Back Pain
Musculoskeletal Specialist or Face to Face Consultation
Book appointment with the MSK specialist (16 years and older)
Book an amber appointment if under 16 years
RED FLAG SYMPTOMS
Book red appointment if any RED flag symptoms:
Pain 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 or Face to Face Appointment
Symptoms of BV include a watery discharge and fishy odour
Send patients to pharmacy for advice and product purchase
Book a green appointment with a clinician if OTC treatment has not worked, recurrent issue or under 16 years old.
Binge Eating
Face to Face Consultation
Book a green appointment
Bites & Stings
Community Pharmacy or Face to Face Appointment
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
Refer to pharmacy first scheme (Excludes: Pregnant individuals under 16 years)
Book a red appointment if the bite is showing signs or symptoms of infection:
- Fever
- Red and hot to touch
- Pus or discharge
- Spreading redness
Refer to ANAPHYLAXIS information if symptoms are severe
Bladder infection in Men
Face to Face Consultation
Book an amber appointment
See SEPSIS
Book a red appointment for suspected kidney infections. Urine symptoms maybe associated with the following:
- A very high temperature or shaking chills (rigors)
- Nausea and vomiting
- Flu like illness
- Pain in the back just under the ribs
- Urine is red/passing blood clots in urine
Patients aged over 65 years old
Book a red appointment
If we are at full capacity for the day and the patient/carer is happy they can wait until the following day, book a red appointment the next day. Anyone who is unable to wait or reports to be very unwell, direct to urgent care
Bladder infection in Women
Community Pharmacy or Face to Face Consultation
Are you pregnant?
YES
Book a red appointment. Ask the patient to bring a urine sample to send for MSU
If we are at full capacity for the day and the patient/carer is happy they can wait until the following day, book a red appointment the next day. Anyone who is unable to wait or reports to be very unwell, direct to urgent care.
NO
Refer to pharmacy first scheme
Exclusions: urinary catheter, recurrent UTIs (2 episodes in the last 6/12 or 3 in the last 12/12), suspected pyelonephritis (kidney infection)
Book an amber appointment if the treatment has failed or the pharmacy is unable to see
Book a red appointment for suspected kidney infections. Urine symptoms maybe associated with the following:
- A very high temperature or shaking chills (rigors)
- Nausea and vomiting
- Flu like illness
- Pain in the back just under the ribs
- Urine is red/passing blood clots in urine
Patients aged over 65 years
Book a red appointment.
If we are at full capacity for the day and the patient/carer is happy they can wait until the following day, book a red appointment the next day. Anyone who is unable to wait or reports to be very unwell, direct to urgent care
Bladder infection in children (5-16 years)
Face to face Consultation
Book a red appointment
Ask the patient/carer to bring a urine sample to the appointment if able
See SEPSIS
Blood in the Urine for Men
Face to Face Consultation
Book an amber appointment
Book a red 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 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 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 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 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
Community Pharmacy 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
Community Pharmacy or Face to Face Consultation
A green face to face if OTC products have not helped/advised by pharmacist
Book a red appointment if there are signs of infection:
- Fever
- Spreading redness
- Red, swollen, hot to touch
- Discharging pus
Bowel Problems / Constipation
Community Pharmacy or Face to Face Appointment
Send patients to pharmacy for advice and product purchase
Book a green appointment if OTC treatment has not worked
Book an amber appointment if aged over 60 years of age and there is an unexplained NEW change in their bowel habit (i.e. not something they have experienced before)
Breast problems in Men
Face to Face Consultation
Book an amber appointment
Breast problems in Women
Face to Face Consultation
Book an amber appointment
(Offer choice of clinician re gender if possible)
Book a red appointment if signs or symptoms of infection:
- Feverish
- A painful, swollen lump/area in the breast with redness, heat and swelling of the overlying skin
Rectal Bleeding, Blood in stool
Book an amber appointment
Book a red face to face consultation if:
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.
Experiencing significant associated pain or have a an extremely painful lump in back passage.
Breathing Problems
999 or 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
A&E or Community Pharmacy 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.
Book a red appointment if concerns of an infected burn