patients under 1 year.
Action for excluded patients & non-complying patients
Refer to GP
Recommended Treatments
Dry, tickly
Simple Linctus s/f (200ml)
Simple Linctus Paediatric s/f (200ml)
Dry, painful Pholcodine Linctus s/f (200ml)
Pholcodine Linctus Paediatric s/f (200ml)
Chesty ,
productive cough
GSL 5-10ml QDS
GSL 5-10ml QDS
P 5-10ml QDS
P 5-10ml QDS
Simple Linctus s/f (200ml)
GSL 5-10ml QDS
Simple Linctus Paediatric s/f (200ml) GSL 5-10ml QDS
Side effects
Constipation is possible with pholcodine
When & How to refer to GP
Conditional referral:
 If cough and other symptoms persist beyond one week the patient should
consult the GP.
Consider supply, but patient advised to make an appointment to see GP:
 A persistent, dry, night time cough in children
 A dry cough in a patient prescribed an ACE Inhibitor
 An asthmatic with a chesty cough
 A third request within 1 month
Rapid referral:
 Chest pain
 Difficulty breathing
 Green or rusty sputum
Headache / Earache / Fever
Definition / Criteria
Pain is very subjective; the nature and location may vary considerably.
Criteria for Inclusion
Patients requiring relief of pain / fever associated with an URTI.
Patients requiring relief of pain / fever associated with teething and earache
Children aged over 2 months who have received vaccinations / immunisations
Criteria for Exclusion
Children under the age of 3 months, except for children aged over 2 months who have
received vaccinations / immunisations.
Action for excluded patients & non-complying patients
Refer to GP
Recommended Treatments
Paracetamol 120mg/5ml s/f suspension (200ml) 1-6yrsP
5-10ml QDS prn
Paracetamol 250mg/5ml s/f suspension (200ml) 6-12yrsP 5-10ml QDS prn
Paracetamol 500mg tablets (32)
P
1-2 QDS prn
Ibuprofen suspension s/f 100mg/5ml (100ml)
P
1-2 yrs, 2.5ml T/QDS prn; 3-7 yrs, 5ml T/QDS prn; 8-12yrs, 10ml T/QDS prn;
Ibuprofen 400mg tablets x24
P
1 TDS prn
Cautions
Ibuprofen should only be used where asthma and GI problems have been excluded
and should be taken after food.
Follow-up and Advice
Enquire about concurrent analgesic usage:
 Paracetamol daily dose – other products containing paracetamol
 Other NSAIDs – prescribed or OTC
Rest, warming, cooling or changing position, may obtain relief from pain. Patients
should be advised to avoid any aggravating factors.
Fever should also be treated with temperature reducing methods such as tepid
bathing.
When & How to refer to GP
Conditional referral:
 If symptoms persist for more than 1 week, patient should consult GP.
Consider supply, but advise patient to make appointment with GP:
 Three requests within 1 month
Rapid referral:
 Earache lasting over 24 hours or which is unresponsive to analgesics
 Fever lasting more than 24 hours in a child with no other symptoms
 Any possibility of meningitis
Meningitis
Check for additional symptoms in case meningitis may be present.
Meningitis Check Sheet
This is a rare illness, causing inflammation of the brain lining, which can be fatal.
Symptoms can be mistaken for flu or a bad cold and it is more difficult to be certain
with babies or children. If unsure, refer to GP urgently.
Symptoms
These can appear in any order and not everyone gets all the symptoms. A fever may
not be present in the early stages, especially with infants under 2 years.









