Download Minor_Ailments_Service_Spec_Final_updated_june_09

Pharmacy First
Minor Ailments Scheme
Service Specification and
formulary
December 2007
1
2
CENTRAL LANCASHIRE PRIMARY CARE TRUST
PHARMACY FIRST
A Minor Ailments Scheme through Community Pharmacies
Index
Page
Introduction
Better Management of Minor Ailments
Aims of the Service
Service Details
1. Who can access the service
2. Referral into the service
3. Patient Registration and Pharmacy First Passport
4. Consultations
5. Rapid Referral and Routine Referral to GP Practice
6. Supplying treatment through Pharmacy First
7. When not to supply treatment through Pharmacy First
8. When to sell and when to supply through Pharmacy First
Service Requirements
1. Who can provide the service
2. Pharmacist and Pharmacy Staff Accreditation
3. Sign up and termination
4. Display
5. Record Keeping
6. Payments
Generic List of Competencies required to Provide a Minor Ailment Scheme
Clinical Governance Implications in Providing a Minor Ailment Scheme
Appendix 1 Key Points for Participating Surgeries
Appendix 2 Model Receptionist Protocol
Appendix 3 Formulary and Ailments
Appendix 4 Pharmacy First: Patient Passport
Appendix 5 Pharmacist First: Consultation Form
Appendix 6 Rapid Referral Form
Appendix 7 Repeated Requests Form
Appendix 8 GP Practices Participating in Pharmacy First
Appendix 9 Pharmacies Participating in Pharmacy First
Appendix 10 Consultation Decision Pathway (locum guide)
Appendix 11 Minor ailment Protocols and Minor Ailment Index
5
5
6
7
7
7
8
9
9
10
11
12
12
12
12
13
13
14
16
17
18
19
20
21
23
24
25
28
31
32
3
4
PHARMACY FIRST
A Minor Ailments Scheme through Community Pharmacies
INTRODUCTION
Building on the success of the minor ailments schemes in operation in the former
Preston PCT and Chorley & South Ribble PCT, Central Lancashire PCT has
reviewed, standardised and developed the existing schemes to produce a new minor
ailment scheme called Pharmacy First.
The first phase of implementation of the Pharmacy First Minor Ailment Scheme will
commence in December 2007 in the West Lancashire Locality. The second and
final phase of implementation will occur In January 2008 across the Chorley, Preston
and South Ribble localities. Therefore, by February 2008 every pharmacy contractor
across Central Lancashire PCT will be providing the new Pharmacy First Minor
Ailment Scheme.
1. Better Management of Minor Ailments
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.
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.
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.
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.
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.’
5
AIMS OF THE SERVICE
The service is designed to meet the following aims for:
1. Patients
 Reduce waiting times
 Improve access to advice
 Offer an alternative to a GP consultation
 Remove anxiety about 'bothering the doctor'
2. GPs
 Reduce inappropriate consultations
 Increase time for tasks that really need medical input
 Help achieve access targets
3. Pharmacists
 Provide an opportunity to work more closely with the primary healthcare
team and raise the profile of community pharmacy
 Make better use of professional skills
6
SERVICE DETAILS
1. Who Can Access The Service?
1.1
The service will be offered to any patient registered with a GP practice in
Central Lancashire PCT, see appendix 8, and who presents with symptoms of
a minor ailment listed in appendix 3.
1.2
Patients registered with either GP practice in Longridge, (Berry Lane Medical
Centre or Stonebridge Surgery, East Lancs PCT), may receive treatment for
the conditions and with the medicines listed under this service following a
consultation in any pharmacy across Central Lancashire PCT.
Documentation and reimbursement requirements are identical to that of all
other patients managed under this service.
1.3
Patients registered with any GP practice in Central Lancashire PCT may
receive treatment for the conditions and with the medicines listed under the
East Lancashire Minor Ailment scheme following a consultation in either
pharmacy in Longridge (Co-op Stonebridge or Lloyds Berry Lane).
1.5
Patients, who are not registered with a GP in Central Lancashire PCT,
excluding Longridge practices, may opt to purchase Over the Counter
medication and should therefore be managed in accordance with Essential
Service 6 – Support for Self Care or if appropriate Essential Service 5 –
Signposting.
1.6
Patients are at liberty to refuse this service.
2. Referral into the Service
Patients can be referred into the scheme through any of the following 3 routes:
2.1
Referral by GP practice or other healthcare professional
Patients presenting at a participating GP surgery, Out of Hours, or Walk in
Centre with one of the minor ailments listed in appendix 3 may be advised of
the scheme and how to access it through their local pharmacy. Surgeries etc
should note that patients who are not exempt from prescription charges will
be required to pay for any medication supplied.
2.2
Patient Self- Referral
Patients, who are aware of the scheme, whether through friends, relatives or
a healthcare professional can self refer into the service.
2.3
Pharmacy Referral
Pharmacists and pharmacy staff may refer patients into the scheme where
they feel it is appropriate.
3. Patient Registration and use of the Pharmacy First Passport
3.1
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:
7
 Evidence produced by the patient of registration with a participating GP
practice e.g. repeat prescription tear-off slip or NHS card.
 Pharmacy PMR record showing evidence of a prescription dispensed
in the last 6 months.
 The pharmacist may also telephone the surgery to confirm registration.
3.2
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.
3.3
Once established that the patient is registered with a participating GP
practice, the pharmacy will supply the patient with a Pharmacy First Passport
(appendix 4). The passport should be completed with the patient’s details,
the condition treated and medication supplied under the scheme. An entry
“Referred to GP; Repeated Requests” should also be made in the passport
when a patient has been referred to their GP because they have presented at
the pharmacy for the treatment of the same ailment for 3 or more occasions in
the past 6 months. The form in appendix 7 should be used to fulfil this
requirement.
3.4
Patients are required to present the Pharmacy First Passport at all
subsequent pharmacy consultations under the scheme. Failure by the patient
to present the Pharmacy First Passport, if already registered, will result in
refusal of supply under the scheme.
3.5
The patient should be encouraged to use the pharmacy that normally
dispenses their prescriptions. Ideally this should also be the pharmacy that
originally issued the Pharmacy First Passport. However presentation of the
passport in association with a minor ailment consultation at another
participating pharmacy in Central Lancashire PCT is acceptable.
3.6
If the patient loses their Pharmacy First Passport then the pharmacy can
furnish the patient with another. However, if the patient repeatedly loses their
passport or regularly leaves it at home the pharmacist is entitled to refuse to
treat the patient under the scheme on the grounds of the patient not adhering
to the conditions of use, as detailed on the passport (appendix 4).
4. Consultation Process
4.1
The pharmacist or suitably trained member of the pharmacy staff should carry
out a professional consultation with reference to the appropriate minor ailment
protocol (appendix 11) which should involve:
 Patient assessment
 Provision of advice
 Provision of Pharmacy First Passport on initial registration and
a replacement when the original passport record section is full.
 Completion of ‘Pharmacy First’ consultation form. See appendix 5.
 Supply of appropriate medication from the agreed formulary
8
4.2
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, but is not a necessity.
4.3
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 5). This should occur each time
the patient accesses the scheme.
4.4
The consultation form must be signed by the pharmacist taking overall
responsibility for the supply of treatment even though a qualified Medicines
Counter Assistant may have undertaken the consultation (excluding
consultations for bacterial conjunctivitis, which the pharmacists must
undertake).
4.5
The consultation form should be sent to Lancashire and South Cumbria
Agency (LaSCA) as detailed under Service Requirements section 6
payments, page 13.
4.6
A copy of the consultation form may also be sent to the GP for information if
so requested by the GP.
4.7
The pharmacy consultation decision pathway is outlined in appendix 10 which
can be used by locums as a quick summary of the scheme.
5. Rapid Referral and Routine Referral of patient from the pharmacy to the GP
5.1
Rapid Referral from the Pharmacy to the GP
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 6) which allows patients to see their GP as soon as
possible.
5.2
Repeated Requests (frequent presentation of the same ailment)
At the pharmacist’s discretion, if a patient presents on 3 or more occasions in
6 months for the treatment of the same ailment, treatment should normally be
withheld and the patient should be referred to their GP for a routine
appointment using the form in Appendix 7. An entry, “Referred to GP;
Repeated Requests” should also be made in the patient’s Pharmacy First
Passport indicating that the patient has been referred to their GP. The GP
will notify the pharmacy of the outcome of the referral, which should also be
documented in the patient’s PMR and passport to complete the audit trail.
6. Supplying treatment through the Pharmacy First Scheme
The pharmacist should ensure that the patient is eligible for treatment within the
scope of the scheme.
6.2
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 contra-indicated and that the treatment provided is in accordance with
the minor ailment protocol.
9
6.3
Only the products listed, in the quantities stated, against the specific minor
ailment as indicated in appendix 3 and in accordance with the ailment
protocols in appendix 11 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.
6.4
The pharmacist must ensure that the patient is advised how to take/use the
medication and is provided with a Patient Information Leaflet at all times.
6.5
When supplying the medication an entry onto the patient’s PMR must be
made and the product labelled in the normal way.
7. When not to supply treatment through the Pharmacy First Scheme
7.1
Central Lancashire PCT fully supports any pharmacist who refuses to supply
a medicine through the Pharmacy First Scheme, if the medicine requested is
deemed to be clinically inappropriate. Other circumstances in which a
Pharmacy First medicine should not be supplied include:
 The patient has already received a recent supply of the same medicine
 At the pharmacist’s discretion, if a patient presents on 3 or more
occasions in 6 months for the treatment of the same ailment, treatment
should normally be withheld and the patient should be referred to their GP
for a routine appointment using the form in Appendix 7. An entry should
also be made in the patient’s Pharmacy First Passport detailing that the
patient has been referred to their GP.
 If the pharmacist suspects the patient is abusing the scheme this should
be reported immediately to the PCT by contacting Stephen Gough on
01772 676179.
 The patient presents with more than 2 ailments (refer to GP if warranted)
 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 registered with a
participating GP practice.
 The patient normally pays a prescription charge (these patients are not
excluded from the scheme, but may choose to purchase OTC medicines
rather than pay a prescription charge for a medicine supplied under
Pharmacy First)
 Patient or parent unwilling to complete/use Pharmacy First documentation
 Recent supply of the Pharmacy First medicine
 Medicine requested due to lost medicine
 Medicine requested ‘just in case’
 Medicine requested to take abroad
 Medicine requested to stock up medicine cabinet
 Medicine requested is in lieu of repeat prescription e.g. paracetamol for
chronic pain (chronic illness must remain to be managed by GPs)
7.2
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)
10
8. When to sell a treatment and when to supply Pharmacy First treatment
8.1
If a patient/customer requests to buy a product or a medicine to treat an
ailment listed in the Minor Ailment Scheme, then these patients/customers
should be sold the appropriate product.
8.2
In the following circumstances treatment should be supplied through the
Pharmacy First scheme:

If a patient has been referred from another healthcare professional or if
they have previously received treatment through the scheme.

If a patient asks (NOT DEMANDS) for a medicine through the scheme
because they have received a supply previously.

If a patient presents for advice on the treatment of an ailment, which is
covered under the pharmacy first scheme and could be satisfied by the
provision of a medicine available under the scheme, then a pharmacy
first medicine should be supplied.
11
SERVICE REQUIREMENTS
1. Who Can Provide The Service?
This service may be provided by any authorised community pharmacy within Central
Lancashire PCT, subject to the following:
1.1
The pharmacy contractor must agree with the PCT to participate in all parts of
the service as detailed in this document along with any subsequent
amendments as agreed with the LPC. This agreement will be in writing
signed by both parties and be considered an enhanced service.
1.2
A standard operating procedure (SOP) must be produced for the provision of
this service, which clearly defines roles and responsibilities of relevant staff
within the authorised pharmacy.
1.3
Medicines Counter Assistant qualified staff may be delegated to undertake
the minor ailment consultation provided they adhere to a minor ailment
scheme SOP and Sales of Medicines protocol. However overall responsibility
and accountability will remain with the responsible pharmacist.
2. Pharmacist and Pharmacy Staff Accreditation
No formal accreditation is required to deliver this service as only Over the Counter
Medication can be supplied as treatment. However the pharmacy must have a
Sales of Medicines Protocol and satisfy the core competencies and Clinical
Governance criteria listed on page 14-16.
3. Sign up and termination
3.1
All pharmacists and pharmacies must agree to the terms of service contained
within this service specification/service level agreement.
3.2
Participating authorised pharmacies may withdraw from the scheme at any
time and the PCT may also terminate provision from a pharmacy. Any such
intention must be made in writing to the same individual identified on the
Enhanced Service agreement form. A notice of 28 days applies.
3.3
If pharmacies withdraw from the scheme, then the pharmacist may continue
to provide the service from other authorised pharmacy premises located
within Central Lancashire PCT.
4. Display
All participating authorised pharmacies may be required to display posters and
leaflets indicating:
12


The availability of treatment through the minor ailment scheme from the
pharmacy.
The range of ailments covered by the Minor Ailment Scheme
5. Record Keeping
5.1
A record of any medication supplied through the minor ailment scheme
should be documented in the Patients Medication Record on the pharmacy IT
system.
5.2
Pharmacy contractors can also choose to keep a record of the medication
supplied through the minor ailment scheme, other than records on the PMR,
by photocopying The Monthly Summary Form detailed in Appendix 12. This
form is for internal use only and should not be submitted to LaSCA or the
PCT.
6. Payments
6.1
Pharmacy contractors will be reimbursed according to the following payment
structure:


