Back Pain
Musculoskeletal Specialist or Face to Face Consultation
Book appointment with the MSK specialist (16 years and older).
If the pain started after recent trauma advise to attend urgent care / A&E.
Book an amber appointment if under 16 years.
RED FLAG SYMPTOMS
Book red appointment if any RED flag symptoms:
Pain started following significant trauma (e.g. fall from height, car accident) – Direct to A&E
Associated with new onset chest pain – Direct to A&E
Numbness or tingling around genitals or buttocks
Pain, tingling, weakness or numbness in BOTH legs
NEW difficulty in passing urine/opening bowels or new loss of bladder/ bowel control (Peeing or pooing themselves)
A high temperature (>38)
A history of cancer
Weight loss without trying
The pain is coming from the top of the back (between your shoulders), rather than their lower back
There is a lump or swelling in their back or their back has changed shape
Bacterial Vaginosis (BV)
Community Pharmacy or Face to Face Consultation
Symptoms of BV include a watery discharge and fishy odour
Send patients to pharmacy for advice and product purchase.
Book a green appointment with a clinician if OTC treatment has not worked, is a recurrent issue or patient is under 16 years old.
Binge Eating
Face to Face Consultation
Book a green appointment.
Bites & Stings
Community Pharmacy or Face to Face Consultation
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
- Check which wounds are at risk of Tetanus here – Tetanus – NHS
Insect Bites and Stings
Refer to pharmacy first scheme (Excludes: Pregnant individuals under 16 years)
Book a red appointment if the bite is showing signs or symptoms of infection:
- Fever
- Red and hot to touch
- Pus or discharge
- Spreading redness
Refer to ANAPHYLAXIS information if symptoms are severe
Bladder infection in Men
Face to Face Consultation
Book an amber appointment.
Ask the patient to bring a urine sample to the appointment if able.
See SEPSIS
Book a red appointment for suspected kidney infections. Urine symptoms maybe associated with the following:
- A very high temperature or shaking chills (rigors)
- Nausea and vomiting
- Flu like illness
- Pain in the back just under the ribs
- Urine is red/passing blood clots in urine
Patients aged over 65 years old
Book a red appointment.
If we are at full capacity for the day and the patient/carer is happy they can wait until the following day, book a red appointment the next day. Anyone who is unable to wait or reports to be very unwell, direct to urgent care.
Bladder infection in Women
Pharmacy First or Face to Face Consultation
Pharmacy First or Face to Face Consultation
Refer to the pharmacy first scheme (Exclusions: urinary catheter, recurrent UTIs (2 episodes in last 6/12 or 3 in last 12/12), suspected pyelonephritis (kidney infection).
If treatment has failed or pharmacy unable to see book an amber appointment.
Book a red appointment for suspected kidney infections. Symptoms include:
- Very high temperature or shaking chills (rigors)
- Nausea and vomiting
- Flu like illness
- Pain in the back just under the ribs
- Urine is red/passing blood clots in urine
Face to Face Consultation
Book a red appointment. Ask the patient to bring a urine sample to send for MSU.
If we are at full capacity for the day and the patient is happy they can wait until the following day, book a red the next day. Anyone who is unable to wait or reports to be very unwell direct to urgent.
Face to Face Consultation
Book a red appointment.
If we are at full capacity for the day and the patient/carer is happy they can wait until the following day, book a red the next day. Anyone who is unable to wait or reports to be very unwell direct to urgent.
Bladder infection in children (5-16 years)
Face to Face Consultation
Book a red appointment.
Ask the patient to bring a urine sample to the appointment if able.
If we are at full capacity for the day and the patient/carer is happy they can wait until the following day, book a red the next day. Anyone who is unable to wait or reports to be very unwell direct to urgent care/111.
See SEPSIS.
Blood in the Urine for Men
Face to Face Consultation
Book an amber appointment.
Book a red appointment if:
- If patient reported to be very unwell e.g. high temperature, shaking/rigors, new confusion, vomiting.
- Severe pain.
- Passing only red urine every time they go/passing blood clots.
Consider this could be part of a urine infection, see bladder infection/urine infection in men for more information.
