Scarlet fever
Face to Face Consultation
Book Appointment
Seizure
999 or Face to face consultation
If patient is having seizure at time of call: Ring 999
Otherwise for all other issues related to seizures to book a face to face appointment with a clinician
Sepsis
Sepsis is a life-threatening reaction to an infection.
Call 999
Refer to surgery SEPSIS protocol.
If in doubt regarding a possible sepsis diagnosis speak with a clinician for advice as soon as possible.
Sexually Transmitted Infection (STI)
Redirect
Give Patients the details of the local Sexual Health Clinic
Refer to external contact information
Shingles
Face to Face Consultation
Book Appointment within 3 days of noticing the rash.
Shortness of Breath
Face to Face Consultation or 999
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
For all other patients book a face to face consultation.
Urgency will be based on the severity of the patients symptoms. If a longstanding issue and has not changed please book as a routine (RAG Green).
See chest infection for further guidance.
Chest infection
Refer to Community Pharmacy Scheme or Face to Face Consultation
Book a face to face consultation with a clinician if the patient has the following:
- Persistent cough lasting more than 3 weeks
- Are unwell with a high temperature (> 38+)
- Is having breathing difficulties (e.g. unable to speak in full sentences/appears breathless)
- Is coughing up blood (haemoptysis)
- Has an underlying respiratory condition (e.g. Asthma, COPD, bronchitis, lung cancer)
- Is immunocompromised (e.g HIV positive, on chemotherapy, organ transplant patient)
- Is pregnant
- Is a child under 5 years (preferably book these face to face)
Otherwise patients can be directed to the community pharmacy/NHS website at https: www.nhs.uk/ conditions/chest-infection for more information on self care.
Advise the patient to seek review if they worsen rapidly or significantly, symptoms have not improved within 3-4 weeks or they become very unwell.
Consider any COVID procedure in place at the time and advise accordingly
Shoulder Pain
Musculoskeletal Specialist (16 years and over)
Book appointment with MSK specialist or sign post to Moving Well service.
Patients can self refer to a physiotherapist(see external contacts for information).
If the pain started after recent trauma advise to attend urgent care/A&E.
Care
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 face to face appointment with a clinician.
Book a same day face to face appointment if there is a possible infected joint (i.e. sudden severe joint pain, feverish, new red hot swollen joint).
Sinusitis
Community Pharmacy or Face to Face Consultation
If symptoms for less than 10 days, signpost Pharmacy.
If MORE than 10 days book appointment.
Skin Lesion
Face to Face Consultation
If meets criteria send to Skin Hub. If NO book appointment
Skin Problem
Community Pharmacy or Face to Face Consultation
Send all patients to pharmacy for advice and product purchase.
If over the counter treatments have not worked book a face to face appointment.
Rash in Children
If the child has a rash check for any of these symptoms and immediately advise calling 999:
- A stiff neck.
- Bothered by light.
- Seems confused.
- A high temperature.
- Their rash does not fade when you press a glass against it (do the glass test for Meningitis).
- Difficulty breathing (you may notice grunting noises or their tummy sucking under their ribs).
- Breathlessness, or they’re breathing very fast.
- Their skin, lips or tongue look pale, blue, grey or blotchy.
These can be signs of Meningitis.
It can be harder to see a change in skin colour on brown and black skin.
- Check the soles of the feet, palms, lips, tongue and inside the eyelids for colour changes.
Slapped cheek syndrome
Community Pharmacy or Face to Face Consultation
Community Pharmacy. Send all patients to pharmacy for advice and product purchase.
Patients can be directed to NHS website for more information: https:// www.nhs.uk/conditions/slapped-cheek-syndrome.
If child not improving to make a face to face appointment with clinician.
Sleeping difficulty
Refer to Community Pharmacy Scheme or Telephone Appointment
Send all patients to pharmacy for advice and product purchase
Signpost website Support:
https://www.nhs.uk/conditions/insomnia
https://www.nhs.uk/live-well/sleep-and-tiredness
Book a telephone 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.
Snoring / Sleep Apnea
Face to Face Consultation
Book appointment
Sore Private Parts
Community Pharmacy or Face to Face Appointment
Women:
Send patients to pharmacy for advice and product purchase. Once tried, book appointment if no better.
Men and Children:
Book appointment
Sore Throat
Community Pharmacy or Face to Face Consultation
Send patients to pharmacy for advice and product purchase.
Advise most sore throats will resolve without treatment within 7-8 days. Self care advice can be found at: https://www.nhs.uk/conditions/sore-throat.
Book a face to face appointment if there is no improvement despite OTC products and self care advice or patient becoming more unwell.
If patient significantly unwell follow SEPSIS guidance.