*A consultation fee of £3.00 per ailment treated
The list price of the medication supplied (based on the drug tariff,
Chemist and Druggist or determined by the LPC), plus VAT. These
costs will be reviewed by the LPC every 6-12 months.
* Please note 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. Likewise no
consultation fee will be paid for minor ailment consultations that results in no
medication being supplied, this is an Essential Service under the pharmacy
contract (Essential Service 5 Signposting and Essential Service 6 Support for
Self-care), for which pharmacy contractors already receive payment.
Claims for payment should be made by the 5th working day of the following
month, late submission may delay payments, by submission of the
consultation form to Lancashire and South Cumbria Agency (LaSCA) at:
Contractor Services
Lancashire and South Cumbria Agency
3 Caxton Road
Fulwood
Preston
PR2 9ZZ
6.3
Payments will be made at the end of the 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.
13
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 & sound analysis, taking account of the patient’s
wishes.
 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.
14
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 prioritise 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
work-based experience, in support of minor ailments management.
 Record 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.
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 address 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.
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 pharmacits 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. 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/
16
Appendix 1
KEY POINTS FOR PARTICIPATING SURGERIES
1.
All patients requesting GP consultation for symptoms in keeping with one of
the minor ailments listed in appendix 3 should be considered for inclusion
and, if appropriate, directed as to how to access the scheme and be provided
with an information leaflet.
2.
Patients presenting in person to the GP surgery should be provided with the
patient information leaflet by the practice and advised to use the pharmacy
where they normally obtain their prescriptions.
7.
Surgeries should liaise with pharmacists to allow the rapid referral procedure
and repeated requests for treatment of the same ailment procedure from the
pharmacy to the GP to operate effectively (appendix 6 and 7).
8.
GP surgeries should endeavour to advertise the scheme using posters and
leaflets provided by Central Lancashire Primary Care Trust.
9.
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.
10.
Practices may find the model Receptionist Protocol helpful in supporting the
scheme.
17
Appendix 2
MODEL RECEPTION STAFF PROTOCOL
This protocol is for use by all persons dealing with requests for appointments either by the
patient presenting in person or by telephone.
For patients making an appointment at GP Practice:
A If the patient is suffering from one of the ailments included in the scheme, see overleaf.
The patient should be Informed of the scheme and asked if they would like to receive
treatment from the pharmacy where no appointment is required. If the patient accepts:
 They should be given the ‘Pharmacy First’ information leaflet, if presenting in person
 Be directed to a pharmacy for consultation and treatment
 If they are exempt from prescription charges they will receive medicines at the
pharmacy for free under the scheme
 If the patient normally pays an NHS prescription charge they can choose to buy the
medication or pay a prescription charge for medicines they receive under the
scheme
B If a patient prefers not to visit the pharmacy an appointment should be made for them
with the Doctor in the usual manner.
C if the patient is not suffering from one of the ailments included in the scheme 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. Consultation and supply
under the scheme will only be made if:



The pharmacist is satisfied that the patient is registered at the surgery by providing
such evidence as NHS card, dispensing records and repeat prescription slip. The
pharmacist may also telephone the surgery to confirm registration.
If registration cannot be confirmed the pharmacist will refuse to supply treatment
under the scheme and will therefore sell a product or refer the patient to the surgery
If a patient presents at the pharmacy with an ailment not covered by the scheme the
patient will be sold a product or be referred to the surgery to see the doctor.
Rapid Referral from the Pharmacy
On some occasions the pharmacist may consider that the patient needs to be seen by a
doctor. The urgency will depend on the symptoms. In the event of a patient needing to be
seen by a GP urgently, for example suspected meningitis, the pharmacist will refer the
patient back to the surgery using the Rapid Referral Form (appendix 6) 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.
Occasionally the pharmacist might refer the patient to the GP for a routine appointment
because the patient has attempted to receive treatment through the scheme for the same
ailment on 3 or more occasions in the last 6 months. In this scenario the form in Appendix 7
Repeated Request will be used to notify the practice.
Please Note:
1. NO PRESCRIPTION ONLY MEDICATION IS INCLUDED IN THE SCHEME
2. PATIENTS SHOULD NOT USE THE SCHEME IN LIEU OF REGULAR REPEAT PRESCRIBED
MEDICATION, SUCH AS PARACETAMOL FOR CHRONIC PAIN
3. THE MEDICATION LISTED CAN ONLY BE USED TO TREAT THE AILMENT LISTED OVERLEAF
18
Appendix 3
FORMULARY & AILMENTS LIST
MINOR AILMENT
MEDICINE
ALLERGIC RHINITIS
(INCLUDING HAYFEVER)
Cetirizine Oral Soln 5mg/5mL (150mL), Cetirizine 10mg Tablets (30),
Chlorphenamine 2mg/5mL Syrup (150mL), Chlorphenamine 4mg Tablets (30),
Sodium Cromoglycate 2% Eye Drops (10mL)
ATHLETES FOOT
Miconazole Cream (30g), Terbinafine 1% cream (7.5g)
BACTERIAL
CONJUNCTIVITIS
Chloramphenicol eye drops (p pack (10ml))
Chloramphenicol eye ointment (p pack (4g))
COLD SORES
Aciclovir 5% Cream (2g)
CONSTIPATION
Glycerin Suppositories 4g (12), Ispaghula Sachets (10), Lactulose solution
(300mL) Senna Tabs (20).
CYSTITIS
Paracetamol 500mgTabs (32), Potassium Citrate powders (6),
Sodium Citrate powders (6)
DERMATITIS
Aqueous Cream (500g), Cetirizine Oral Soln 5mg/5mL (150mL),
Cetirizine 10mg Tablets (30), Chlorphenamine 2mg/5mL Syrup (150mL),
Chlorphenamine 4mg Tablets (30), Emulsifying Ointment (500g),
Hydrocortisone Cream 1% (15g)
DIARRHOEA
Electrolyte sachets (6)
EARACHE AND MINOR
OUTER EAR INFECTIONS
Ibuprofen Suspension 100mg/5mL (100mL), Ibuprofen 200mg Tabs (24),
Paracetamol Suspension 120mg/5mL (100mL)
Paracetamol suspension 250mg/5mL (100mL), Paracetamol 500mg Tabs (32)
Acetic acid 2% spray (5mL)
FLU-LIKE SYMPTOMS
(COUGHS, COLDS,
FEVER)
Glycerine Lemon and Honey (200mL),
Ibuprofen Suspension 100mg/5mL (100mL), Ibuprofen 200mg Tabs (24),
Menthol and Eucalyptus Inhalation (100mL),
Normal Saline Nose Drops (10mL)
Paracetamol Suspension 120mg/5mL (100mL),
Paracetamol Suspension 250mg/5mL (100mL), Paracetamol 500mg Tabs (32),
Xylometazoline adult and paediatric Nasal Drops (10mL),
HEADACHE
Ibuprofen 200mg Tabs (24),
Paracetamol Suspension SF 250mg/5mL (100mL),
Paracetamol 500mg Tabs (32)
HEAD LICE
Dimeticone 4% lotion (50ml x2), Malathion 0.5% Aqueous Liquid or Lotion
(50mLx2), Phenothrin 0.5% Liquid or 0.2% Lotion (50mLx2),
INDIGESTION / REFLUX
Gaviscon Liquid (150mL), Magnesium Trisilicate Mixture (200ml)
INSECT BITES & STINGS
Cetirizine Oral Soln 5mg/5mL (150mL), Cetirizine 10mg Tablets (30),
Chlorphenamine 2mg/5mL Syrup (150mL), Chlorphenamine 4mg Tablets (30),
Crotamiton 10% cream (30g), Hydrocortisone Cream 1% (15g),
MOUTH ULCERS
Adcortyl in Orabase (5g), Chlorhexidine Mouthwash (300ml)
NAPPY RASH
Sudocrem (125g)
SCABIES
Cetirizine Oral Soln 5mg/5mL (150mL), Cetirizine 10mg Tablets (30),
Chlorphenamine 2mg/5mL Syrup (150mL), Chlorphenamine 4mg Tablets (30),
Malathion 0.5% Aqueous Liquid (50mLx2), Permethrin Dermal Cream (30g),
SORE THROAT
Aspirin Sol Tabs 300mg (16), AAA Throat spray (60 sprays),
Difflam Throat spray (30mL), Ibuprofen Suspension 100mg/5mL (100mL),
Ibuprofen 200mg Tabs (24), Glycerine Lemon and Honey (200mL),
Paracetamol Suspension 120mg/5mL (100mL),
Paracetamol Suspension 250mg/5mL (100mL), Paracetamol 500mg Tabs (32)
TEETHING
Calgel (10g)
THREADWORM
Mebendazole 100mg Tabs (2) (4)
THRUSH (not oral)
Clotrimazole 2% cream (20g), Clotrimazole Combi Pack (1), Fluconazole
150mg cap (1)
VERRUCAS / WARTS
Cuplex Gel 5g, Verrugon (6g),
19
Appendix 4 Pharmacy First Passport
20
Pharmacy First: Consultation Form
Appendix 5
1. Patient Details
Date of Consultation ……………………………..
Please print off bag label
and affix here detailing
Patient Name and
Patient Address
Date of Birth…………………………………….
GP Practice Name (e.g. The Lots-Better Surgery)
…………………………………………………………..
2. Referral Method
 GP Surgery
 Pharmacist
3. Minor Ailment
 Allergic Rhinitis (Hay fever)
 Athletes Foot
 Bacterial Conjunctivitis
 Cold Sores
 Constipation
 Cystitis
 Patient Self Referral
 Dermatitis
 Diarrhoea
 Earache/Outer Ear Infection
 Cough/Cold/Fever (Flu)
 Headache
 Head Lice
 Out of Hours
 Indigestion/Reflux
 Insect Bites/Stings
 Mouth Ulcers
 Nappy Rash
 Scabies
 Sore Throat
 Other
 Teething
 Threadworm
 Thrush (not oral)
 Verrucas/Warts
4. Formulary Item Supplied
 Adcortyl in Orabase (5g)
 AAA Throat spray x 1
 Acetic Acid 2% spray (5 ml)
 Aciclovir 5% cream (2g)
 Aqueous cream (500g)
 Aspirin sol tabs 300mg (16 )
 Calgel (10g)
 Cetirizine 10mg tabs (30)
 Cetirizine sol 5mg/5ml (150ml)
 Chloramphenicol eye drops (10ml)
 Chloramphenicol eye oint (4g)
 Chlorhexidine mouthwash (300ml)
 Chlorphenamine 2mg/5ml (150ml)
 Chlorphenamine 4mg tabs (30)
 Clotrimazole combi pack (1)
 Clotrimazole 2% cream (20g)
 Cuplex gel (5g)
 Crotamiton 10% cream (30g)
 Difflam Throat spray (30ml)
 Dimeticone 4% lotion (50mlx2)
 Electrolyte sachets (6)
 Emulsifying ointment (500g)
 Fluconazole cap 150mg (1)
 Gaviscon liquid (150ml)
 Glycerin suppositories 4g (12)
 Glycerin Lemon & Honey (200ml)
 Hydrocortisone cream 1% (15g)
 Ibuprofen 200mg tabs (24)
 Ibuprofen susp100mg/5ml (100ml)
 Ispaghula sachets (10)
 Lactulose soln (300ml)
 Magnesium trisilicate mix. (200ml)
 Malathion 0.5% Aq. liq.(50ml x2)
 Malathion 0.5% lotion (50ml x2)
 Mebendazole 100mg tabs (2)
 Mebendazole 100mg tabs (4)
Pharmacist Signature ……………..………………………….
Date ………………………………………………………………
 Menthol & Eucalyptus inh (100ml)
 Miconazole cream (30g)
 Normal saline nose drops (10ml)
 Paracetamol 500mg tabs (32)
 Paracetamol susp 120mg/5ml (100ml)
 Paracetamol susp 250mg/5ml (100ml)
 Permethrin dermal cream (30g)
 Phenothrin 0.5% liquid (50ml x 2)
 Phenothrin 0.2% lotion (50ml x 2)
 Potassium Citrate powders (6)
 Senna tabs (20)
 Sodium Citrate powders (6)
 Sodium cromoglycate 2% E/drops(10ml)
 Sudocrem cream (125g)
 Terbinafine 1% cream (7.5g)
 Xylometolazone adult N/drops (10ml)
 Xylometolazone paed. N/drops (10ml)
 Verrugon (6g)
Pharmacy Stamp
Please ensure exemption declaration overleaf is signed
21
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.
22
Appendix 6
Pharmacy First Minor Ailments Scheme
Pharmacist Rapid Referral Form
Patient Name
.......................................
GP Name
………………………….
Patient’s D.O.B
.......................................
GP Address
………………………….
Patient Address
……………………………
……………………………
……………………………
………………………….
………………………….
………………………….
Please make an appointment ASAP for this patient.
Pharmacist’s comments:
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
Pharmacist’s Name (please print) ……………………………………..
Pharmacy Telephone Number:
……………………………………..
Pharmacy Address
……………………………………..
……………………………………..
……………………………………..
Date and Time:
……...………………………………
Pharmacist Signature
……………………………………..
Please Fax this form to the patients GP practice and give to the
Patient to take to their GP
23
Appendix 7
Pharmacy First Minor Ailments Scheme
Repeated Requests Form
F.A.O Pharmacist: Please Fax this form to the patients GP practice and give to the
Patient to take to their GP at their next routine appointment
To be completed by the pharmacist
Patient Name
Patient’s D.O.B
Patient Address
.......................................
.......................................
GP Name
GP Address
………………………..….
……………………………
…………………………...
……………………………
……………………………
……………………………
……………………………
……………………………
Pharmacist’s Name
……………………………
Date
……………………………
Pharmacy Tel Number
……………………………
Pharmacy Fax
……………………………
Pharmacy Address
……………………………
Pharmacist’s
signature
……………………………
……………………………
……………………………
Dear Doctor,
This patient has presented at the pharmacy on…….. occasions in the past …………. months for
the treatment of ……………………………… and received the following treatment:
1. ……………………………………………..
2. ……………………………………………..
3. ……………………………………………..
As a requirement of the Pharmacy First Minor Ailment scheme, if a patient presents more than on 3
occasions in a 6 month period for the treatment of the same ailment, treatment should normally be withheld
and the patient should be referred to their GP for a routine appointment.
Please advise how you wish this patient’s specific ailment to be managed.
Please
Tick
To be completed by the GP
1. I, the patient’s GP, will manage this specific ailment. Therefore please refrain from treating this
ailment for this patient for …… months through the Minor Ailment Scheme
2. Please continue to manage this patient’s ailment through the Minor Ailment Scheme for
another ……… months.
3. Other …………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………
GP Signature ………………………… Date……………….
GP Practice Stamp
F.A.O GP: Please fax this form back to the pharmacy and give
a copy to the patient for future reference when accessing the scheme
24
Appendix 8 GP Practices Participating in the Pharmacy First Scheme
Fax
Number
Telephone
Number
Identifier
Post Code
County
Address2
Address1
Practice
Name
Snr Prtner
CENTRAL LANCASHIRE PRACTICE CONTACT LIST - PRESTON LOCALITY
ACCESS CTR, PRESTON PCT ACCESS CENTRE, PRESTON PCT
98 DEEPDALE ROAD
PRESTON
LANCS PR1 5AR
P
01772 203838
BAROUDI G
DR G BAROUDI
RIBBLE VILLAGE SURGERY
200 MILLER ROAD, RIBBLETON, PRESTON
LANCS PR2 6NH
P
01772 792864
01772 705251
CHAKRABARTI H P
DR HP CHAKRABARTI
110 DEEPDALE ROAD
PRESTON
LANCS PR1 5AR
P
01772 884308
