Guidance for GPs on who to refer to Pharmacy First Scheme

CRITERIA FOR REFERRING A PATIENT TO THE PHARMACIST FOR THE MANAGEMENT AND TREATMENT OF THE FOLLOWING MINOR AILMENTS
CONSTIPATION
Refer the patient to the pharmacist if they present with uncomplicated, acute constipation for duration of less than 7 days and they have not tried anything to treat it.
LOW BACK PAIN
Refer the patient to the pharmacist if they present with low back pain where any serious underlying causes have been excluded and high strength analgesic medication is not currently indicated.
ATOPIC ECZEMA
Refer any patient over the age of 12 to the pharmacist if they present with mild to moderate uninfected atopic eczema which presently could be managed with emollients and/or a mild topical steroid.
Advise the patient to return if the rash does not resolve after 7 days of treatment with an over the counter product
SORE THROAT
Refer the patient to the pharmacist if they present with a sore throat which is likely to be viral in origin and has lasted for less than 2 weeks and where all red flag symptoms and causes have been excluded.
FEVER IN CHILDREN OVER THE AGE OF SIX MONTHS
Refer to the pharmacist if the child is over the age of 6 months and have a fever which is likely to be of viral origin and where any serious underlying causes have been excluded.
Advise the parent/carer to return with the child if the fever has not resolved within 5 days OR earlier if any red flag symptoms develop
HEARTBURN AND INDIGESTION
Refer the patient to the pharmacist if they present with acute symptoms of indigestion and/or heartburn once any serious underlying causes have been excluded.
Advise the patient to return if symptoms do not resolve within two weeks or earlier if there is any deterioration of symptoms or any red flag symptoms develop.
7. COUGH
Refer the patient to the pharmacist if they present with an uncomplicated cough which is viral in origin and does not require antibiotics or further investigation.
8. SPRAINS AND STRAINS
Refer the patient to the pharmacist if they present with a simple strain or sprain which does not currently require further investigation and can be managed with simple oral and/or topical analgesics
9. HEADACHES AND MIGRAINE
Refer the patient to the pharmacist if they present with an uncomplicated headache of less than three days duration, which has not been treated with over the counter medication on a regular basis
10. ACNE
Refer the patient to the pharmacist if they have mild to moderate acne which can be
managed by over the counter products.
All patients referred to the pharmacist should be given the appropriate Patient Information Leaflet and READ coded as 8HHm (‘Patient referred to Community Pharmacist’).

Things that Patients can get from Chemist instead of GP

The General Medical Council (GMC) advise that prescribers should only prescribe drugs to meet the identified needs of patients and never for their own convenience or simply on patient demand.

Declining patient requests from the outset may deter patients from making similar future demands (for example requests for simple analgesia or for antibiotics for viral infections).

List of Medications Available OTC which are not recommended for routine prescribing at first presentation to the GP

Constipation - Fybogel sachets, Senna tablets, Lactulose solution, Bisacodyl tablets, Sodium Picosulfate
Diarrhoea - Dioralyte sachets, Loperamide capsules
Indigestion/heartburn - Peptac, Gaviscon, domperidone 10mg tablets, ranitidine
75mg, omeprazole 10mg
Threadworms - Ovex (mebendazole) tablets, Pripsen sachets
Haemorrhoids - Anusol cream, Anusol suppositories, Anusol HC cream
Mouth Ulcers - Corsodyl mouthwash, Bonjela adult, Difflam spray
Cold Sores - Aciclovir cream 2%
Sore Throat - Soluble aspirin, Throat lozenges
Athletes Foot - Miconazole cream, Miconazole powder, Terbinafine cream (Lamisil)
Acute pain relief – Paracetamol, Co-codamol 8/500mg, Ibuprofen, Paracetamol suspension, Ibuprofen suspension 100mg/5ml
Warts & verrucas - Cuplex gel, Bazuka gel, Salactol wart paint Head lice - Hedrin lotion, Derbac M, Lyclear rinse
Hay fever/allergies - Loratadine tablets, Beclometasone nasal spray, Sodium cromoglicate eye drops, Chlorphenamine tablets/syrup

Whats included in the scheme?

Allergies
Chlorphenamine 4mg tablets (30) Chlorphenamine 2mg/5ml syrup (150ml) Loratadine 10mg tablets (7) Loratadine 5mg/5ml syrup (100ml)
12 years+
1 year+(up to 12yrs) 12 years+
2 years+(up to 12 yrs)
Supply once only per card

Bites and Stings
Loratadine 10mg tablets (7) Loratadine 5mg/5ml syrup (100ml)
12 years+
2 years+(up to 12 yrs)
Supply once only per card (evidence needed)

Hayfever
Chlorphenamine 4mg tablets (30) Chlorphenamine 2mg/5ml syrup (150ml) Loratadine 10mg tablets (7) Loratidine 10mg tablets (30) Loratadine 5mg/5ml syrup (100ml) Sodium Cromoglycate 2% eye drops (10ml) Beclomethasone nasal spray (200)
12 years+
1 year+ (up to 12yrs) 12 years+
12 years+
2 years+(up to 12 yrs) 16 years+
Redirect to GP after 2 supply per hayfever season (March to Sept) (not to be repeated )
Colds/Flu temperature/fever (children only)
Paracetamol 500mg tablets (32) Paracetamol 120mg/5ml SF suspension (100ml) Paracetamol 250mg/5ml SF suspension (100ml) Ibuprofen 200mg tablets (24) Ibuprofen 100mg/5ml SF suspension (100ml)
12 years+
3 months+ (up to 6 yrs) 6 years +(up to 12 yrs) 12 years+
6 months+ (up to 12 yrs)
Supply twice only in 3 months

Cold sores
Aciclovir 5% cream (2g)
2 years +
Twice only in 6 months

Nasal Congestion
(for babies under 1 year)
Sodium chloride 0.9% nasal drops (10ml)
Under 1 year only
Twice only in 6 months

Conjunctivitis
Chloramphenicol eye drops 0.5% (10ml)
2 years+
Once only per card then refer
Constipation
Senna tablets (20)

12 years+
Once only per card

Cystitis
Sodium citrate sachets (6) Potassium citrate sachets (6)

16 years+ 16 years+
Once only per card
Diarrhoea
Loperamide (diah-limit) 2mg capsules (6) Electrolyte sachets (6)

12 years+ 2 years +

Once only within 2 months
Indigestion / Heartburn
Gaviscon® liquid (150ml) Gaviscon® 250 tablets (16) Ranitidine 75mg tablets (6)

16 years+ 16 years+ 16 years+
Twice only within 3 months

Pain Relief
(inc. back ache: toothache:headache & sore throat
Paracetamol 500mg tablets(32) Paracetamol 120mg/5ml SF suspension (100ml) Paracetamol 250mg/5ml SF suspension (100ml) Ibuprofen 200mg tablets (24) Ibuprofen 100mg/5ml SF suspension (100ml)

12 years+
3 months+(up to 6 yrs) 6 years+ (up to 12 yrs) 12 years+
6 months+ (up to 12 yrs)
twice only within 3 months

Vaginal Thrush
Clotrimazole cream 2% (20g) Clotrimazole 500mg pessary (1) Fluconazole 150mg capsule (1)

16-60 years 16-60 years 16-60 years
Supply once only within 2 months then refer

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