Scabies
Face to Face Consultation
Direct to pharmacy for review and product purchase. We do not prescribe treatment.
Book an amber appointment if the pharmacy direct back or there is uncertainty of scabies.
Scabies is contagious. Patients should avoid close physical contact with others until treated.
Scarlet fever
Face to Face Consultation
Book an amber appointment.
Sciatica
Musculoskeletal Specialist (16 years and over)
Book appointment with MSK specialist or signpost 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 an amber face to face appointment with a clinician.
See back pain for red flags
Seizure
Call 999 or Face to Face Consultation
If patient is having seizure at time of call: Ring 999.
If patient is known to have a seizure condition e.g. epilepsy and wants to discuss this, book a green appointment.
For all other new, recent, recurrent seizure activity book a red appointment.
Sepsis
Call 999
Sepsis is a life-threatening reaction to an infection
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.
If patient declines to attend GUM, book a green appointment with an appropriate clinician.
If under 16 for red face to face appointment if declines GUM clinic.
Patients (16 and over) can order home testing kits from Online Ordering Options │ Blackpool and Lancashire Sexual Health Services
Shingles
Face to Face Consultation
Book an amber appointment (ideally within 3 days of noticing the rash).
Book a red appointment if:
- Pregnant
- Breastfeeding and the rash is on the breast
- Rash is on the eye or nose
- New changes in vision
- Have a weakened immune system e.g. having chemotherapy, taking immunosuppressant drugs
- Are 17 years old or younger
You can not catch shingles from someone else. However, you can get chickenpox from someone who has shingles if you haven’t had chickenpox before.
If the patient has new blisters forming after treatment book an amber appointment (within 3 days) with a clinician.
Shortness of Breath
Face to Face Consultation or 999
Book a red face to face appointment for new or worsening SOB.
Consider ringing 999 if the SOB is severe such as can’t complete a sentence on the phone/in person or gasping for breath, lips and skin turning very pale/blue.
See chest infection or other relevant page for associated symptoms reported for further guidance.
Book a green appointment for patients who report shortness of breath on exertion such as walking up the stairs/exercising.
Shoulder Pain
Musculoskeletal Specialist (16 years and over)
Book appointment with MSK specialist or signpost 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 an amber face to face appointment with a clinician.
Book a red face to face appointment if there is a possible infected joint (i.e. sudden severe joint pain, feverish, new red hot swollen joint).
Sinusitis
Pharmacy First or Face to Face Consultation
12 years and above: Send to pharmacy first scheme (Exclusions: immunocompromised e.g. on chemotherapy, pregnant individuals under 16 years, chronic symptoms that have lasted more than 12 weeks)
Book a green appointment for anyone else or if treatment from the pharmacy has failed.
Skin Lesion
Face to Face Consultation
Book an amber appointment
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.
Slapped cheek syndrome is a viral infection that often gets better without any treatment within 3 weeks.
Book a red appointment if very unwell, immunocompromised (e.g. on chemotherapy, organ transplant patients) or are pregnant.
Sleeping difficulty
Community Pharmacy or Face to Face Consultation
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 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.
Smoking Cessation
Telephone or Face to Face Consultation
For patients wishing for help to stop smoking direct to smoking cessation services (Smoke-Free Lancashire).
Book a green appointment for patients wishing for medication (Varenicline) to be prescribed for smoking cessation. They MUST be under the smoking cessation service for us to do this and must attend for regular medication reviews with us.
Snoring / Sleep Apnea
Face to Face Consultation
Book a green appointment
Sore Private Parts (excludes testicles)
Face to Face Consultation
If patient has suspected STI/thrush/BV/testicular issues/spots on genitals – see relevant pages
For all others book an amber appointment.
Sore Throat
Pharmacy First Scheme or Face to Face Consultation
Refer to pharmacy first scheme (exclusions: pregnant individuals under 16 years, immunocompromised).
Book an amber appointment if treatment from the pharmacy has failed or pharmacy has referred back to the GP.
If patient significantly unwell follow SEPSIS guidance.
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 treatments have not worked over time book a green appointment with a clinician.
Book a red appointment if signs of infection:
- Fever
- Pus & discharge from rash/spots
- The area is hot to touch
- The area is swollen
- There is spreading redness
Consider symptoms and signs of meningitis in ALL ages
If the patient has a rash check for any of these symptoms and immediately advise calling 999.
- A stiff neck
- Bothered by light
- Seem confused
- A high temperature
- Their rash does not fade when you press a glass against it (do the glass test for meningitis)
- Difficulty breathing
- Breathlessness or they are breathing very fast
- Their skin, lips or tongue look pale, blue, grey or blotchy
If can be harder to see a change in skin colour on brown or black skin.
Check the soles of the feet, palms, lips, tongue and inside of the eyelids for colour changes.
Spots on Penis
Redirect or Face to Face Consultation
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 green appointment.
Spots on Vulva
Redirect or Face to Face Consultation
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 green 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 an amber face to face appointment with a clinician.
Book a red face to face appointment if there is a possible infected joint (i.e. sudden severe joint pain, feverish, new red hot swollen joint).
Stomach Ache/Pain
Community Pharmacy or Face to Face Consultation
Sudden Severe Abdominal Pain
Book a red appointment
Consider directing to A+E/999 if so severe they are can’t wait to be seen or report being very unwell with the pain such as high fever/N+V/vomiting blood or coffee ground like vomit/collapse/can’t breath properly/chest pain/diabetic with high sugars and ketones.
Stomach Cramps with Diarrhoea/Vomiting/Bloating
Signpost Pharmacy for products to help.
If OTC treatments have not helped book a green appointment.
See vomiting/diarrhoea pages for more information.
Repeated/ Reoccurring Stomach Problems
Book a green 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 an amber face to face appointment with a clinician.
Book a red face to face appointment if there is a possible infected joint (i.e. sudden severe joint pain, feverish, new red hot swollen joint).
Stress
Face to Face Consultation
Book a green appointment.
If other mental health concerns see the relevant page.
Stings, Bites, Scratches
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
Insect bites and Stings
Direct to community pharmacy
Book a red appointment if the bite is showing signs of infection:
- Fever
- Red and hot to touch
- Pus or discharge
- Spreading redness
Refer to ANAPHYLAXIS information on this page if symptoms are severe.
Direct to A&E / 999.
Stroke
Triage Symptoms First
The main symptoms of a stroke can happen suddenly. They may include the FAST symptoms below.
- 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 a patient is having a suspected stroke OR has had symptoms suggesting a stroke in the last 24 hours call 999
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.
Face to Face Consultation
Book a red appointment.
Sunburn
Community Pharmacy
Send Patient to pharmacy for advice and product purchase.
Suicidal
Face to Face Consultation
Book a red appointment
Difficulty Swallowing
Face to Face Consultation
If patient has any symptoms of a 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 unable to swallow even their own saliva.
- They are choking on food and drink preventing them from eating and drinking.
Excessive sweating
Community Pharmacy
Send patients to pharmacy for advice and product purchase.
If OTC treatments have failed book a green appointment.
Swollen feet, legs, ankles
Face to Face Consultation
Book a green appointment
Book a red appointment if:
- A single leg (particularly calf swelling) has become swollen especially if sudden onset/recent long haul flight/pregnant or had baby recently/recent surgery/immobile
- Associated with difficulty in breathing
- Associated with chest pain