01772 887735
CHESWORTH R J H
COMMUNITY DRUG TEAM
LYTHAM ROAD SURGERY
LYTHAM ROAD SURGERY
2A LYTHAM ROAD, FULWOOD
LANCS PR2 8JB
P
01772 716033
01772 715445
COMMUNITY DRUG TEAM
BICKERSTAFFE HOUSE
53 GARSTANG ROAD, PRESTON
LANCS PR1 1LB
P
01772 676000
CONWAY H P
DR HP CONWAY
ASHTON HEALTH CENTRE
PEDDARS LANE, ASHTON, PRESTON
LANCS PR2 1HR
P
01772 726839
DAS BT
DR BT DAS
34-35 ASHTON STREET
ASHTON, PRESTON
LANCS PR2 2PP
P
01772 726588
01772 726613
EYRE D J
FLETCHER D J
THE PARK MEDICAL PRACTICE
THE PARK MEDICAL PRACTICE ASHTON HEALTH CENTRE, PEDDARS LANE, ASHTON, PRESTON
LANCS PR2 1HR
P
01772 726500,794172
01772 768138
RIBBLETON MEDICAL CENTRE
RIBBLETON MEDICAL CTR
243 RIBBLETON AVENUE, PRESTON
LANCS PR2 6RD
P
01772 792512
01772 693521
GHORI S S
DR SS GHORI
104 WOODPLUMPTON ROAD
FULWOOD, PRESTON
LANCS PR2 2LR
P
01772 729756
01772 760862
GPSI (SKIN)
GPSI (SKIN)
PRESTON HEALTHPORT
VICARAGE LANE, FULWOOD, PRESTON
LANCS PR2 8DW
P
01772 783271
HANN J C
PARK VIEW SURGERY
PARK VIEW SURGERY
23 RIBBLESDALE PLACE, PRESTON
LANCS PR1 3NA
P
01772 258474
01772 884200
JANDU
JHA J N
BRIARWOOD MEDICAL CENTRE
BRIARWOOD MEDICAL CENTRE 514 BLACKPOOL ROAD, ASHTON, PRESTON
LANCS PR2 1HY
P
0844 4773038
0844 4773028
DR JN JHA
310 ST. GEORGES ROAD
DEEPDALE, PRESTON
LANCS PR1 6NR
P
01772 254546
KHAN Q O
MEADOW STREET SURGERY
MEADOW STREET SURGERY
57-59 MEADOW STREET, PRESTON
LANCS PR1 1TS
P
01772 252414
01772 254984
01772 254101
KHANNA V K
CLAYTON BROOK SURGERY
CLAYTON BROOK SURGERY
TUNLEY HOLME, CLAYTON BROOK, BAMBER BRIDGE, PRESTON
LANCS PR5 8ES
P
01772 313950
01772 620467
KUMAR B
L.D.SERVICE
THE ST PAULS SURGERY
THE ST PAULS SURGERY
36-38 EAST STREET, DEEPDALE, PRESTON
LANCS PR1 1UU
P
01772 252409
01772 885509
L.D.SERVICE
93 GARSTANG ROAD
PRESTON
LANCS PR1 1LD
P
01772 401203
NAIK R K
BEECH DRIVE SURGERY
THE SURGERY
17-19 BEECH DRIVE, FULWOOD, PRESTON
LANCS PR2 3NB
P
01772 863033
01772 865492
NAIR & LEE
NATH K
DOCLANDS MEDICAL CENTRE
DOCLAND MEDICAL CENTRE
BLANCHE STREET, PRESTON
LANCS PR2 2RL
P
01772 723222
01772 726619
DR K NATH
ASHTON HEALTH CENTRE
PEDDARS LANE, ASHTON, PRESTON
LANCS PR2 1HR
P
01772 726169
01772 768138
PATEL D C
DR D C PATEL & PARTNERS
BROADWAY SURGERY
2 BROADWAY, FULWOOD
LANCS PR2 9TH
P
01772 645665
01772 769733
PATEL D C
PRESTON PC CENTRE OOH
PATEL D C (Branch Surgery)
INGOL HEALTH CENTRE
87 VILLAGE GREEN LANE, INGOL, PRESTON
LANCS PR2 7DS
P
01772 717261
PRESTON PC CENTRE OOH
ROYAL PRESTON HOSPITAL
SHAROE GREEN LANE, FULWOOD
LANCS PR2 9HT
P
01772 713016
PRITCHETT A H J
THE NEW HALL LANE PRACTICE
NEW HALL LANE PRACTICE
GEOFFREY STREET, PRESTON
LANCS PR1 5NE
P
01772 799805, 401730
ROBB G A
DRS G A & A ROBB
THE SURGERY
63-65 GARSTANG ROAD, PRESTON
LANCS PR1 1LB
P
01772 253554
01772 799806
01772 909131
ROSSALL C J
SHAHID S Z
MEDICOM LTD
THE HEALTHCARE CENTRE
FLINTOFF WAY, DEEPDALE, PRESTON
LANCS PR1 5AF
P
01772 655599
01772 909080
DR
SHAHID STREET
THESZ
GEOFFREY
SURGERY
232 DEEPDALE ROAD
PRESTON
LANCS PR1 6QB
P
01772 555733
01772 885406
GEOFFREY STREET SURGERY
THE HEALTH CENTRE, GEOFFREY STREET, PRESTON
LANCS PR1 5NE
P
01772 401760
01772 401950
SINGH B
SINGH H
DEEPDALE SURGERY
DEEPDALE SURGERY
98 DEEPDALE ROAD, PRESTON
LANCS PR1 5AR
P
01772 821069
01772 556778
FISHERGATE HILL SURGERY
FISHERGATE HILL SURGERY
50 FISHERGATE HILL, PRESTON
LANCS PR1 8DN
P
01772 254484
01772 881835
SMITH E M
MOOR PARK SURGERY
MOOR PARK SURGERY
49 GARSTANG ROAD, PRESTON
LANCS PR1 1LB
P
01772 252077
01772 885451
THANDA
WEBSTER M
AVENHAM LANE PRACTICE
AVENHAM LANE PRACTICE
AVENHAM HEALTH CENTRE, AVENHAM LANE, PRESTON
LANCS PR1 3RG
P
01772 401931
01772 886567
FRENCHWOOD SURGERY
49 FRENCHWOOD AVENUE
PRESTON
LANCS PR1 4ND
P
01772 254173
01772 563669
WILSON C M
DR WILSON & PARTNERS
THE HEALTHCARE CENTRE
FLINTOFF WAY, DEEPDALE, PRESTON
LANCS PR1 5AF
P
01772 655533
01772 653414
YOUNG ADDACTION
YOUNG ADDACTION
URBAN EXCHANGE
MOUNT STREET, PRESTON
LANCS PR1 8BQ
P
01772 255307
SHAW S
25
Telephone
Number
Identifier
Post Code
County
Address2
Address1
Practice
Name
Snr Prtner
CENTRAL LANCASHIRE PRACTICE CONTACT LIST - CHORLEY & SOUTH RIBBLE LOCALITY
AHAD G W
STATION SURGERY
STATION SURGERY
8 GOLDEN HILL LANE, LEYLAND
LANCS PR25 3NP C
01772 622505
AHMAD Q
BALL D R
CROSTON VILLAGE SURGERY
ROSLEA SURGERY
CROSTON VILLAGE SURGERY
ROSLEA SURGERY
OUTLANE, CROSTON
51 STATION ROAD, BAMBER BRIDGE, PRESTON
LANCS PR26 9HJ
LANCS PR5 6PE
C
C
01772 600722
01772 335128, 339733
BAMFORD P A C
CHORLEY HEALTH CENTRE - BAMFORD CHORLEY HEALTH CENTRE
COLLISON AVENUE, CHORLEY
LANCS PR7 2TH
C
01772 644184
BENNETT R J C
DOCTORS LANE SURGERY
20 DOCTORS LANE
ECCLESTON, CHORLEY
LANCS PR7 5RA
C
01257 451221
BROWN A K
C.A.M.H.S.
COPPULL MEDICAL PRACTICE
COPPULL MEDICAL PRACTICE
ACRESWOOD SURGERY, COPPULL
LANCS PR7 5EJ
C
01257 793578
C.A.M.H.S.
SHAWBROOK HOUSE
BALCARRES ROAD, LEYLAND
LANCS PR25 2ED C
01772 644644
C.D.T. CHORLEY
C.D.T. CHORLEY
14 WEST STREET
CHORLEY, LANCASHIRE
LANCS PR7 2SJ
C
01257 230452
CHORLEY MEDICS LTD OOH
CHORLEY MEDICS LTD OOH
114 WIGAN ROAD
EUXTON, CHORLEY
LANCS PR7 6JW
C
01257 418010
CURTIS P R
SANDY LANE SURGERY
SANDY LANE SURGERY
SANDY LANE, LEYLAND
LANCS PR25 2EB
C
01772 909915
DASGUPTA R
KINGSFOLD MEDICAL CENTRE
KINGSFOLD MEDICAL CENTRE
WOODCROFT CLOSE, PENWORTHAM
LANCS PR1 9BX
C
01772 746492
DAWOUD E M H
PRESTON ROAD SURGERY
652 PRESTON ROAD
CLAYTON-LE-WOODS, CHORLEY
LANCS PR6 7EH
C
01772 323021
ELHALHULI OA
ADLINGTON MEDICAL CENTRE
ADLINGTON MEDICAL CENTRE 22-24 BABYLON LANE, ANDERTON, CHORLEY
LANCS PR6 9NW
C
01257 482076
EVISON R A
REGENT HOUSE SURGERY
REGENT HOUSE SURGERY
21 REGENT ROAD, CHORLEY
LANCS PR7 2DH
C
01257 264842
FRANCE M M
WITHNELL HEALTH CENTRE
WITHNELL HEALTH CENTRE
RAILWAY ROAD, WITHNELL, CHORLEY
LANCS PR6 8UA
C
01254 830311
GALE M S J
CHORLEY HEALTH CENTRE - GALE
THE HEALTH CENTRE
COLLISON AVENUE, CHORLEY
LANCS PR7 2TH
C
01772 644194
GARG K K
CROSTON MEDICAL CENTRE
CROSTON MEDICAL CENTRE
30 BROOKFIELD, CROSTON
LANCS PR26 9HY C
01772 600081
HILTON S N
INTERMEDIATE
DERM
SERVICE
CUNLIFFE MEDICAL CENTRE
CUNLIFFE MEDICAL CENTRE
41 CUNLIFFE STREET, CHORLEY
LANCS PR7 2BA
C
01257 267127
INTERMEDIATE DERM SERVICE
LEYLAND CLINIC
YEWLANDS DRIVE, LEYLAND
LANCS PR25 2TN
C
01772 644100
JONES I H
CHORLEY HEALTH CENTRE - JONES
CHORLEY HEALTH CENTRE
COLLISON AVENUE, CHORLEY
LANCS PR7 2TH
C
01772 644180
LEELAKUMARI T
GOLDEN HILL LANE SURGERY
THE SURGERY
8 GOLDEN HILL LANE, LEYLAND
LANCS PR25 3NP C
01772 622808
LEWIS S E
NEW LONGTON SURGERY
THE VILLAGE SURGERY
2 CHURCHSIDE, NEW LONGTON
LANCS PR4 4LU
C
01772 613804
LOFTHOUSE W
LORD S R
LIBRARY HOUSE SURGERY
THE EUXTON MEDICAL CENTRE
LIBRARY HOUSE SURGERY
AVONDALE ROAD, CHORLEY
THE EUXTON MEDICAL CENTRE ST.MARY'S GATE, EUXTON, CHORLEY
LANCS PR7 2AD
LANCS PR7 6AH
C
C
01257 262081
01257 267402
LYONS R M
CHORLEY HEALTH CENTRE - LYONS
CHORLEY HEALTH CENTRE
COLLISON AVENUE, CHORLEY
LANCS PR7 2TH
C
01772 644186
MASHAYEKHY K
LOSTOCK HALL VILLAGE SURGERY
VILLAGE SURG,1 WILLIAM ST
LOSTOCK HALL, PRESTON
LANCS PR5 5RZ
C
01772 697666
MCCRAITH N S
ST.MARY'S HEALTH CENTRE
ST.MARY'S HEALTH CENTRE
COP LANE, PENWORTHAM
LANCS PR1 0SR
C
01772 744404
MOSS S D
LONGTON HEALTH CENTRE
LONGTON HEALTH CENTRE
FRANKLANDS, OFF LIVERPOOL RD, LONGTON
LANCS PR4 5HA
C
0844 613204
MUMFORD P A
O'CONNOR T P
GRANVILLE HOUSE MED CTRE
ST FILLAN'S MEDICAL CTRE
GRANVILLE HOUSE MED CTRE GRANVILLE STREET, ADLINGTON, CHORLEY
ST FILLAN'S MEDICAL CTRE
2 LIVERPOOL ROAD, PENWORTHAM, PRESTON
LANCS PR6 9PY
LANCS PR1 0AD
C
C
01257 481966
01772 745427
PARKER J
WORDEN MEDICAL CENTRE
WORDEN MEDICAL CENTRE
WEST PADDOCK, LEYLAND
LANCS PR25 1HW C
01772 423555
PATEL K
CENTRAL PARK SURGERY
CENTRAL PARK SURGERY
BALFOUR STREET, LEYLAND
LANCS PR25 2TD
C
01772 623110
PHILLIPS A B
PITALIA S
RIVERSIDE MEDICAL CENTRE
RIVERSIDE MEDICAL CENTRE
194 VICTORIA ROAD, WALTON-LE-DALE, PRESTON
LANCS PR5 4AY
C
01772 556703
EAVES LANE SURGERY
311 EAVES LANE
CHORLEY
LANCS PR6 0DR
C
01257 272904
PRASAD R K
LOSTOCK HALL MEDICAL CTR.
LOSTOCK HALL MEDICAL CTR.
410 LEYLAND ROAD, LOSTOCK HALL, PRESTON
LANCS PR5 5SA
C
01772 518080
SERVICE M A
WHITTLE SURGERY
WHITTLE SURGERY
199 PRESTON ROAD, WHITTLE-LE-WOODS, CHORLEY
LANCS PR6 7PS
C
01257 262383
SULE H D
MOSS SIDE MEDICAL CENTRE
MOSS SIDE MEDICAL CENTRE
16 MOSS SIDE WAY, LEYLAND
LANCS PR26 7XL
C
01772 623954
TANDON A K
BEECHES MEDICAL CENTRE
BEECHES MEDICAL CENTRE
LIVERPOOL ROAD, LONGTON, PRESTON
LANCS PR4 5AB
C
01772 613123
WIJETHILEKE G G K
MEDICARE UNIT SURGERY
MEDICARE UNIT
1 CROSTON ROAD, LOSTOCK HALL, PRESTON
LANCS PR5 5RS
C
01772 330724
YOUNG D W
THE RYAN MEDICAL CENTRE
THE RYAN MEDICAL CENTRE
ST MARY'S ROAD, BAMBER BRIDGE, PRESTON
LANCS PR5 6TE
C
01772 335136
26
BISARYA A
DR A BISARYA
SANDY LANE HEALTH CENTRE
SANDY LANE, SKELMERSDALE
LANCS WN8 8LA
WL 01695 727772
BISHOP-CORNET H R L
LEYLAND HOUSE SURGERY
LEYLAND HOUSE SURGERY
18 DERBY STREET, ORMSKIRK
LANCS L39 2BY
WL 01695 579501
BISWAS S
BEACON PRIMARY CARE
HILLSIDE HEALTH CENTRE
TANHOUSE ROAD, SKELMERSDALE
LANCS WN8 6DS
WL 0844 4778680
BISWAS S
BEACON PRIMARY CARE
BEACON PRIMARY CARE
SANDY LANE HEALTH CENTRE, SKELMERSDALE
LANCS WN8 8LA
WL 0844 4778680
BONSOR R
THE SURGERY
THE SURGERY
6 STANLEY STREET, ORMSKIRK
LANCS L39 2DH
WL 01695 572085
CAINE J M
CHANG S K
COMMUNITY DRUGS TEAM
PARBOLD SURGERY
HALL GREEN SURGERY
THE SURGERY
HALL GREEN SURGERY
4 THE GREEN, PARBOLD, WIGAN
164 ORMSKIRK ROAD, UPHOLLAND, SKELMERSDALE
LANCS WN8 7DN WL 01257 463126
LANCS WN8 0AB WL 01695 622268, 624999
COMMUNITY DRUGS TEAM
75 WEST GATE
SKELMERSDALE, LANCASHIRE
LANCS WN8 8LP
WL 01695 50740
COMMUNITY PAEDIATRICS
COMMUNITY PAEDIATRICS
CHILD DEVELOPMENT CENTRE ORMSKIRK & DIST GEN HPL, WIGAN RD, ORMSKIRK
LANCS L39 2JW
WL 01695 598401
CUNNINGTON A
PARKGATE SURGERY
PARK GATE SURGERY
28 ST HELEN'S ROAD, ORMSKIRK
LANCS L39 4QR
WL 01695 573093, 572561
DARLEY S N
ROSE ALLOD SURGERY
21 KNOWSLEY ROAD
ORMSKIRK
LANCS L39 4RB
WL 01695 577215
EBDY M J
TARLETON GROUP PRACTICE
TARLETON GROUP PRACTICE
THE HEALTH CENTRE, GORSE LANE, TARLETON
LANCS PR4 6UJ
WL 01772 812205
GULATI V
VIRAN MEDICAL CENTRE
VIRAN MEDICAL CENTRE
291 HESKETH LANE, TARLETON, PRESTON
LANCS PR4 6RJ
WL 01772 812207
HAWKES B L
JAIN JL
STANLEY COURT SURGERY
BURSCOUGH HEALTH CENTRE
STANLEY COURT, LORD STREET, BURSCOUGH
LANCS L40 4LA
WL 01704 892254
DR JL JAIN
BIRLEYWOOD HEALTH CENTRE BIRLEYWOOD, SKELMERSDALE
LANCS WN8 9BW WL 01695 725555
KEWLEY
RAILWAY ROAD SURGERY
11 RAILWAY ROAD
ORMSKIRK