Babies under 2 years
They can be difficult to wake
Their cry may be high-pitched
and different from normal
They may vomit repeatedly,
not just after feeds
They refuse feeds, either from
bottle, breast or spoon
Their skin may appear pale or
blotchy, possibly with a red or
purple rash, which does not
fade when you press a glass
tumbler or finger against it
The soft spot on top of the
baby’s head (the fontanelle)
may be tight or bulging
The baby may seem irritable
and may dislike being handled
The body may be floppy or
else stiff with jerky movements
There may or may not be a
fever (especially in the early
stages)




Older children
Constant, generalised headache
High
temperature,
although
hands & feet may be cold
Vomiting

Stomach pain, sometimes with
diarrhoea
A rash of red or purple spots or
bruises, which does not fade
when a glass tumbler or finger is
pressed against it. Rash may not
be present in the early stages
Neck stiffness; moving the chin to
their chest will be very painful at
the back of the neck
Joint or muscle pain

Drowsiness


Confusion
Sensitivity to bright
daylight or even TV
Rapid breathing



lights,
Sore Throat
Definition / Criteria
A painful throat, which is often accompanied by a viral illness.
Criteria for Inclusion
Sore throat , which requires soothing.
Criteria for Exclusion
Children under 3 months
Patients allergic to aspirin should use paracetamol.
Pregnant women should use paracetamol.
Action for excluded patients & non-complying patients
Refer to GP
Recommended Treatments
Aspirin 300mg Soluble tablets (32)
P (adults only) 1 QDS prn
Paracetamol 500mg tablets (32)
P
1-2 QDS prn
Paracetamol 120mg/5ml s/f suspension (200ml) 1-6yrsP
5-10ml QDS prn
Paracetamol 250mg/5ml s/f suspension (200ml) 6-12yrsP
5-10ml QDS prn
Follow-up and Advice
Patients should be advised to gargle with the dissolved aspirin and then swallow.
Patients should avoid smoky or dusty atmospheres and reduce or stop smoking.
Patients who find swallowing painful should be on a light fluid diet.
Aspirin should only be used where asthma and GI problems have been excluded.
Enquire about concurrent analgesic usage:
 Paracetamol daily dose – other products containing paracetamol, prescribed or
OTC
 Other NSAIDs – prescribed or OTC
When & How to refer to GP
Conditional referrals:
 If symptoms persist for more than 1 week, the patient should consult GP
Consider supply, but patient advised to make appointment with GP
 Difficulty swallowing
 Symptoms suggesting oral candidiasis / tonsillitis
 Patients on immunosuppressants / oral steroids
 The condition has persisted for more than 1 week
 A second request within 1 month
Rapid referral:
 Patients who are unable to swallow
 Patients on carbimazole.
 Patients unable to open mouth
Nasal Congestion
Definition/Criteria
Blocked nose associated with colds and upper respiratory tract infections
Criteria for Inclusion
Congestion where seasonal allergy has been excluded
Criteria for Exclusion
Recurrent nosebleeds;
Patients taking Mono Amine Oxidase Inhibitors should not use topical or systemic
decongestants.
Action for excluded patients & non-complying patients
Refer to GP
Recommended Treatments
Sodium chloride nasal drops (0-2 years) (10ml) GSL 1-2 drops QDS prn
Xylometazoline Paed nasal drops (3mths-12yrs) GSL 1-2 drops BD prn
Menthol & Eucalyptus Inhalation (over 12 years) GSL use prn
Follow-up and advice
Patients should be advised to put 1 teaspoonful (5ml) of menthol & eucalyptus in a
pint of hot (not boiling) water and use a cloth / towel over the head to trap the steam.
Maximum use of topical decongestants is 7 days.
When & How to refer to GP
Consider supply but patient should be advised to make an appointment to see the
GP:
 A third request within 1 month
Supply of medication for the Management of Hay Fever Symptoms
Definition/Criteria
Seasonal allergy to plant pollen. Symptoms include nasal obstruction, sneezing, profuse rhinorrhoea,
nasal and ocular itch, and conjunctivitis.
Criteria for INCLUSION
Patients registered with a South Tyneside PCT surgery, presenting to a Community Pharmacist involved
in the Care at The Chemist project, with hayfever (seasonal rhinitis) requiring symptomatic relief
Criteria for EXCLUSION including contra-indications*
-
Patients under the age of 4 (except for use with Beclometasone nasal spray, which is 6 yrs)
Patients with known hypersensitivity to a particular product
Pregnancy is an exclusion criteria for oral preparations
Action for excluded patients & non-complying patients


