Dandruff
Community Pharmacy or Face to Face Consultation.
Refer to Pharmacy for advice and product purchase.
Book green 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
Depression Children
Diarrhoea and/or Vomiting
Community Pharmacy or Face to Face Consultation
Send patients to pharmacy for advice and product purchase
Book a green appointment if OTC treatment has been tried but symptoms are ongoing
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 can’t keep any fluids down
- With symptoms of severe dehydration (confusion, passing little or no urine, dry tongue/lips)
- Blood diarrhoea/rectal bleeding
- High fever
- Associated with severe abdominal pain
Diabetic Foot
Face to Face Appointment
Book a red 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 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.
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
Community 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
Face To Face Consultation
If patient has any symptoms of sore throat/tonsillitis please refer to that guidance first
If no symptoms of a sore throat book an amber appointment
Book a red appointment if:
- They are choking on food and drink preventing them from eating and drinking
- They are unable to swallow even their own saliva
Dizziness / Vertigo
Face to Face Appointment
Book a green appointment
Book a red appointment if:
- Associated with collapse/loss of consciousness
- Vertigo with a severe headache
- Vertigo so severe they are struggling to walk
- Associated with vomiting
- Associated with a high fever
Caution: If sudden onset of symptoms, symptoms are so severe they are unable to walk consider stroke, see relevant page to screen for symptoms – Advise to ring 999 immediately
DNACPR/DNAR (Do Not Attempt Resuscitation)
Face to Face Consultation
Book an advanced care planning appointment
Drug Reaction
Follow Medicines Management Flow Chart
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
Book a red appointment if they are unwell (no red flags of anaphylaxis) or it is a critical medication
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.