LANCS L39 2DN
WL 01695 572096
KIPPAX A G
LEDSON
LATHOM HOUSE SURGERY
LATHOM HOUSE SURGERY
31 LORD STREET, BURSCOUGH
LANCS L40 4BZ
WL 01704 895566
DR LEDSON
BURSCOUGH HEALTH CENTRE
STANLEY COURT, BURSCOUGH
LANCS L40 4LA
WL 01704 892708
LITTLER A
DR A LITTLER
SANDY LANE HEALTH CENTRE
SANDY LANE, SKELMERSDALE
LANCS WN8 8LA
WL 01695 723279
MODHA J
DR J MODHA
SANDY LANE HEALTH CENTRE
SANDY LANE, SKELMERSDALE
LANCS WN8 8LA
WL 01695 559558
NAYYAR
DR NAYYAR
THE HEALTH CENTRE
MARK SQUARE, GORSE LANE, TARLETON, PRESTON
LANCS PR4 6UJ
WL 01772 814429
OWLS GP OOH SERVICES
OWLS GP OOH SERVICES
THE WALK IN CENTRE
116-118 THE CONCOURSE, NORTHWAY, SKELMERSDALE
LANCS WN8 6LJ
WL 01695 554240
PCT DERMATOLOGY
PCT DERMATOLOGY
HANTS LANE CLINIC
HANTS LANE, ORMSKIRK
LANCS L39 1PX
WL 01695 573526
WALK IN CENTRE
116-118 THE CONCOURSE, SKELMERSDALE
LANCS WN8 6LJ
WL 01695 598325
PCT ORTHOPAEDICS SERVICE PCT ORTHOPAEDICS SERVICE
RAY R
COUNTY ROAD SURGERY
109 COUNTY ROAD
ORMSKIRK
LANCS L39 1NL
WL 01695 572714
RYDER PG M
MATTHEW RYDER CLINIC
MATTHEW RYDER CLINIC
20 DINGLE ROAD, HALL GREEN, UPHOLLAND
LANCS WN8 0EN
WL 01695 624042
SAXENA S
ASHURST PRIMARY CARE
ASHURST HEALTH CENTRE
LULWORTH, ASHURST, SKELMERSDALE
LANCS WN8 6QS WL 01695 732468
SHARMA U
SINGH BB
MANOR PRIMARY CARE
HILLSIDE HEALTH CENTRE
TANHOUSE ROAD, SKELMERSDALE
LANCS WN8 6DS
WL 01695 722424
DR BB SINGH
HILLSIDE HEALTH CENTRE
TANHOUSE ROAD, SKELMERSDALE
LANCS WN8 6DS
WL 01695 726888
SINGH U
DR U SINGH
BIRLEYWOOD HEALTH CENTRE BIRLEYWOOD, SKELMERSDALE
LANCS WN8 9BW WL 01695 728073
STUBLEY M W
SUR S K
AUGHTON SURGERY
AUGHTON SURGERY
LANCS L39 6SE
DR SK SUR
BIRLEYWOOD HEALTH CENTRE BIRLEYWOOD, SKELMERSDALE
LANCS WN8 9BW WL 01695 723333
SURI S
BURSCOUGH FAMILY PRACTICE
BURSCOUGH HEALTH CENTRE
STANLEY COURT, BURSCOUGH
LANCS L40 4LA
WL 01704 894997
TAGGART-JEEWA
NORTH MEOLS MEDICAL CENTRE NORTH MEOLS MED CTR
CHURCH ROAD, BANKS, SOUTHPORT
LANCS PR9 8ET
WL 01704 227333
TRAVIS
THE ELMS SURGERY
THE ELMS SURGERY
5 DERBY STREET, ORMSKIRK
LANCS L39 2BJ
WL 01695 573123
WALK IN CENTRE
SKELMERSDALE NHS WIC
UNIT 116-118
CONCOURSE CENTRE,SOUTHWAY, SKELMERSDALE
LANCS WN8 6LJ
WL 01695 554260
19 TOWN GREEN LANE, AUGHTON, ORMSKIRK
Fax
Number
Telephone
Number
Identifier
Post Code
County
Address2
Address1
Practice
Name
Snr Prtner
CENTRAL LANCASHIRE PRACTICE CONTACT LIST - WEST LANCASHIRE LOCALITY
WL 01695 422384
27
Appendix 9 Pharmacies Participating in the Pharmacy First Scheme
A & J SINGH LTD, SHAROE GREEN PHARMACY
APA LTD, ASHTON PHARMACY
ASDA PHARMACY, ASDA SUPERSTORE
BOOTS THE CHEMIST
BOOTS THE CHEMIST
BOOTS THE CHEMIST
C & S PATEL, AVENHAM PHARMACY
C PATEL, MOOR PARK PHARMACY
FRENCHWOOD PHARMACY
GAMULL PHARMACY LTD, GAMULL PHARMACY
GOOSNARGH PHARMACY
H & AK FLETCHER LTD, BROADWAY PHARMACY
H UMAR, DDL DAVIES
KADRI PHARMACY
L ROWLAND & CO (RETAIL) LTD, KNIGHTS PHARMACY
L ROWLAND & CO (RETAIL) LTD, ROWLAND'S
PHARMACY
L ROWLAND & CO (Retail) LTD, INGOL PHARMACY
LLOYDS PHARMACY LTD, LLOYDS PHARMACY
LLOYDS PHARMACY LTD, LLOYDS PHARMACY
LLOYDS PHARMACY LTD, LLOYDS PHARMACY
LLOYDS PHARMACY LTD, LLOYDS PHARMACY
LLOYDS PHARMACY LTD, LLOYDS PHARMACY
LLOYDS PHARMACY LTD, LLOYDS PHARMACY
LLOYDS PHARMACY LTD, LLOYDS PHARMACY
MORRISON PHARMACY, MORRISONS SUPERMARKET
MOSS E LTD, ALLIANCE PHARMACY
MOSS E LTD, ALLIANCE PHARMACY
SAINSBURY'S PHARMACY, SAINSBURY'S STORE
SUPERDRUG STORES LTD, SUPERDRUG PHARMACY
WHITTLE PHARMACIES LTD, POMFRET'S CHEMIST
WHITTLE PHARMACIES LTD, RIBBLETON PHARMACY
WHITTLE PHARMACIES LTD, SMITHSON'S PHARMACY
UNIT 9 BOOTHS SHOPPING COMPLEX, SHAROE GREEN LANE
33 ASHTON STREET
EASTWAY
10-13 FISHERGATE
440 BLACKPOOL ROAD
UNIT C2, DEEPDALE RETAIL PARK, BLACKPOOL ROAD
42 AVENHAM LANE
32 GARSTANG ROAD
1 RUSKIN STREET
RIBBLETON MEDICAL CENTRE, 245 RIBBLETON AVENUE
6 CHURCH LANE
331 GARSTANG ROAD
59-61 PLUNGINGTON ROAD
87-89 MEADOW STREET
14 ELSWICK ROAD
BLANCHE STREET
86 VILLAGE GREEN LANE
112 DEEPDALE ROAD
GEOFFREY STREET HEALTH CENTRE, GEOFFREY STREET
78-80 LANCASTER ROAD
LONGSANDS LANE
234-236 DEEPDALE ROAD
3 LYTHAM ROAD
258 NEW HALL LANE
MARINERS WAY
76 PEDDARS LANE
UNIT 5, KWIK SAVE DEVELOPMENT, RIBBLE VILLAGE CENTRE, 198 MILLER ROAD
FLINTOFF WAY, OFF DEEPDALE ROAD
NEW UNIT 1, FISHERGATE WALK, ST GEORGE'S CENTRE
22 LANCASTER ROAD
182 RIBBLETON AVENUE
51 FISHERGATE HILL
FULWOOD,
PRESTON
PRESTON
FULWOOD,
PRESTON
PRESTON
ASHTON, PRESTON
PRESTON
PRESTON
PRESTON
PRESTON
PRESTON
GOOSNARGH,
PRESTON
FULWOOD,
PRESTON
PRESTON
PRESTON
LARCHES ESTATE,
PRESTON
PRESTON
INGOL, PRESTON
PRESTON
PRESTON
PRESTON
FULWOOD,
PRESTON
PRESTON
FULWOOD,
PRESTON
PRESTON
ASHTON, PRESTON
ASHTON, PRESTON
PRESTON
PRESTON
PRESTON
PRESTON
RIBBLETON,
PRESTON
PRESTON
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
PR2 9HD
PR2 2PP
PR2 9NP
PR1 3QA
PR2 2LP
PR1 6QY
PR1 3TS
PR1 1NA
PR1 4NA
PR2 6RD
PR3 2BE
PR2 4UP
PR1 7EN
PR2 1TS
PR2 1NT
PR2 2RL
PR2 7DS
PR1 5AR
PR1 5NE
PR1 1DD
PR2 9PS
PR1 6QB
PR2 4JE
PR1 4ST
PR2 2YN
PR2 1HN
PR2 6NH
PR1 6PJ
PR1 2NR
PR1 1DA
PR2 6QN
PR1 8DN
TELEPHONE
POSTCODE
Identifier
TOWN
STREET
PHARMACY
NAME
CENTRAL LANCASHIRE PCT – PRESTON LOCALITY
01772 712244
01772 726383
01772 703174
01772 254517
01772 726602
01772 792265
01772 259915
01772 555150
01772 491185
01772 796142
01772 865238
01772 717574
01772 556030
01772 823751
01772 728111
01772 721893
01772 726955
01772 254937
01772 493224
01772 250486
01772 653031
01772 493234
01772 718022
01772 493257
01772 732925
01772 726149
01772 654139
01772 651374
01772 253752
01772 252468
01772 796131
01772 252033
28
ASDA PHARMACY, ASDA SUPERSTORE
ASTLEY VILLAGE PHARMACY
SHEEPHILL LANE, CLAYTON GREEN
UNIT 5, HALLGATE
BAMFORD MH
BOOTS THE CHEMIST LTD
BOOTS THE CHEMIST LTD
BUCKLEY, PETER LTD
CLAYFIELDS CHEMIST
COHENS PHARMACY
CROSTON PHARMACY
FACER AS (LONGTON) LTD
FISHLOCK S & D
KINGSFOLD PHARMACY
KNIGHTS PHARMACY
L ROWLAND & CO LTD / SEVEN STARS PHARMACY
L ROWLAND & CO LTD / TOWNGATE PHARMACY
L ROWLAND & CO LTD / WORDEN PHARMACY
LLOYDS PHARMACY LTD
LLOYDS PHARMACY LTD
LLOYDS PHARMACY LTD
LLOYDS PHARMACY LTD
LLOYDS PHARMACY LTD
LLOYDS PHARMACY LTD
LLOYDS PHARMACY LTD
MOSS E LTD. ALLIANCE PHARMACY
O'DONNELL G W
POMFRETS CHEMIST
RICHARDSON PHARMACY LTD
RIMMER M D
RIMMER M D
SAINSBURY'S PHARMACY, SAINSBURY'S STORE
ST MARYS PHARMACY LTD
STEARNE'S PHARMACY
TESCO EXTRA, TESCO IN-STORE PHARMACY
163 CHORLEY ROAD
219-22 STATION ROAD
24 MARKET WALK
111 STATION ROAD
8 ALDER DRIVE
EAVES GREEN
69 STATION ROAD
66 LIVERPOOL ROAD
6-10 CARRINGTON CENTRE
69 POPE LANE
15 MARKET STREET
350 LEYLAND LANE
2-4 TOWNGATE
37 WEST PADDOCK
180 DEVONSHIRE ROAD
185 STATION ROAD
209/211 SPENDMORE LANE
246 EAVES LANE
96 DEVONSHIRE ROAD
LIBRARY STREET
97 MARKET STREET
45 HOUGH LANE
22 LIVERPOOL ROAD
182 VICTORIA ROAD
13 HOPE TERRACE
22 RUNSHAW LANE
25 MAIN SQUARE, BUCKSHAW VILLAGE
CUERDEN WAY
COP LANE
MOSS SIDE SHOPPING CENTRE, OFF DUNKIRK LANE
ACKHURST PARK INDUSTRIAL ESTATE, FOXHOLE ROAD
VILLAGE PHARMACY
WHITTLE BROOK PHARMACY
WHITTLE BROOK PHARMACY
WITHNELL PHARMACY
356 CHAPEL LANE
230 PRESTON NEW ROAD
74 TUNLEY HOLME
17 BURY LANE
CHORLEY
ASTLEY VILLAGE,
CHORLEY
ADLINGTON
TELEPHONE
POSTCODE
Identifier
TOWN
STREET
PHARMACY
NAME
CENTRAL LANCASHIRE PCT – CHORLEY & SOUTH RIBBLE LOCALITY
C
C
PR6 7JY
PR7 1XA
BAMBER BRIDGE
CHORLEY
BAMBER BRIDGE
HOGHTON
CHORLEY
CROSTON
LONGTON
ECCLESTON
PENWORTHAM
ADLINGTON
LEYLAND
LEYLAND
LEYLAND
CHORLEY
BAMBER BRIDGE
COPPULL
CHORLEY
CHORLEY
CHORLEY
CHORLEY
LEYLAND
PENWORTHAM
WALTON LE DALE
LOSTOCK HALL
EUXTON
CHORLEY
BAMBER BRIDGE
PENWORTHAM
LEYLAND
CHORLEY
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
PR6 9LP
PR5 6LD
PR7 1DE
PR5 6QS
PR5 OAD
PR7
PR26 9RL
PR4 5PB
PR7 5SZ
PR1 9BY
PR7 4HE
PR25 1TB
PR25 2FN
PR8 1HR
PR7 2BY
PR5 6LA
PR7 5BY
PR6 0PT
PR7 2DJ
PR7 2EE
PR7 2SQ
PR25 2SA
PR1 0DQ
PR5 4AY
PR5 5RU
PR7 6UA
PR7 7AR
PR5 6BJ
PR1 0SR
PR26 7SN
PR7 1NW
NEW LONGTON
WHITTLE LE WOODS
CLAYTON BROOK
WITHNELL
C
C
C
C
PR4
PR6
PR5
PR6
4AA
7HW
8ES
8RX
01772 332290
01257 234220
01257 480322
01772 335458
01257 262648
01772 335540
01254 854376
01257 233744
01772 600289
01772 613286
01257 451251
01772 749331
01257 482868
01772 622255
01772 622211
01772 622288
01257 272111
01772 315506
01257 791322
01257 262385
01257 263238
01257 263628
01257 262613
01772 421169
01772 743383
01772 259919
01772 311328
01257 269862
01772 452341
01772 312457
01772 742615
01772 459779
0845 677 9157
01772 615974
01257 262536
01772 311075
01254 830180
29
TELEPHONE
POSTCODE
Identifier
TOWN
STREET
PHARMACY
NAME
CENTRAL LANCASHIRE PCT – WEST LANCS LOCALITY
BBR SKELMERSDALE LTD
HILLSIDE HEALTH CENTRE, TANHOUSE ROAD
SKELMERSDALE
WL
WN8 6DS
BOOTS THE CHEMIST LTD
3B MOOR STREET,
ORMSKIRK
WL
L39 2AA
BOOTS THE CHEMIST LTD
20 THE CONCOURSE,
SKELMERSDALE
WL
WN8 6ND.
BUCKLEY, PETER LTD. T/A JOHN HALTON
11 THE COMMON
PARBOLD
WL
WN8 7HA
L. ROWLAND & CO. (RETAIL) LTD
BEACONSFIELD CORNER, MOOR STREET
ORMSKIRK
WL
L39 4AW
L. ROWLAND & CO. (RETAIL) LTD
6, MILL LANE
BURSCOUGH
WL
L40 5TS
L. ROWLAND & CO. (RETAIL) LTD
22 MOSS DELPH LANE,
AUGHTON, ORMSKIRK
WL
L39 5DZ.
L. ROWLAND & CO. (RETAIL) LTD
21, LYNDALE,
ASHURST, SKELMERSDALE
WL
WN8 0EN.
L. ROWLAND & CO. (RETAIL) LTD
37, LIVERPOOL ROAD NORTH
BURSCOUGH, ORMSKIRK
WL
L40 0SA.
L. ROWLAND & CO. (RETAIL) LTD
(BRYANS CHEMIST), 1, DINGLE ROAD
UPHOLLAND
WL
WN8 0EN
L. ROWLAND & CO. (RETAIL) LTD
38 BURSCOUGH STREET
ORMSKIRK
WL
L39 2ES
L. ROWLAND & CO. (RETAIL) LTD
24, MARK SQUARE,
TARLETON, PRESTON
WL
PR4 6TU
L. ROWLAND & CO. (RETAIL) LTD
115 COUNTY ROAD
ORMSKIRK
WL
L39 1NL
MORRISONS PHARMACY, MORRISONS SUPERMARKET
PARK ROAD
ORMSKIRK
WL
L39 2AQ
NORTH MEOLS PHARMACY LTD.
15, CHURCH ROAD,
BANKS, SOUTHPORT
WL
PR9 8ET
ROUGHWOOD CHEMISTS LTD
55, WESTGATE
SKELMERSDALE
WL
WN8 8LP
ROUGHWOOD CHEMISTS LTD
123 BIRLEYWOOD,
DIGMOOR, SKELMERSDALE
WL
WN8 9HR
RUFFORD PHARMACY
124 LIVERPOOL ROAD
RUFFORD
WL
L40 1SL
SALRAM LTD
5 STATION ROAD
HESKETH BANK, PRESTON
WL
PR4 6SN
THE WALK IN CENTRE
UNIT 116-118 THE CONCOURSE SHOPPING CENTRE
SKELMERSDALE
WL
WN8 6LJ
01695 725720
01695 578360
01695 725339
01257 462277
01695 573532
01704 892275
01695 421262
01695 731518
01704 893179
01695 622446
01695 574118
01772 812619
01695 580564
01695 573289
01704 227075
01695 723566
01695 723664
01704 821111
01772 814098
01695 554260
30
Appendix 10
PHARMACY FIRST CONSULTATION
DECISION PATHWAY LOCUM GUIDE
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
Is the patient exempt from paying a
prescription charge?
NO
YES
Suggest (as appropriate)