Non-complying patients: counsel with regards to pros and cons of treatment
Patients with known hypersensitivity may be offered an alternative product (see below for choice)
Recommended Treatments, Route and Legal status*
Treatment Options
Route
Legal status
Dose
Quantity
Chlorpheniramine 4mg Tablets
po
P
1 TDS
up to 3x30
Chlorpheniramine 2mg/5ml Syrup
po
P
5ml TDS
1x150ml
Loratidine Tablets
po
P
1 OD
30
po
Loratidine Syrup 5mg/5ml
P
5ml Daily
Cetirizine 10mg Tablets
po
P
1 OD
30
Soium Cromogylcate 2% Eye Drops
topical
P
1 drop QDS
10ml
P
2 sprays BD
(per nostril)
200 dose
container
Beclomethasone 50mcg/spray Nasal Spray nasal
100ml
Dosage and Criteria*
Chlorpheniramine tablets}
Loratidine syrup & Tabs }
Cetirizine tablets
}
Chlorpheniramine syrup}
Oral antihistamines are suitable for the majority of patients particularly when a variety of symptoms are
present. Chlorpheniramine causes drowsiness, which has been reported as problematic by 14% of the
population in one paper. This effect is short lived as tolerance develops after a few days. Patients should
start taking chlorpheniramine in the evening for the first couple of days in order to see whether they will
be affected. Cetirizine & Loratidine are useful alternatives when drowsiness is a problem.
PRN use of most antihistamines is acceptable for many patients who only experience symptoms in the
morning or night and not necessarily both. Consequently a once daily administration regime is not
always required.
Sodium Cromoglycate:
Eye drops
Sodium cromoglycate gives prompt relief and should be used on its own when ocular symptoms
predominate or as an adjunct to oral antihistamines when the latter fail to control ocular symptoms.
Beclomethasone:
Nasal Spray
Intranasal beclomethasone should be used on its own when nasal symptoms predominate or as an
adjunct to oral antihistamines at times of high pollen counts when antihistamine cover is inadequate.
Avoid in patients using steroid inhalers for asthma or COPD. Use in children under the age of 6 is
excluded.
Frequency of administration & maximum dosage*
As above. Medication issued monthly for a maximum of 3 months.
Follow-up & advice
-
Pollen avoidance measures
Not to exceed maximum doses
Chlorpheniramine may cause drowsiness; cetirizine and loratidine may very rarely cause
drowsiness. If affected do not drive or operate machinery. Avoid alcoholic drink.
Possible interactions with Cetirizine or Loratidine, patient should be advised to inform
GP/Pharmacist if prescribed any other medication.
Side effects and their management*
Chlorpheniramine Tabs & syrup:
Cetirizine Tablets:
Loratidine syrup & Tabs:
Sodium Cromoglycate Eye Drops:
Beclomethasone Nasal Spray:
Most common drowsiness. Less commonly GI disturbances.
Rarely fatigue, nausea and headache.
Rarely fatigue, nausea and headache.
Transient stinging and burning may occur after instillation.
Dryness and irritation of the nose & throat. Unpleasant taste and smell.
When & how to refer to GP
Conditional referral:
Pregnancy:
Patient should consult the GP if treatment is ineffective or persists beyond 3 months.
If essential, consider supply of topical preparation, but advise patient to make an
appointment to see the GP.
Facilities & Supplies
*The summary of product characteristics for the individual product to be used should always be checked
prior to administration.
Special considerations/Concurrent medication
Glaucoma (antihistamines contra-indicated)