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Blood in the urine for women
Face to Face Consultation
Book amber appointment.
Book a red appointment if:
- If patient reported to be very unwell e.g. high temperature, shaking/rigors, new confusion, vomiting.
- Severe pain.
- Passing only red urine every time they go/passing blood clots.
Consider this could be part of a urine infection, see bladder infection/urine infection in women for more information.
Blood in urine for Children (Under 16 years)
Face to Face Consultation
Book a red appointment.
Blood Pressure High or Low
Follow guidance
Face To Face Consultation
A low BP is a reading of <90/60mmHg.
Check if the patient is symptomatic (e.g. dizzy, lightheaded, collapsing or confused). If they have any symptoms book a red appointment.
No Action Needed
BP <140/90mmHg
Advise patient is within normal limits and to check every 5 years or more often if close to 140/90.
Face to Face Consultation
BP 140/90 to 179/119
Check if the patient has any red flag symptoms – if so follow guidance under red flags.
If no red flags, ask patient to record blood pressure readings for 7 days or refer to pharmacy for ambulatory blood pressure readings and submit to the surgery. If the result is high the patient will be contacted to make a green appointment.
Face to Face Consultation
BP 180/120 or more (either top or bottom reading or both raised)
Book a red appointment with a GP/ANP.
RED FLAG SYMPTOMS
Book a RED face to face appointment if the patient has a blood pressure over 140/90 and has any of the following symptoms:
Headache/Dizziness
Nausea and vomiting
Severe anxiety
Visual disturbances/blurred vision
Chest pain
Feeling of pulsations in the neck or head
Seizures
Nosebleeds
Shortness of breath
Bloodshot eye
Community Pharmacy or Face to Face Consultation
Send patients to pharmacy for advice and product purchase.
Book a green appointment if advised by pharmacy or OTC has failed.
If any other eye symptoms (e.g. painful eye or visual disturbance), see relevant page.
Boils / Blisters
Community Pharmacy or Face to Face Consultation
Direct to pharmacy for advice and product purchase.
Book a green appointment if OTC products have not helped/advised by pharmacist.
Book a red appointment if there are signs of infection:
- Fever.
- Spreading redness.
- Red, swollen, hot to touch.
- Discharging pus.
Bowel Problems / Constipation
Community Pharmacy or Face to Face Consultation
Send patients to pharmacy for advice and product purchase.
Book a green appointment if OTC treatment has not worked.
Book an amber appointment if aged over 60 years of age and there is an unexplained NEW change in their bowel habit (i.e. not something they have experienced before).
See Abdominal Pain for more information if present.
Breast problems in Men
Face to Face Consultation
Book an amber appointment.
Book a red appointment if signs or symptoms of infection:
- Feverish.
- A painful, swollen lump/area in the breast with redness, heat and swelling of the overlying skin.
Breast problems in Women
Face to Face Consultation
Book an amber appointment
(Offer choice of clinician re gender if possible)
Book a red appointment if signs or symptoms of infection:
- Feverish.
- A painful, swollen lump/area in the breast with redness, heat and swelling of the overlying skin.
Rectal Bleeding, Blood in stool
Book an amber appointment.
Book a red appointment if:
- Passing large amounts of fresh red blood/passing blood clots.
- Passing jet black, sticky, smelly stools that looks like tar.
- Unwell with bleeding e.g. feeling lightheaded, collapse, short of breath.
- Experiencing significant associated pain or have a an extremely painful lump in back passage.
Consider A+E for the above if any symptoms seem severe or patient very unwell.
Breathing Problems
999 or Face to Face Consultation
Discuss with the patient the extent of the immediate problem. If the patient has new sudden onset of severe SOB/difficulty breathing, can’t talk in full sentences, gasping for breath or has features as per the chest pain guidance direct to A+E/Call 999.
For others book a red face to face appointment with a clinician.
See Chest Infection for further guidance.
Burns
A&E or Community Pharmacy or Face to Face Consultation
Any significant new burns need to attend A&E.
Minor burns can be directed to the pharmacy or the treatment room if dressings are needed.
Book a red appointment if concerns of an infected burn.