Back Pain
Appointment with Musculoskeletal Specialist or Face to Face Appointment with Clinician
Book appointment with the MSK specialist, or signpost to self-referral option.
If the patient is under 16 years old book a face-to-face appointment with clinician.
Book red face to face appointment if any RED flag symptoms:
- If 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 Scheme or Face to Face Appointment
Send patients to pharmacy for advice and product purchase.
If symptoms have not resolved despite OTC management then book a green appointment with a clinician.
Children under 16 – face to face appointment first.
Symptoms of BV include a watery discharge and fishy odour.
Vaginal discharge
Community Pharmacy
Send patients to pharmacy for advice and product purchase.
If OTC treatments have been unsuccessful book a green face to face appointment
Binge Eating
Telephone Consultation
Book Appointment.
Bites & Stings
Refer to Pharmacy or Face to Face Appointment
Animal Bites/Scratches that have broken the skin and are showing signs of infection, book patient in for a red face to face assessment.
Insect Bites and Stings
refer to pharmacy first service if aged 1 year or over (Excludes: Pregnant individuals under 16 years).
The symptoms can vary. Refer to ANAPHYLAXIS information if symptoms are severe.
Direct to A&E / 999.
Bladder infection in Men
Face to Face Consultation
Book an amber face to face appointment for all men with a suspected bladder/urine infection.
Ask patient if they are able to bring a urine sample to the appointment for the clinician.
Book a red face to face appointment in those who report to be unwell e.g. fever, shaking, confusion, severe pain, vomiting.
Patients aged over 65 years old
Book a red face-to-face appointment.
Ask all patients in this age group to bring a urine sample to their appointment to send for MSU.
Do NOT dip urine in this age group as it is unreliable.
Bladder infection in Women
Community Pharmacy or Face to Face Consultation
Are you pregnant?
YES
Book a red day face to face appointment.
Ask the patient to bring a urine sample to send for MSU.
NO
Have you tried over the counter pharmacy treatments?
YES
If patient has already been treated with antibiotics or has a recurrent urine infection book an amber appointment. Ask patient if possible to bring a urine sample to the appointment.
NO
Pharmacy First Scheme
Send all patients to pharmacy using the pharmacy first scheme.
Patients aged over 65 years
Book a red face-to-face appointment.
Ask all patients in this age group to bring a urine sample to their appointment to send for MSU.
Do NOT dip urine in this age group as it is unreliable.
Bladder infection in Children (Aged 5-16)
Face to face consultation
Make an amber face to face appointment and ask to bring a urine sample to the appointment.
Book a red appointment if reports very unwell such as high fever/vomiting/severe pain/blood in urine
Blood in the Urine for Men
Face to Face Consultation
Book an amber appointment
Book a red face to face appointment in those who report to be unwell e.g. high fever, shaking, confusion, severe pain, vomiting or passing only red urine every time they go/blood clots
Blood in the urine for women
Face to Face Consultation
Book amber appointment
Book a red face to face appointment in those who report to be unwell e.g. high fever, shaking, confusion, severe pain, vomiting or passing only red urine every time they go/blood clots
Blood in urine for Children (Under 16)
Face to Face Consultation
Book a red face to face appointment
Blood Pressure High or Low
Follow guidance
- BP under 140/90 – Advise patient is within normal limits and to check every 5 years or more often if close to 140/90. A low BP of <90/60 where the patient is symptomatic (dizzy, lightheaded, collapsing or confused) book a red face to face appointment.
- BP 140/90 to 179/119 and patient has none of the red flag symptoms – 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.
- BP 180/120 or more (either reading) – Book a red face to face 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
Refer to Community Pharmacy Scheme or Face to Face Consultation
Send patients to pharmacy for advice and product purchase.
Book a green face to face appointment if advised by pharmacy or OTC has failed.
Boils / Blisters
Refer to Community Pharmacy Scheme / Face to Face Appointment
A green face to face if OTC products have not helped/advised by pharmacist.
Book a red appointment if there are signs of infection or are unwell e.g. high fever/spreading redness/hot to touch/discharging pus
Bowel Problems / Constipation
Refer to Community Pharmacy Scheme or Face to Face Appointment
Send patients to pharmacy for advice and product purchase.
If the patient is under 12 years of age or has long term constipation make a green face to face appointment.
Book an amber face to face appointment if aged over 60 years of age and there is an unexplained NEW change in their bowel habit (e.g. not something they have experienced before).
Breast problems in Men
Face to Face Consultation
Book Appointment
Breast problems in Women
Face to Face Consultation
Book Appointment
(Offer choice of clinician re gender if possible).
Rectal Bleeding, Blood in stool
Book an amber face to face appointment
Book a red face to face consultation if patient:
- 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, chest pain.
- Experiencing significant associated pain or have a an extremely painful lump in back passage.
- Experiencing associated symptoms such as unintentional weight, aged 60 years or older with a new change in bowel habit for more than 3 weeks.
Breathing Problems
999/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 999 otherwise book a red face to face appointment with a clinician.
See Chest Infection for further guidance.
Burns
Refer to Community Pharmacy Scheme 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