OTC Sale.

Routine GP appointment

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

YES
Suggest (as appropriate)

OTC Sale.

Routine GP appointment.

Urgent doctor’s appointment
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?
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
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)?
YES

Request patient to order routine repeat
prescription.
NO
Does the patient refuse the appropriate
medicine as identified in the Pharmacy First
Formulary?
YES
NO
Document refusal by the patient.
NO
YES
Suggest (as appropriate)

OTC Sale.

Routine GP appointment.

Urgent doctor’s appointment
Suggest (as appropriate)

OTC Sale.

Routine GP appointment.

Urgent doctor’s appointment
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.
31
Appendix 11
Minor Ailment Protocols
Page
Allergic Rhinitis (inc hayfever)
33
Athletes Foot
35
Bacterial Conjunctivitis
36
Cold Sores
38
Constipation
39
Cystitis
40
Dermatitis
41
Diarrhoea
43
Earache and Minor Outer Ear Infection
44
Flu-like Symptoms (coughs, colds, fever)
46
Headache
48
Head Lice
49
Indigestion / Reflux
51
Insect Bites & Stings
52
Mouth Ulcers
53
Nappy Rash
54
Scabies
55
Sore Throat
57
Teething
59
Threadworm
60
Thrush (not oral)
61
Verrucas / Warts
62
32
Allergic Rhinitis (including hayfever) Protocol
Definition/criteria for
inclusion






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
Treatment and doses
Age
Dosage and frequency
Adults and children over 6
2x5ml daily or 5ml BD
6- 12 years
5ml 4-6hrly (max 12mg (30ml) daily)
Adults and children over 12 years
10ml 4-6hrly (max 24mg (60ml) daily)
Cetirizine 10mg tablets (30)
Adults and children over 12 years
Chlorphenamine 4mg tablets (30)
6-12 years
Adults and children over 12 years
One daily
Half a tab 4-6 hrly (max 12mg daily)
Sodium cromoglycate 2% eye drops
Adults and children over 6
Cetirizine 5mg/5ml (150ml)
Chlorphenamine 2mg/5ml (150ml)
Other advice to be given
One tablet 4-6 hrly (max 24mg daily)
1-2 drops QDS
Important;
Check cautions and contra-indications
Hay fever undiagnosed previously by G.P; only one supply of treatment can be made. The patient needs to be seen by doctor for
diagnosis before future supplies issued.
Previously diagnosed by G.P; no more than three issues over six months.
Soft contact lens wearers should not use preservative-containing eye drops.
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 collects dust from the bedroom e.g. rugs, stuffed toys, open cupboards
 Pets should be kept out of the bedroom (or house if possible)
 Use vacuum cleaners with high-efficiency particulate air cleaner (HEPA) filters
33
When to refer/criteria for
exclusion
References
Review Date







Children under 6 years old are not eligible for treatment under the scheme
Pregnant and breastfeeding women
Symptoms unresponsive to treatment
Very severe photophobia
Severe persistent symptoms (consider 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
SPC; Piriton tablets, Piriton liquid, Zirtek Allergy relief for children, Zirtek allergy relief, Opticrom allergy eye drops
CKS; Allergic Rhinitis Oct 2007
Nov 2009
34
Athlete’s Foot Protocol
Definition/Criteria for
inclusion




Fungal infection of the feet, which is otherwise known as Tinea pedis.
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.
Gradually, the edges of the infected area become milky white and the skin begins to peel.
Treatment and doses
Other advice to be given
When to refer/Exclusion
criteria
References
Review Date
Age
Miconazole cream 2% (30g)
Children over 2mnths and
adults
Terbinafine cream (7.5g)
Children over 16 years
Dosage and frequency
Apply twice daily to affected and surrounding area;
continue for ten days after infection has visibly
cleared to ensure spores are eradicated.
Apply thinly 1-2 x daily for up to 1 week
Important;
Check cautions and contra-indications
 Anti-fungal sprays and powder may be purchased for direct application to shoes and hosiery.
 Wash and dry feet thoroughly, especially between the toes. Wash towels regularly.
 Change socks daily and wear clean wool or cotton socks to allow the skin to breath.
 Athlete’s foot is more common in people that wear artificial soles and especially trainers and sports shoes.
 Consider alternating between different shoes every 2-3 days to allow each pair to dry fully.
 It can help to expose feet to the air where possible.
 Avoid walking barefoot in public areas and do not share towels.
 Children under 2 months of age
 Diabetic patients
 Treatment failures.
 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.
SPC; Daktarin cream,
CKS; Fungal (dermophyte) skin infections
BNF for children 2007
Nov 2009
35
Bacterial Conjunctivitis Protocol (consultations must be undertaken by the pharmacist)
Definition/Criteria for
inclusion
 Acute eye infection caused by bacteria which leads to an inflammation of the conjunctiva. (The membrane covering the white of
the eye and the inside of the eyelid)
 Eyes look inflamed and red or pink
 Eye discomfort described as burning or gritty, (but not sharp or significant pain) and discharge, that can make it difficult to open
the eyes in the morning.
 Sticky and mucopurulent in bacterial infection.
 Usually starts in one eye and can spread to the other.
 Vision not usually affected, discharge can cause blurring.
Treatment and doses
Age
Chloramphenicol 0.5% Eye drops
(10ml)
Chloramphenicol 1% eye ointment
(4g)
Other advice to be given
When to refer/exclusion
criteria
Elderly, adults and children 2
years and over
Elderly, adults and children 2
years and over
Dosage and frequency
One drop to affected eye(s) every 2 hours for
48hours, every 4 hours thereafter. Course for
5 days.
Small amount applied to the affected eye(s)
either at night if drops are used through the
day, or 3-4 times daily if used alone. Course
for 5 days.
Important;
Check cautions and contra-indications
Following RPSGB advice consultations for this treatment should be dealt with by the pharmacist.
In normal circumstances it should not be necessary to supply both the drops and the ointment.
The ointment is available as a more viscous option possibly preferable when treating young or elderly.
 See Doctor if no improvement after 48hours treatment with chloramphenicol
 See Doctor if symptoms worsening despite using chloramphenicol
 Do not share bottles if more than one person affected
 Wash hands before and after applying and take care not to touch the eye or eye lashes
 Avoid sharing towels/flannels with other people and discard any affected cosmetics
 In pharmacy setting drops to be stored in the fridge, discard five days after opening
 Children under 2 years of age
 Photophobia (intolerance to light)
 A watery discharge may indicate viral infection; this is usually associated with recent upper respiratory infection.
 Contact lens use
 If already using any eye drops/oints
 Suspected foreign body or injury to eye
 Pain or swelling around eye or face, restriction in eye movement or severe pain within the eye.
 Vision affected
 Pupil looks unusual, i.e. torn, irregular, dilated or non-reactive to light
36
References;
Review Date
 Cornea cloudy
 Copious yellow-green purulent discharge that re-accumulates after being wiped away
 Eye inflammation associated with rash on scalp or face
 Patient feels unwell
 Conjunctivitis in recent past
 Glaucoma
 Dry eye syndrome
 Eye surgery or laser treatment in past six months
 Personal or family history of bone marrow problems
 Pregnant or breast feeding
 Patient recently returned from abroad
 Concomitant administration with other bone marrow depressant drugs
SPC; Brochlor ointment, Brochlor eye drops
RPSGB Practice guidance; OTC Chloramphenicol eye drops June 2005
Nov 2009
37
Cold Sores Protocol
Definition/criteria for
inclusion
Advice to be given
 Painful fluid filled blisters on or around the lips caused by reactivation of the herpes simplex virus.
 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 compromised;
 Can be triggered by exposure to intense sunlight, emotional stress, menstruation, impaired immunity, upper respiratory tract
infections.
 The virus can only be transmitted by close personal contact such as kissing.
 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.
 The blisters heal without scarring but tend to reoccur.
 In children, the virus can infect the mouth and throat and can be accompanied by fever, aches and pains.
 Cold sores are infectious for about four days after symptoms start.
 Wash hands regularly including before and after application, avoid contact with immunocompromised people and avoid kissing
others while infective
Treatment and doses
Aciclovir 5% cream
(2g)
When to refer/exclusion
criteria
References
Review Date
Age
Dosage and frequency
Adults and
children over
six years
Apply 5 x daily at approx 4 hour intervals, omitting the night time application.
Continue for at least four days. If healing has not occurred, treatment may be
continued for up to 10 days.
Important;
Check cautions and contra-indications
 Children under 6 year of age
 Patient is immunocompromised e.g. AIDS
 Infection of mucous membranes, eye or vagina
 Pregnancy
 Children under 12 years should be referred automatically if intra oral and not just the lips.
 Infants under one year
 If cold sore still present after 10 days of treatment with aciclovir.
 Consider referral if severe recurrent cold sores.
SPC; Zovirax cream
CKS; Herpes simplex Oct 2007
Nov 2009
38
Constipation Protocol
Definition/Criteria for
inclusion
 Reduced frequency of stools compared to normal bowel habits, difficulty in passing stools or a sense of incomplete emptying
after a bowel movement, not responding to dietary and lifestyle adjustments
Treatment and doses
Senna tablets (20)
Ispagula sachets (10)
Lactulose (300ml)
Glycerin suppositories (12)
Advice to be given
When to refer/exclusion
criteria
References
Review Date
Age
Dosage and frequency
6-12 years
One at bedtime
Adults and children over 12 years
Two at bedtime
Adults and children over 12 years
One sachet BD
6-10 years
10ml BD
Adults and children over 10 years
15ml OD - BD
Adults and children over 12 years
Moisten suppository with water before use.
Adult (over 12 years) 4g
Important; Check cautions and contra-indications
 Senna a stimulant laxative, effects within 8-12 hours
 Ispagula a bulk forming laxative requires adequate amounts of fluid to avoid obstruction, effects may take several days
 Lactulose an osmotic laxative, can take 2-4 days to work
 Glycerin suppositories are a softener & stimulant, use when oral therapy has not moved bowels or when rapid relief is needed
 Diet and lifestyle changes are preferred. E.g. increase fluid & fibre intake and physical activity where possible
 Avoid regular use of laxatives as they can cause a lazy bowel
 Senna should be avoided in pregnancy.
 Senna can colour the urine red or yellow
 Try to avoid suppressing the urge to defecate and be aware that changes in routine such as stress and travel can be a cause
 Children under 6 years of age.
 If the constipation persists beyond one week.
 Nausea and vomiting are also present.
 Sharp or severe abdominal pain, especially if also bloated or rectal pain.
 Sudden constipation with abdominal cramps and an inability to pass gas or stool.
 Unexplained weight loss.
 Blood in the stool.
 Constipation alternating with diarrhoea.
 If patient is regularly requesting laxatives.
 Constipation caused by regular medication.
SPC; Lactugal, Fybogel, senokot liquid and tablets, BNF; Glycerin suppositories. CKS; constipation Oct 2007
Nov 2009
39
Cystitis Protocol
Description/Criteria for
inclusion





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 or be cloudy in appearance.
Mild pain in the lower back or abdomen.
Treatment and doses
Other advice to be given
When to refer/exclusion
criteria
Reference:
Review Date
Age
Dosage and frequency
Paracetamol tablets (32)
Adults and children aged 12 and over
2 tablets QDS PRN
Potassium citrate powders (6)
Adults and children aged 12 and over
Sodium citrate powders (6)
Adults and children aged 12 and over
One sachet dissolved in water TDS, all 6
to be taken to complete 48hr course
One sachet dissolved in water TDS, all 6
to be taken to complete 48hr course
Important; Check cautions and contra-indications
Sodium based agents are best avoided with cardiac disease or hypertension.
Potassium based agents may cause hyperkalaemia in those taking potassium-sparing diuretics, aldosterone antagonists and ACE
inhibitors.
 Drink at least eight glasses of water each day.
 Wipe from front to back after going to the toilet.
 Use a hot-water bottle to alleviate abdominal pain.
 Although evidence is lacking drinking plenty of cranberry juice may help.
 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.
 Children under 12 years of age or any male patient.
 Confusion in elderly suggestive of UTI
 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.
C&D Guide to OTC Sep 07; Cystapurin, Cymalon
Nov 2009
40
Dermatitis Protocol
Definition/Criteria inclusion
criteria





Atopic - often occurs in conjunction with asthma or hayfever, very prone to irritant dermatitis
Contact - Irritant; direct effect of an irritant substance on the skin; soaps, disinfectants, detergents or chemicals
- Allergic; immune system reacts to a specific substance but previous exposure is required; cosmetics, hair dyes, nickel, chromium
and some plants.
Commonly presents with redness, inflammation, itching, skin blistering, cracking, dry skin.
New areas may weep or become crusted.
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.
Treatment and doses
Age
Dosage and frequency
Apply PRN (minimum BD or TDS) and as soap
substitute
Apply PRN (minimum BD or TDS) and as soap
substitute
Aqueous cream (500g)
All ages
*Emulsifying oint (500g)
All ages
Hydrocortisone cream 1% (15g)
Over 10 years
Apply BD-TDS
Chlorphenamine 4mg tablets
Children 6-12 years
Half tablet 4-6 hourly (max 12mg daily)
Adults
One tablet 4-6 hourly (max 24mg daily)
1-2 years
2.5ml BD
2-5 years
2.5ml 4-6 hourly (max 6mg i.e. 15ml daily)
6-12 years
5ml 4-6 hourly (max 12mg i.e. 30ml daily)
Adults
10ml 4-6 hourly (max24mg i.e. 60ml daily)
Children over 12 years and
adults
Children over 6 years and
adults
One daily
(30)
Chlorphenamine 2mg/5ml
syrup (150ml)
Cetirizine 10mg tabs (30)
Cetirizine 5mg/5ml soln. (150ml)
10ml once daily or 5ml BD
Important;
Check cautions and contra-indications
*NPSA guidance should be followed where 100g or more of paraffin based products are supplied e.g. Emulsifying oint including:

Information should be given about the potential fire risks of smoking (or being near to patient who are smoking), or exposure to any
open flame or other potential cause of ignition during treatment and about regularly changing clothing or bedding impregnated with
paraffin based products (preferably on a daily basis) as the paraffin soaks into the fabrics and can potentially be a fire hazard.

