Abscess
Face to face Consultation
Clarify with patient if the issue is dental or not.
If dental direct to dentist. If patient has no dentist advise to call 111 for emergency dentist review.
If not dental in nature book a red appointment.
Abdominal Pain
Sudden Severe Abdominal Pain
Book a red appointment
Consider directing to A+E/999 if so severe they are can’t wait to be seen or report being very unwell with the pain such as high fever/N+V/vomiting blood or coffee ground like vomit/collapse/can’t breath properly/chest pain/diabetic with high sugars and ketones
Repeated/reoccurring stomach problems
Book a green appointment
Acid Reflux
Community Pharmacy or Face to Face Consultation
Send patient to Community Pharmacy for advice and appropriate products.
Book a green appointment if OTC treatment has been tried and not helped
Acne
Community Pharmacy or Face to Face Consultation
Send to patient for advice and product purchase
Book a green appointment if OTC treatments have not worked
Acute Medication Request
Follow appropriate flow chart
See flow chart in reception bible
ADHD/Autism
Patients aged 5 and above do not need a GP appointment if they are only requesting a referral for ADHD or ASD assessment.
Advise patients to go to www.adhduk.co.uk/right-to-choose for information about the process. Send patients a link via Accurx.
Patients should:
- Research and identify a private provider that fits their needs and criteria (e.g., if they want to be considered for medication, or just an assessment/diagnosis).
- Once they have chosen a clinic:
- Inform the surgery of the clinic name.
- Check whether the referral requires any paperwork (e.g., questionnaires).
- The patient must print, complete, and bring any required forms to the surgery.
If the patient does not wish to use the Right to Choose route:
Currently there are no referral options through GP for ASD
- ADHD
- They can be added to the standard NHS waiting list, which is currently approximately 4 years.
- Send the patient the relevant Accurx ADHD/ASD questionnaire.
- Once the completed questionnaire is returned, the secretaries will add the patient to the NHS waiting list.
Advanced Care Planning (ACP)
Face to Face Consultation
Book into an advanced care planning slot
Alcohol/Drug misuse
Local Drug and Alcohol Services
Provide Patient with details of local Drug and Alcohol Services
Book a green appointment if they wish to discuss further with a clinician
Allergies
For all allergies consider ANAPHYLAXIS (see relevant heading)
Symptoms of an allergic reaction usually develop within a few minutes of being exposed to something you’re allergic to, although occasionally they can develop gradually over a few hours. The symptoms can vary.
Common symptoms of an allergic reaction include:
- Sneezing and an itchy, runny or blocked nose (allergic rhinitis)
- Itchy, red, watering eyes (conjunctivitis)
- Wheezing, chest tightness, shortness of breath and a cough.
- A raised, itchy, red rash (hives).
- Swollen lips, tongue, eyes or face.
- Tummy pain, feeling sick, vomiting or diarrhoea.
- Dry, red and cracked skin
Community Pharmacy or Face to Face Consultation
Direct to pharmacy for advice and product purchase
Book a green appointment if the patient wishes to discuss allergies, testing and ongoing management
Community Pharmacy or Face to Face Consultation
Direct to pharmacy for advice and product purchase
Book a green appointment if the patient wishes to discuss allergies, testing and ongoing management
Community Pharmacy or Face to Face Consultation
Direct to pharmacy for advice and product purchase
Book a green appointment if the patient wishes to discuss allergies, testing and ongoing management
Face to Face consultation or Emergency Care
Triage for anaphylaxis – direct to A+E/999 if concerns
Book a green appointment if the patient wishes to discuss allergies or intolerances, testing and ongoing management
Community Pharmacy or Face to Face Consultation
Direct to pharmacy for advice and product purchase
Book a green appointment if the patient wishes to discuss allergies, testing and ongoing management
Community Pharmacy or Face to Face Consultation
Direct to pharmacy for advice and product purchase
Book a green appointment if the patient wishes to discuss allergies, testing and ongoing management
Community Pharmacy or Face to Face Consultation
Refer to community pharmacy scheme (excludes: pregnant individuals under 16 years)
Book a red appointment if the bite is showing signs of infection:
- Fever
- Red and hot to touch
- Pus or discharge
- Spreading redness
Community Pharmacy or Face to Face Consultation
Direct to pharmacy for advice and product purchase
Book a green appointment if the patient wishes to discuss allergies, testing and ongoing management
Face to Face Consultation or Emergency Care
Triage for anaphylaxis – direct to A+E/999 if concerns
Book an amber appointment for patients who suspect they have had an adverse reaction to a medication and need an alternative
Community Pharmacy or Face to Face Consultation
Direct to pharmacy for advice and product purchase
Book a green appointment if the patient wishes to discuss allergies, testing and ongoing management
Anaphylaxis
Severe allergic reaction (Anaphylaxis)
In rare cases, an allergy can lead to a severe allergic reaction, called anaphylaxis or anaphylactic shock, which can be life-threatening.
