Dandruff
Refer to Pharmacy or Face to Face Consultation.
Refer to Pharmacy for advice and product purchase.
Book green face to face appointment if:
- The condition is severe
- the condition is long standing and has not cleared despite using OTC products
- there are any skin lesions or blisters with discharge (consider a red appointment if signs of infection)
Dementia/Memory loss
Face to Face Appointment
Book a green appointment
Depression Adult
Face to Face Consultation
Non Emergency:
Book an amber face to face appointment
EMERGENCY CARE: (threat to life/harm)
Discuss with an available clinician on action to be taken (i.e. same day red face to face appointment/999/crisis team)
Depression Children
Face to Face Consultation
Non Emergency:
Book an amber face to face appointment
EMERGENCY CARE: (threat to life/harm).
Discuss with an available clinician on action to be taken (i.e. same day red face to face appointment/999/crisis team)
Diarrhoea & Vomiting
Refer to Pharmacy or Face to Face Consultation
Send patients to pharmacy for advice and product purchase
If this has been tried but symptoms are ongoing book a green face to face appointment within a week.
Book an amber appointment for patients over 60 years with a new change in bowel habit that is not resolving within a couple of weeks
Book a red face to face appointment for those:
- With severe symptoms and cant keep any fluids down
- With symptoms of severe dehydration (confusion, passing little or no urine)
- Bloody diarrhoea/rectal bleeding
- High fever
- Associated severe abdominal pain
Diabetic Foot
Face to Face Appointment
Book a red face to face appointment with a clinician if the patient reports:
- Hot swollen foot/signs of infection
- Discharge
- Discolouration of the foot
- Black skin
- Gangrene
- New ulceration
- Severe pain
Diabetic
Face to Face Appointment
Book appointment with practice nurse (patients with confirmed diabetes)
Book a green appointment with a clinician if a patient is concerned they may have diabetes but have no diagnosis
Book a red face to face appointment with a clinician if a known diabetic is reporting to be very unwell/vomiting/high temperature/very high sugar and/or ketone levels or very low sugars.
Diarrhoea
Refer to Pharmacy or Face to Face Consultation
Send patients to pharmacy for advice and product purchase
If this has been tried but symptoms are ongoing book a green face to face appointment within a week
Book an amber appointment for patients over 60 years with a new change in bowel habit that is not resolving within a couple of weeks
Book a red face to face appointment for those:
- Are unwell with associated symptoms such as high fever, persistent vomiting
- With symptoms of severe dehydration (confusion, passing little or no urine)
- Bloody diarrhoea/rectal bleeding
- Associated severe abdominal pain
Difficulty passing urine
Face to face Consult or 999
Direct to 999/A&E If the patient has not passed urine for 12 or more hours OR unable to pass urine and are in pain or distress as a result.
For all other patients arrange a red face to face consultation with a clinician
Difficulty Sleeping
Refer to Pharmacy or face to face consultation
Direct patients to pharmacy for advice and product purchase.
Signpost to online resources:
Book a green appointment with a clinician if patients have tried sleep hygiene measures & OTC products for at least a few weeks, the issue has lasted several months or the insomnia is affecting daily life in a way that makes it hard for them to cope.
Difficulty Swallowing
Telephone Consultation
If patient has any symptoms of sore throat/tonsillitis please refer to that guidance first.
If NO symptoms of sore throat please book an amber face to face consultation.
Dizziness / Vertigo
Face to Face Appointment
Book an amber appointment.
Book a red appointment if red flags as below:
They have vertigo and:
- have a severe headache
- are being sick or feel very sick
- have a very high temperature or feel hot and shivery
Consider assessing for stroke in patients present with new, sudden onset severe vertigo. See link for more symptoms of a stroke.
DNACPR/DNAR (Do Not Attempt Resuscitation)
Book a Green Appointment
Book a double green appointment with a clinician with any patient wishes to discuss this
This could be terminal/cancer/palliative patients who wish to discuss advance care planning or this has been requested by their hospital/specialist team. Any patient however can request to discuss.
Drug Reaction
Follow Medicines Management Flow Chart
Book appointment with a clinician.
If severe reaction (see Anaphylaxis for more information) ring 999/attend A&E
Dyslexia
Redirect to relevant service
For children: Advice to speak with school for an assessment.
For Adults: Assessments are not available on the NHS. They can seek private referrals. More information and support can be found at the British Dyslexia Associated website.