Sports injury
Musculoskeletal Specialist (16 years and over)
Book appointment with MSK specialist or sign post to Moving Well service.
Patients can self refer to a physiotherapist(see external contacts for information).
If the pain started after recent trauma advise to attend urgent care/A&E.
Care
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 face to face appointment with a clinician.
Spots, Rash and Skin problems
Community Pharmacy or Face to Face Consultation
Send all patients to pharmacy for advice and product purchase.
If over the counter products have not worked over time; Book appointment, detail information in booking notes.
See below for worrying features of a rash in children.
Rash in Children
If the child has a rash check for any of these symptoms and immediately advise calling 999:
- A stiff neck.
- Bothered by light.
- Seems confused.
- A high temperature.
- Their rash does not fade when you press a glass against it (do the glass test for Meningitis).
- Difficulty breathing (you may notice grunting noises or their tummy sucking under their ribs).
- Breathlessness, or they’re breathing very fast.
- Their skin, lips or tongue look pale, blue, grey or blotchy.
These can be signs of Meningitis.
It can be harder to see a change in skin colour on brown and black skin.
- Check the soles of the feet, palms, lips, tongue and inside the eyelids for colour changes.
Spots on Penis
Redirect or Face to Face Appointment
Give patient the details for the local Sexual Health Clinic.
If the problem is not a sexual health issue or the patient declines to attend the GUM clinic, book a face to face appointment.
Spots on Vulva
Redirect or Face to Face Appointment
Give patient the details for the local Sexual Health Clinic.
If the problem is not a sexual health issue or the patient declines to attend the GUM clinic, book a face to face appointment.
Sprains
Musculoskeletal Specialist (16 years and over)
Book appointment with MSK specialist or sign post to Moving Well service.
If patient is under 16 years please book a telephone consult with a clinician.
Patients can self refer to a physiotherapist (see external contacts for information).
If the pain started after recent trauma advise to attend urgent care/A&E.
Care
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 face to face appointment with a clinician.
Sticky/Sore Eye
Community Pharmacy or face to face Consultation
Patients over 2 years old:
Send patients to pharmacy for advice and product purchase
If the patient is under 2 years of age, has glaucoma or diabetes, book a face to face appointment with a clinician.
Stomach Ache/Pain
Community Pharmacy Scheme or Face to Face Consultation
Stomach cramps with bloating:
- Signpost Pharmacy for products to help
Sudden stomach cramps with diarrhoea:
- Signpost Pharmacy for products to help
Sudden severe abdominal pain:
- Book a same day face to face appointment.
Repeated/Reoccurring stomach problems:
- Book a routine face to face appointment.
Strains
Musculoskeletal Specialist (16 years and over)
Book appointment with MSK specialist or sign post to Moving Well service.
If patient is under 16 years please book a telephone consult with a clinician.
Patients can self refer to a physiotherapist (see external contacts for information).
If the pain started after recent trauma advise to attend urgent care/A&E.
Care
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 face to face appointment with a clinician.
Stress
Telephone Consultation
Book Appointment
Provide patient with information for Mindsmatter service and advise they can self refer (see external contacts for details) – For over 16’s only.
Stings, Bites, Scratches
Community Pharmacy Scheme or Face to Face Appointment
Animal bites/Scratches
That have broken the skin and are showing signs of infection, book patient in for a face-to-face assessment.
Insect bites and Stings
Adults and children over 2 years with insect bites or stings can get advice and treatment directly from a pharmacy.
If there is a lot of swelling and blistering or if there is pus and the pharmacist feels there may be an infection, book a face-to-face appointment.
Stroke
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.
Book face to face appointment within a week.
Book appointment.
Styes
Community Pharmacy
Send Patient to pharmacy for advice and product purchase.
Subdermal Contraceptive Implants
Telephone Consultation or Face to Face Appointment
For patients requesting information about a first-time procedure or would like a routine insertion/removal, book a telephone appointment with the clinician who will be performing the procedure to discuss first.
If a patient wants a removal and or refit, send a task to the clinician who fits the device with all the details and ask when they would like them to be booked in.
Alternatively, Patients can be signposted to local family planning clinics.
Sunburn
Community Pharmacy
Send Patient to pharmacy for advice and product purchase.
Suicidal
Face to Face Consultation
Same day consultation.
Discuss with available clinician as the urgency.
Difficulty Swallowing
Telephone Consultation
If patient has any symptoms of sore throat/tonsillitis please refer to the guidance first.
if NO symptoms of sore throat please book a consultation.
Excessive sweating
Community Pharmacy
Send patients to pharmacy for advice and product purchase.
Swollen feet, legs, ankles
Refer to Community Pharmacy Scheme or Face to Face Consultation
Refer to Community Pharmacy Scheme if suitable.
For all other patients book a face to face appointment.