This affects the whole body and usually develops within minutes of exposure to something you’re allergic to.
Signs of anaphylaxis include any of the symptoms below, as well as:
- swelling of the throat, mouth and/or tongue
- difficulty breathing
- light-headedness
- confusion
- blue skin or lips
- collapsing and losing consciousness
Anaphylaxis is a medical emergency that requires immediate treatment.
Call 999 immediately
Ankle Pain
Musculoskeletal specialist or Face to Face Consultation
Book appointment with MSK specialist
Care
If the pain started after recent trauma advise to attend urgent care / A&E
Book an amber appointment if the patient is not coping with current pain levels and/or there are “medical” causes for the pain or if they are under 16 years of age.
Book a red appointment if there is a possible infected joint (i.e. sudden severe joint pain, feverish, new red hot swollen joint).
Anorexia
Face to Face Consultation
Book a green appointment
Animal Bites Scratches and Stings
Community Pharmacy or Face to Face Appointment
Animal bites/Scratches
Direct to community pharmacy for minor bites and scratches
Book a red appointment if signs or symptoms of infection
- Wound is red, swollen, hot to touch
- Pus from wound
- Fever
Direct to A+E if:
- The wound is large or deep
- Bleeding will not stop
- Exotic animal bites
- Concerns regarding risk of tetanus, rabies, hepatitis or HIV
Insect bites and Stings
Direct to community pharmacy
Book a red appointment if the bite is showing signs of infection:
- Fever
- Red and hot to touch
- Pus or discharge
- Spreading redness
Refer to ANAPHYLAXIS information on this page if symptoms are severe.
Direct to A&E / 999.
Anxiety
Face to Face Consultation
Book a green appointment
If other mental health concerns see relevant page
If requesting medication due to anxiety surrounding having a scan or procedure see ‘Medication for procedure’
Arthritis
Musculoskeletal specialist or Face to Face Consultation
Book appointment with MSK specialist
Care
Book an amber appointment if the patient is not coping with current pain levels or if they are under 16 years of age.
Book a red appointment if there is a possible infected joint (i.e. sudden severe joint pain, feverish, new red hot swollen joint.
Asthma
Face to Face Consultation
Book a green appointment for those who suspect they may have asthma or wish to discuss their asthma with a clinician
Book a red appointment if they are unwell with their asthma e.g. suspected chest infection, difficulty breathing (see relevant pages)
Book a CDM review with the practice nurse if they are due their annual asthma review or they wish to discuss their asthma treatment.
Athletes Foot
Community Pharmacy or Face to Face consultation
Send patients to pharmacy for advice and product purchase.
Book a green appointment if OTC treatments have not worked
Pins and Needles/Arm/Face Numbness
Triage Symptoms First
- Face – the face may have dropped on 1 side, the person may not be able to smile, or their mouth or eye may have drooped.
- Arms – the person may not be able to lift both arms and keep them there because of weakness or numbness in 1 arm.
- Speech – their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake; they may also have problems understanding what you’re saying to them.
- Time – it’s time to dial 999 immediately if you notice any of these signs or symptoms.
- Complete paralysis of 1 side of the body
- Ask the person to stick out their tongue. If the tongue is crooked’ if it goes
to one side or the other. - Sudden loss or blurring of vision
- Dizziness
- Confusion
- Difficulty understanding what others are saying
- Problems with balance and co-ordination
- Difficulty swallowing (dysphagia)
- A sudden and very severe headache resulting in a blinding pain unlike anything experienced before
- Loss of consciousness
- If anyone is with the patient at home ask them to call 999 immediately.
- Send a task message to the clinical team advising them of the patient situation.
- If no one is at home with the patient, ask a colleague to call 999 for you whilst you remain on the phone with the patient.
- Bring the call to the attention of your supervisor.
If the patient has no red flag symptoms
Book an amber appointment
Swollen Feet/Legs/Ankles
Face to Face Consultation
Book a green face to face appointment
Book a red appointment if they have:
- A single leg (particularly calf swelling) has become swollen especially if sudden onset/recent long haul flight/pregnant or had a baby recently/recent surgery/immobile – could be a deep vein thrombosis (DVT)
- Associated with difficulty in breathing (see breathing problems)
- Associated with chest pain (see chest pain protocol)