NHS Pharmacy First Scotland will allow community pharmacies to give people expert help for treating conditions such as sore throats, earache and cold sores, along with common clinical conditions such as urinary tract infections (UTI’s). Pharmacy teams offers advice, treatment or referral to other healthcare teams if required.
This service will help people access the right care in the right place, without having to go to their GP practice or local Accident and Emergency Department for non-urgent treatment.
What is it?
NHS Pharmacy First Scotland (NHS PFS) is a consultation service designed to encourage the
public to visit their community pharmacy as the first port of call for all minor illnesses and
common clinical conditions. It is available in every Community Pharmacy in Scotland and
replaces the Minor Ailments Service.
Who is eligible?
Everyone registered with a GP practice in Scotland or the Defence Medical Services on a
permanent or temporary basis (including care home residents).
People who live in Scotland (including gypsy or travellers / asylum seeker or dependent of an
asylum seeker).
Visitors to Scotland are excluded.
The narrative around the service nationally is intentionally designed not to set the
expectation that a consultation will result in supply of medication, and this messaging
should be carried through locally as well.
What are the possible outcomes?
The patient (or patient representative) will consult with a member of the pharmacy team,
this can be in person or over the phone. The pharmacy team will assess their symptoms
resulting in one or more of the following outcomes:
- Providing self-care advice to allow patient to manage their symptoms themselves
- Supply treatment for symptoms either via NHS or for the patient to purchase
- Refer the patient to another appropriate healthcare professional
There are some medicines available via PGD for the treatment of UTI, skin infections,
impetigo and shingles as below.
- NB there are strict exclusion criteria so please do not refer patients who will be excluded (see Table 1 below)
Unlike the Minor Ailments Scheme only those medicines that appear on the Pharmacy First
Approved List are available to be supplied as part of the patient’s treatment (see Table 2 for
the conditions included).
Table 1 – Conditions where a PGD exists for treatment
| Condition | Patients potentially suitable for referral to NHS Pharmacy First Scotland |
| Cystitis (UTI) | Women ages 16 – 65 except: Pregnant or breastfeeding women Diabetes Catheterised patients Immunocompromised patients Vaginal itch/discharge Blood in the urine Confused patients Symptoms for more than 7 days Had antibiotic treatment for UTI in last month 2 or more UTI episodes in last 6 months 3 or more UTI episodes in last 12 months Taking a regular antibiotic to prevent UTIs Symptoms suggesting an upper urinary tract infection such as: Fever, chills, nausea, vomiting, acute onset back pain, loin pain, flank tenderness or systemically unwell |
| Impetigo | All patients over 2 years old except: Impetigo in last 3 months Multiple sites of skin infection Underlying skin condition at same site as impetigo Systemically unwell |
| Shingles | All patients over 18 years except: Rash affecting head, neck, arms or legs (only rash on torso can be treated on NHS PFS) Rash involving multiple adjacent or non-adjacent dermatomes or where the rash spreads across both sides of the body Rash present for more than 72 hours Pregnant or breastfeeding women Systemically unwell including symptoms of headache or fever Recurrent shingles (2 or more episodes in patient’s lifetime) Severe pain not responding to OTC analgesics There are additional PGD exclusions for aciclovir but are relatively rare. Community pharmacists will refer a patient presenting with these back to the practice for assessment. |
| Skin Infections Infected insect bite Cellulitis (patient afebrile and healthy other than cellulitis) Acute paronychia with signs of cellulitis | All patients over 18 years except: Cellulitis where patient has features suggestive of systemic infection e.g. febrile/feeling unwell Cellulitis related to animal or human bite Cellulitis related to surgical wound or chronic wound/leg ulcer/burns Any sign of cellulitis on the face / around the eye (periorbital/ pre-septal/orbital cellulitis) Cellulitis on arms or torso NOT linked to an insect bite Recurrent cellulitis (more than one episode in 12 months) Acute paronychia with signs of cellulitis AND a collection of pus requiring drainage AND/OR in severe pain Diabetic foot infection |
Table 2 – General Conditions
| Condition | Patients potentially suitable for referral to NHS Pharmacy First Scotland | |
| A | Acne Allergies Athletes Foot | All patients unless severe All patients over 1 year old All patients (caution if diabetic) |
| B | Bacterial Conjunctivitis | Refer to optometry as first option if available All patients over 2 years old without pain or visual disturbance |
| D | Dry Eyes Dry Skin | Refer to optometry as first option if available All patients over 18 years old without pain or visual disturbance or chronic symptoms All patients except those who have failed to respond to treatment or have symptoms indicative of infection |
| E | Earache | All patients except: Systemically unwell Fluid leaking from ear Swelling around ear Hearing loss/change in hearing Something stuck in the ear Children under 2 with pain in both ears |
| H | Haemorrhoids (piles) Hayfever Headlice | All patients over 18 years old except: Duration longer than 7 days despite treatment from pharmacy Blood mixed in stool rather than on surface All patients over 1 year old All patients unless inflammation of scalp is present |
| M | Mouth Ulcers | All patients except: Ulcer present for foe than 3 weeks Systemically unwell Significant symptoms (multiple/large lesions) |
| N | Nappy Rash | All patients except: Standard treatment fails or symptoms persist Signs of infection or eczema |
| R | Ringworm | All patients except: Symptoms persist despite treatment |
| S | Scabies Sore Throat | All patients over 2 years old All patients except: Systemically unwell No improvement in symptoms for more than 7 days Difficulty swallowing liquids or associated breathing problems |
| T | Threadworms Thrush Oral Thrush | All patients over 2 years old except: Pregnant & breastfeeding women Women between 16 – 60 years old except: Pregnant women More than 2 episodes in 6 months Symptoms still present 7-14 days after treatment Immunocompromised patients Other symptoms eg frequent urination/vaginal bleeding etc All patients over 4 months |
| W | Warts & Verrucae | All patients except: Warts on face or anogenital region |