Patients on anti-arrhythmic drugs (antihistamines contra-indicated)
Patients using steroid inhalers should not receive beclomethasone nasal spray
SOUTH TYNESIDE PCT Monthly Claims Form
Drug
Cost price (A)
Aspirin 300mg Soluble Tablets x32
Beclomethasone Aqueous Nasal Spray 1x200pack
Cetirizine 10mg Tablets x30
Chlorpheniramine 4mg Tablets x30
Chlorpheniramine Syrup 2mg/5ml x150ml
Ibuprofen 400mg Tablets x24
Ibuprofen SF suspension x100ml
Loratidine 10mg Tablets x30
Loratidine Syrup x60ml
Menthol & Eucalyptus Inhalation x100ml
Paracetamol 120mg/5ml SF Suspension x200ml
Paracetamol 250mg/5ml SF Suspension x200ml
Paracetamol 500mg Tablets x32
Pholcodine Linctus BP x200ml
Pholcodine Linctus Paediatric BP x90ml
Simple Linctus BP x200ml
Simple Linctus Paediatric BP x200ml
Sodium Chloride 0.9% Nasal drops x10ml
Sodium cromoglycate Eye Drops x10ml
Xylometazolone Paed Drops x10ml
Oral Syringe
Month…………………………….
Number Dispensed (B)
Claim A x B
27p
£3.00
£5.01
50p
£2.28
80p
£1.82
£2.50
£2.28
58p
84p
£1.10
39p
80p
£1.11
57p
67p
£1.42
£2.85
£1.59
50p
No. of Pharmacist prescriptions submitted
Drug Costs (Claim A x B)
+ Consultation Fees (No. of forms x £3)
- Rx fees collected
Total Claimed (X)
I certify this claim is accurate and the items supplied are in accordance with
the Care at the Chemist Scheme.
Pharmacy Stamp
Name………………………………………………
Signed……………………………………………..Date……………………………
…
Amount Claimed - Minor Ailments (X)
Total Claimed – Smoking Cessation (Y)
(only Pharmacies with trained Intermediate
Advisers may prescribe)
Total Claimed for
Month ……………………….
(X +Y)
Please send this claim form, with prescriptions, to Marion Tate, South Tyneside PCT, Clarendon,
Windmill Way, Hebburn NE31 1AT by the 5th working day of the month.
Smoking Cessation (only for Intermediate Smoking Cessation Advisers)
Drug
Cost price (C)
Nicotine 21mg/24 hours patches x7
(Nicotinell first choice)
£9.97
Nicotine 14mg/24 hours patches x7
(Nicotinell first choice)
£9.97
Nicotine 7mg/24 hours patches x7
(Nicotinell first choice)
£9.97
Nicotine 15mg/16 hours patches x7
(Nicorette, only if patient pregnant)
Nicotine 10mg/16 hours patches x7
(Nicorette, only if patient pregnant)
Nicotine 5mg/16 hours patches x7
(Nicorette, only if patient pregnant)
Nicotine 2mg lozenges sugar free x72
(Niquitin CQ)
Nicotine 4mg lozenges sugar free x72
(Niquitin CQ)
Nicotine 2mg medicated chewing gum
sugar free x 105 pieces
Nicotine 4mg medicated chewing gum
sugar free x 105 pieces
Nicotine 2mg sublingual tablets x105
£9.07
Nicotine 10mg inhalation cartridges with
device x 42
Nicotine 500micrograms/actuation nasal
spray
£11.37
Number Dispensed
(D)
Claim C x D
£9.07
£9.07
£9.97
£9.97
£8.89
£10.83
£9.84
£10.99
No. of Pharmacist prescriptions submitted
No. Of NRT Vouchers submitted
Drug Costs (Claim C x D)
+ Prescription Consultation Fees (No. of smoking
cessation Rx forms x £3)
+ Voucher Dispensing Fee @ £1
- Rx fees collected
Total Claimed (Y)
I certify that I am an accredited and approved Intermediate Adviser with
Gateshead & South Tyneside Smoking Cessation Service.
Name………………………………………………
Signed……………………………………………..Date……………………………
…
Page 2
Care at the Chemist Scheme
Appendix 3: Pharmacist to GP Rapid Referral Form
Patient Name:
Patient Address:
Dear Doctor
Please see this patient for an appointment today.
Reason for rapid referral:
Pharmacy stamp
Surgery Contacted?
Yes/no
Name of person spoken to…………………
Appointment given?
If yes what time?
Pharmacist Signature:
Date:
Yes/no