This information should be given on the first occasion that such treatment is prescribed, dispensed or administered and a record kept
41
confirming that such advice has been given (please log in the patients passport and PMR). A check should be made on subsequent
occasions that the advice has been received previously and understood.
Other advise to be given




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.
Emollients restore the “epidermal barrier” they should continue to be used during treatment with steroid creams but at a different time of
day.
Topical steroids treat “flare-ups” by reducing skin inflammation and itching, but 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:
1. 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.
2. 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.
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.
Chronic dermatitis may lead to thickened and scaly (lichenified) skin.
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.
When to refer/criteria for
exclusion







Reference:
SPC; piriton syrup/tablets, Zirtek syrup/tablets,
CKS; Dermatitis
Review Date
Nov 2009
42
Diarrhoea Protocol
Definition/Criteria for
inclusion






An increase in the normal frequency of bowel movements with the passage of abnormally soft or watery faeces
Sudden onset (acute diarrhoea)
5 or more watery or loose stools
Abdominal cramps, flatulence, weakness and malaise may be present
Most common cause is bacteria or virus, often from the ingestion of contaminated food or water.
Other short term causes include medicines, emotional upset or anxiety, drinking too much alcohol, coffee or sweets.
Treatment and doses
Electrolyte sachets (6)
Other advice to be given
When to refer/criteria for
exclusion
Reference:
Review Date
Age
Dosage and frequency
Infants up to the age of 2 years
One to one & a half the usual 24hr feed volume daily
2-12 years
1 sachet following each loose bowel
Adults and children over 12 years
1-2 sachets following each loose bowel
Important; Check cautions and contra-indications
Follow manufacturers directions carefully
 Usually a self limiting condition
 Preventing dehydration is especially important for babies, frail and the elderly; replacement sachets or water should be
consumed following diarrhoea in addition to normal daily fluid intake (at least 1.5 litres daily)
 Eat as normally as possible but ideally until feeling better avoid food high in fat or sugar, encourage foods high in carbohydrate
 Take care with hygiene, wash hands after going to toilet and before preparing food
 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 (for more than two weeks)
 Recent travel to a foreign country
 Patient is taking/recently finished a course of antibiotics
CKS; Gastroenteritis Oct 2007
Nov 2009
43
Earache and Minor outer ear infection.
Definition/criteria for
inclusion





A cold or allergy can block the eustachian tube leading to build up of pressure in the middle ear which may present as earache.
Earache is more common in young children where the Eustachian tube is smaller and more easily blocked.
An earache can be a sharp, dull or burning pain. The pain may be transient or constant
Stuffiness and some hearing loss may be present.
Mild Otitis Externa; superficial inflammation of the outer ear.
Treatment and doses
Ibuprofen 100mg/5ml (100ml)
Ibuprofen 200mg tabs (24)
Paracetamol 120/5ml (100ml)
Other Advice to be given
When to refer/ criteria for
exclusion
Age
Dosage and frequency
Babies 6 month-12 months
2.5ml TDS-QDS
Children 1year-3 years
5ml TDS
4 years-6 years
7.5ml TDS
7 years-9 years
10ml TDS
10 years-12 years
15ml TDS
Over 12 years and adults
1-2 tablet(s) TDS Max 6 tabs in 24hrs
3 months-1year
2.5ml-5ml QDS
1year-under 6 years
5-10ml QDS
Paracetamol 250mg/5ml (100ml)
Children 6-12 years
5-10ml QDS PRN
Paracetamol 500mg tabs (32)
Adults and children over 12 yrs
1-2 tablets QDS PRN
*Acetic acid 2% spray (5ml)
Adults and children over 12 yrs
One spray TDS, max 1 spray every 2-3hrs
Important;
Check cautions and contra-indications
*Otitis Externa; This is the only indication for Earcalm. Treatment should be continued for two days after symptoms have
disappeared but for no longer than 7 days (earache or otitis media are not indications.) If symptoms do not resolve after treatment
refer to doctor.
 Apply a cold wet washcloth to the outer ear to reduce discomfort.
 Steam could help keep mucous thin and clear the Eustachian tubes.
 Children under 3 months old
 Earache continues for more than 12hours after taking pain killers
 Severe earache or symptoms have been present for longer than 3 days
 Rapid noticeable hearing loss
 Constant ringing, buzzing or hissing in ears
 Symptoms suggestive of infection; severe pain, continuous pain, discharge from the ear
 Associated with fever, nausea, vomiting, dizziness or loss of balance.
 Recurrent symptoms in the previous 3 months
44
Reference:
Review Date
SPC; Earcalm, CKS; Earache Oct 2007 C+D Guide to OTC Sept 2007
Nov 2009
45
Flu-like Symptoms (coughs, colds, fever)
Definition/Criteria for
inclusion


Adults and older children; sore throat, nasal irritation, congestion, sneezing, nasal discharge, cough, headache, muscular pain,
general malaise. Fever usually low grade
Younger children and babies; nasal congestion that interferes with breathing, feeding and sleeping, restlessness or irritation,
coughing, fever (<39oC), inflamed throat, swollen lymph glands
Treatment and doses
Age
Dosage and frequency
Babies 6 month-12 months
2.5ml TDS-QDS
Children 1 year-3 years
5ml TDS
4 years-6 years
7.5ml TDS
7 years-9 years
10ml TDS
10 years-12 years
15ml TDS
Over 12 years and adults
2-3 months Following
vaccination
and fever present
1-2 tablet(s) TDS Max 6 tabs in 24hrs
2.5ml dose followed by a second 2.5ml dose 46 hours later PRN, Max 2 single doses allowed
3 mnths-1 year
2.5ml-5ml QDS
1 year-under 6 years
5-10ml QDS
Paracetamol 250mg/5ml (100ml)
Children 6-12 years
5-10ml QDS PRN
Paracetamol 500mg tabs (32)
*Xylometazoline Adult nasal
drops (10ml)
*Xylometazoline Paediatric
nasal drops (10ml)
Adults and children over 12 yrs
Adults and children over 12 yrs
1-2 tablets QDS PRN
One application (2-3 drops) in each nostril BD
or TDS
Children 2-12years
1-2 drops to each nostril OD-BD
1-5 years
2.5ml TDS-QDS
6-12 years
Adults and children over
12years
5ml TDS-QDS
Menthol & Eucalyptus
Adults and children over 3mnth
Dilute 5ml in one pint warm water, use four
hourly PRN
Normal Saline nasal drops
From birth onwards
1-2 drops each nostril
Ibuprofen 100mg/5ml (100ml)
Ibuprofen 200mg tabs (24)
Paracetamol 120mg/5ml (100ml)
Glycerin Honey and Lemon
(200ml)
5-10ml TDS-QDS
Important; Check cautions and contra-indications
46
*Xylometazoline nasal drops should not be used for more than seven consecutive days to avoid rebound congestion.
Other advice to be given
When to refer/criteria for
exclusion
References
Review date









Normal body temperature is 37oC
Hot water inhalations (for chesty / productive coughs)
Hot shower or bath before bedtime.
Keep room warm but airy, don’t wrap children up too warmly
Drink plenty of non-alcoholic fluids particularly hot water with honey and lemon have a soothing effect
Avoid smoking and smoky rooms.
Rest and avoid strenuous exercise if symptoms are severe
Smoking cessation advice if appropriate
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.
 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, high temperature (above 40oC), Poor
feeding or Abnormal breathing.
 Infants under the age of three months, except those from two months post vaccination.
 If child acts oddly i.e. changes in speaking, walking, unable to sit up, drowsy all the time
 Severe earache.
 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 duration.
 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
SPC; Calpol liquid, Nurofen tablets/liquid, Otrivine nasal drops, Otrivine Paediatric nasal drops
BNF; paracetamol
CKS; Cold Oct 2007
Nov 2009
47
Headache Protocol
Definition/criteria for
inclusion
Tension headache
Usually bilateral, non-pulsating, does not affect normal routine. Described as tightness or squeezing around
the head
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
Treatment and doses
Age
Dosage and frequency
Ibuprofen 200mg tabs (24)
Adults and children over 12 years
1-2 every four hours, max 6 tabs in 24hrs
Paracetamol 250mg/5ml
liquid(100ml)
Children 6 year-2 years
5-10ml QDS PRN
Children over 12 years and adults
10-20ml every four hours , Max 4 doses in 24hrs
One-two tablets every four hours
Max four doses in 24hrs
Paracetamol 500mg tabs (32)
Other advice to be given
When to refer/criteria for
exclusion
Reference:
Review Date
Adults and children over 12 years
Important;
Check cautions and contra-indications
 Liquid formulations may have faster speed of action.
 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
 Children under 6 years of age
 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
 Subarachnoid haemorrhage; Sudden onset described as “sudden blow to the head”
 Cranial arteritis; jaw pain, scalp or muscle tenderness, general malaise esp. if over 50 years of age.
 Headache associated with; High temp, stiff neck, photophobia, drowsiness, vomiting, anorexia, rash, unequal pupils,
symptoms of meningitis- bulging fontanelle in babies, rash or seizures
 Recent head injury within the last 14 days.
 Undiagnosed migraine
 Taking the oral contraceptive pill
SPC; Calpol six plus,
CKS; Headache Oct 2007
Nov 2009
48
Head lice Protocol
Definition/criteria for
inclusion
 Only treat if infestation of scalp by live moving head lice is confirmed.
 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.
Treatment and doses
Age
Phenothrin 0.2%
aqueous liquid and
lotion (50ml x 2)
Children over 6mnths
and adults
Malathion 0.5% aqueous
liquid and lotion (50ml x 2)
Children over 6mnths
and adults
Dimeticone 4% lotion
Children over 6mnths
and adults
(50ml x2)
Other advice to be given
When to refer/criteria for
exclusion
Dosage and frequency
Apply to dry hair, allow to dry naturally in well ventilated room,
shampoo after 12hours (liquid) or 2hours (lotion), rinse and comb wet
hair. Repeat treatment after 7 days to prevent lice emerging from any
eggs that survive the first application
Apply to dry hair, allow to dry naturally in well ventilated room,
shampoo after 12hours (liquid) or 2-12hours (lotion), rinse and comb
wet hair. Repeat treatment after 7 days to prevent lice emerging from
any eggs that survive the first application
Apply to dry hair, allow to dry naturally in well ventilated room,
shampoo after 8hours or overnight, rinse and comb wet hair.
Repeat treatment after 7 days to prevent lice emerging from any eggs
that survive the first application
Important;
 Check cautions and contra-indications.
 Only infected members of the household should be treated. Each family member will have to be registered into the scheme
and be under the care of one of the participating GP practices. Separate consultations and passport entries must be completed
per person. Although all members do not need to be present, the pharmacist should be satisfied that live lice are present in all
who are receiving treatment.
 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.
 Dimeticone is the only treatment listed that is suitable during pregnancy or breastfeeding.
 Repeat treatment after 7 days 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 use is NOT evidence based.
 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.
 Choice of treatment should follow the mosaic approach
 Children under 6 months of age
 Treatment failures with Malathion and Phenothrin.
 Sores on the scalp
49
Reference:
Review Date
CKS; Headlice, SPC; Derbac M, Prioderm lotion, Full Marks liquid and lotion, C&D OTC Guide; Hedrin
Nov 2009
50
Indigestion / Reflux Protocol
Definition/criteria for
inclusion


Dyspepsia; Upper abdominal discomfort, pain associated with food/hunger relieved by antacids, nausea and bloating
Gastro-oesophageal reflux; Heartburn, acid regurgitation, epigastric pain, belching, waterbrash
Formulary
Other advice to be given
When to refer/criteria for
exclusion
Reference:
Review Date
Age
Dosage and frequency
Magnesium trisilicate
mixt (200ml)
6-12 years
5-10ml with water TDS
Children over 12 years and adults
10-20ml with water TDS
Gaviscon liquid (150ml)
6-12 years
5-10ml after meals and at bedtime
Children over 12 years and adults
10-20ml after meals and at bedtime
Important;
Check cautions and contra-indications
 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
 Gaviscon is considered safe for use in pregnancy, providing sodium intake is not to be restricted.
 Children under 6 years of age
 First symptoms of indigestion at 45 years old or over with new or recently changed symptoms of indigestion
 You have had to take an indigestion remedy continuously for 4 or more weeks
 Unintended weight loss in association with indigestion
 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
 Received abdominal surgery
 Have a history of gastric ulceration, Barrett’s oesophagus, dysplasia
 Receiving NSAIDs or other medicines known to cause gastric irritation
 Pain in the chest indicative of another aetiology
CKS; dyspepsia Oct 2007
BNF for children 2007
Nov 2009
51
Insect bites and stings Protocol
Definition/Criteria for
inclusion
 Biting insects commonly encountered in the U.K include midges, gnats, mosquito’s, fleas, flies, bedbugs, ticks and mites; the
antigenic salivary gland secretions in the bite can inflict local swelling, papule and itching.
 Stinging insects commonly encountered in the U.K include honeybees, hornets, wasps and bumblebees; venom contains
allergens and pharmacologically active substances that cause a local pain, erythema and swelling at the site of the sting
Treatment and doses
Age
Dosage and frequency
Adults and children over 6 years
10ml once daily or 5ml BD
6-12years
5ml 4-6hrly (max 12mg daily)
Children over 12 yrs and adults
10ml every 4-6 hrly (max 24ml daily)
Cetirizine 10mg tablets (30)
Children over 12 yrs and adults
One daily
Chlorphenamine 4mg tablets (30)
Children 6-12years
Half tab 4-6 hrly (max 6 halves daily)
Adults and children over 12yrs
One tablet 4-6 hrly (max 24mg daily)
Children over 10 yrs and adults
Apply BD-TDS
Cetirizine 5mg/5ml (150ml)
Chlorphenamine 2mg/5ml (150ml)
Hydrocortisone cream 1% (15g)
Other advice to be given
When to refer/exclusion
criteria
Reference:
Review date
Crotamiton 10% cream (30g)
Infants over 2 yrs and adults
Apply BD-TDS
Important; Check cautions and contra-indications
 Wash the affected area with soap and water
 Apply ice to reduce swelling if present
 Do not scratch, as this will make the itch worse and increase the risk of infection
 Avoid exposed skin by wearing covering clothing
 Mosquito’s are attracted to pregnant women
 Bites from fleas, mites, and bedbugs maybe due to an infestation, the source should be confirmed and eliminated.
 Signs of anaphylaxis seek urgent medical support
 Previous severe reaction or anaphylaxis to stings
 Secondary bacterial infection
 Recent travel abroad
 Expanding red rash if suspicions of Lyme disease
 Fever or malaise
 Multiple stings
 A serum sickness type reaction-with urticaria, joint swelling and arthralgia that can develop 7-10 days after the sting
 Symptoms that have not improved within several days
CKS; insect bites and stings. SPC; Piriton liquid/tablets, Zirtek liquid/tablets, Eurax cream. BNF; hydrocortisone March 07
Nov 2009
52
Mouth Ulcers Protocol
Definition/Criteria for
inclusion
 A mouth ulcer is any ulcerative lesion affecting the oral mucosa.
 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.
 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.
Treatment and doses
Other advice to be given
When to refer/criteria for
exclusion
Reference:
Review Date
Age
Adcortyl in orabase (5g)
Adults and children over 12 years
Chlorhexidine mouthwash (300ml)
Adults and children over 12 years
Dosage and frequency
Apply at night and BD-QDS,
preferably after meals. Max 5 days
Rinse thoroughly with 10ml BD
Important;
Check cautions and contra-indications
 Single isolated traumatic ulcers are often due to catching the gum with the toothbrush or badly fitting dentures.
 Known risk factors include; female gender, stress or anxiety, stopping smoking, changes in hormone levels (e.g. just before
their menstrual period or after the menopause), a lack of vitamins B12 or folic acid or iron, genetic predisposition.
 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.
 Maintain good oral hygiene
 If suggesting Corsodyl, advise how to reduce staining; avoid tea, coffee, red wine, brush teeth before using mouthwash rather
than after but rinse mouth well as some ingredients in toothpaste can inactivate corsodyl. Corsodyl should be used for 48hrs
after resolution of symptoms.
 Children under 12 years of age
 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.
 Recurrent or multiple ulcers
CKS; mouth ulcers. C&D Guide to OTC Sept 07
Nov 2009
53
Nappy Rash Protocol
Description
 Nappy rash is a red rash, or sore area, which 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 by-products which also damage baby’s skin.
Pharmacy First Formulary
Sudocrem (125g)
General advice
When to refer
Reference:
Review Date
Age
Dosage and frequency
All ages
Apply thin cover after every nappy change
Important;
Check cautions and contra-indications
 When possible, leave the nappy off allowing air to get to the skin.
 Change the baby’s nappy as soon as possible after it becomes wet or soiled
 Clean the nappy area thoroughly after each bowel movement, pat with towel rather than rubbing
 Do not use talcum powder
 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.
 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.
SPC; Sudocrem
CKS; nappy rash
Nov 2009
54
Scabies Protocol
Definition/Criteria for
inclusion
 Scabies is an allergic irritant condition resulting from the burrowing of the human scabies mite.
 Intense itching and/or rash often worsens when hot, generally symmetrical on the body, commonly begins 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)
Treatment and doses
Age
Cetirizine 5mg/5ml
(150ml)
Chlorphenamine
2mg/5ml (150ml)
Cetirizine 10mg
tablets (30)
Chlorphenamine
4mg tablets (30)
Adults and children
over 6 years
2-5 years
6-12 years
> 12 years and Adults
2x5ml daily or 5ml BD
> 12 years and Adults
One daily
6-12 years
> 12 years and Adults
> 2 years and Adults
Half tab 4-6 hrly (max 12mg daily)
One tablet 4-6 hrly (max 24mg daily)
Apply to whole body, excluding head, with particular attention to
fingers, toes, wrist, elbows, armpits, knees, knees, external genitalia,
buttocks and under nails. Wash thoroughly after 8-12hours, but
reapply to hands in the meantime if washed with soap in the
treatment period.
Apply thin layer to entire skin surface, scalp face ears neck, avoid
eyes and mouth. Not to wash or bathe for 24hrs, if hands needed to
be washed reapply immediately. Repeat treatment after 7 days
Apply thin layer to entire skin surface, excluding scalp, face, ears and
neck. Not to wash or bathe for 24hrs, if hands needed to be washed
reapply immediately. Repeat treatment after 7 days
Permethrin 5%
Dermal cream (30g)
6 mnths-2years
Malathion 0.5%
aqueous liquid
(100ml)
> 2 years and Adults
Other advice to be given
Dose and Frequency
2.5ml 4-6 hrly (max 6mg daily)
5ml 4-6 hrly (max 12mg daily)
10ml 4-6 hrly (max 24 mg daily)
Important;
Check cautions and contra-indications
When one member of the family presents with scabies, the entire family should be treated. Although each member does not need to
present in person to the pharmacy, they will each need a passport and a separate consultation form completing.
 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
55
When to refer/exclusion
criteria
Reference:
Review Date
 Itching may persist for 2-3 weeks after successful treatment. During this time no new lesions should develop. All members of the
household should be treated at the same time even in the absence of symptoms i.e. 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.
 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.
 When treating those under 2 years of age consider referral to practice nurse.
 Children under 6months, pregnant and lactating women should be referred to the G.P.
 Treatment failure
 Signs of bacterial infection
SPC; Lyclear Dermal cream, Zirtek tablets, Piriton tablets, Derbac M Liquid
CKS; Scabies
C&D Guide to OTC Sept 2007
Nov 2009
56
Sore Throat Protocol
Definition/criteria for
inclusion




The majority of pharmacy consultations for sore throats are viral in origin; therefore antibiotics would not be indicated.
Sore throat and / or ear
Pain on swallowing.
Mild fever, headache and malaise.
Treatment and doses
Age
Dosage and frequency
Babies 6 mnths-12 months
2.5ml TDS-QDS
Children 1 year-3 years
5ml TDS
4 years-6 years
7.5ml TDS
7 years-9 years
10ml TDS
10 years-12 years
15ml TDS
Ibuprofen 200mg tabs
(24)
Paracetamol
120mg/5ml (100ml)
Over 12 years and adults
1-2 tablet(s) TDS, Max 6 tabs in 24hrs
3 months -1year
2.5ml-5ml QDS
1 year-under 6
5-10ml QDS
Paracetamol
250mg/5ml (100ml)
Paracetamol 500mg
tabs (32)
Difflam Throat spray
30ml
Children 6-12 years
5-10ml QDS PRN
Adults and children over 12 yrs
1-2 tablets QDS PRN
Under 6 years
One puff per 4kg body weight, max 4 puffs every 1.5 3hrs
6-12 years
Four puffs every 1.5-3hrs
Adults
Four - eight puffs 1.5-3hrs
Children 6-12 years
One dose every 2-3 hours, max 8 doses in 24hrs
Children over 6 years and adults
Two doses every 2-3 hours, max 16 doses in 24hrs
Adults (over 16 years only)
One dissolved in water four times a day and used as
gargle.
1-5 years
2.5ml TDS-QDS
6-12 years
5ml TDS-QDS
Adults and children over 12years
5-10ml TDS-QDS
Ibuprofen 100mg/5ml
(100ml)
AAA Throat spray (60
sprays)
Aspirin 300mg
dispersible tablets (16)
Glycerin Honey and
Lemon (200ml)
57
Important; Check cautions and contra-indications
Other advice to be given
When to refer/criteria for
exclusion
Reference:
Review Date







Sore throats are usually a self-limiting illness (whether caused by viral or bacterial infection) and will resolve in 7 – 10 days
Minimize talking, avoid smoking and alcohol
Taking regular sips of warm drinks, like honey and lemon, can help to relieve the symptoms.
Sucking sugar free lozenges can help.
Babies under 6 months
Poor immune response (illness or drug related).
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.
 Severe symptoms.
 Swallowing drinks is not possible.
 Difficulty in breathing.
 Repeated tonsil infections or abscesses.
 Severe Earache.
 Hoarseness for more than 3 weeks.
CKS; sore throat Nov 2007
SPC; Difflam Sore throat spray
Nov 2009
58
Teething Protocol
Definition/criteria for
inclusion
 The emergence of teeth through the gums of the mouth usually begins between the 6th 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.
 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
Treatment and doses
Calgel (10g)
Other advise to be given
When to refer/exclusion
criteria
Reference:
Review Date
Age
Dosage and frequency
Infant over 3 months
Apply one third of an inch gel, repeated maximum of 6 x daily
Important;
Check cautions and contra-indications
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.
 Give the baby something cool to chew on. E.g. teething rings, which can be cooled in the fridge or 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 concurrent diarrhoea
 If symptoms and pain are excessive or if the baby is crying inconsolably. Teething shouldn’t be excruciating
C&D Guide to OTC Sept 07 & www.mhra.gov.uk/NewsCentre/Pressreleases/CON044014 accessed on 23rd April 2009
Nov 2009
59
Threadworm Protocol
Definition/criteria for
inclusion
Treatment and doses




A parasitic worm which is caught after swallowing the eggs
Anal Pruritus mainly at night is quite often the only symptom
Sometimes worms can be seen around the anus or in the stools.
Threadworms are extremely common. Infection can spread rapidly between family members by direct transfer of eggs.
Age
Adults and children over 2
Mebendazole 100mg chewable tab (2 or 4) years
Other advice to be given
When to refer/criteria for
exclusion
Reference:
Review Date
Dosage and frequency
One tablet single dose
Repeat treatment in 14 days if reinfection suspected
Important;
Check cautions and contra-indications
One consultation form is sufficient to treat four family members. Families of greater numbers will require a second consultation form
completing. For treatment of re-infection two weeks later, a new consultation will be needed for that individual.
 All members of the family should be treated at the same time
 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
 It is not necessary to keep children off school
 Children under 2 years
 Use of Anthelmintics needs to be combined with hygiene measures to be prevent ova being transferred form the anus to the
mouth
 Pregnant or potentially pregnant women, or breast feeding
 Signs of bacterial infection (Day and night time irritation, red and inflamed skin around the anus or purulent mucus discharge
from the anal canal)
SPC; Ovex tablets.
CKS; Threadworms, Oct 2007
Nov 2009
60
Thrush (not oral) Protocol
Definition/criteria for
inclusion
 Vaginal candidiasis (fungal) infection of the lower female genital tract with previous diagnosis of thrush, in those who are
confident it is a recurrence of the same condition and their sexual partner.
 Presenting symptoms include thick, white vaginal discharge, pain or burning on urination, soreness and itching
Treatment and doses
Gender
Age
Dosage and frequency
Male
only
16-60
Apply two or three times daily for seven days
Clotrimazole combi
500mg/2% (1)
Female
only
16-60
Use pessary at night, continue with cream two or three times daily
until symptoms have resolved
Fluconazole 150mg (1)
Female
or Male
16-60
Single oral dose
Clotrimazole cream 2%
(20g)
Other Advise to be given
When to refer
Reference:
Review Date
Important;
A separate consultation must take place for male (sexual partner) i.e. the patient must present in the pharmacy and the product
issued recorded on their passport.
Only one product can be provided per patient.
Check cautions and contra-indications
 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 (if suitable on Minor ailments a separate consultation must be done.)
 Symptoms may take up to 7 days to resolve, if this fails to occur then the patient should be advised to see their doctor.
 Pessaries best used at night to aid retention
 Patient is under 16 or over 60 years of age.
 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
 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
Manufacturers guidance
Nov 2009
61
Verruca & Wart Protocol
Description
 Cutaneous warts (Verruca vulgaris) are small rough skin coloured lesions affecting the epidermis of the skin and caused by
infection with the human papilloma virus (HPV)
 Friction wears away the dead cells of the wart which exposes thrombosed blood vessels giving the verruca its typical
appearance with black dot in the middle
 Only those on the hands or the feet.
Pharmacy First Formulary
Other advice to be given
When to refer
References
Review Date
Site on body
Age
Dosage and frequency
Verrugon (6g)
Feet only
6 years onwards
Apply at night for up to 12 weeks.
Cuplex (5g)
Hands or feet
Adults and children over 1
year
Apply twice a day for up to 12 weeks.
following manufacturers directions
Important;
 Always follow the manufacturers directions
 Check cautions and contra-indications
 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
 Warts anywhere else on the body other than hands or feet
 Painful verrucas
 Suspect skin cancer
 Diabetic patient
 Pregnancy
 immuno-compromised – check medication
C&D Guide to OTC; Sept 2007
CKS; Warts and Verrucae Nov 2007
Nov 2009
62
63