Pharmacy First PGDs

The Pharmacy First service also currently includes 10 PGDs for the treatment of impetigo, uncomplicated UTI, skin infections, shingles and hayfever. See details below for the current PGDs and related documents.These can be found on our PGD page

Impetigo

• PGD for Fusidic Acid 2% Cream (review date August 2027)
• Impetigo patient assessment form (review date August 2027)
• Impetigo assessment form WORD
• GP Notification Form

Uncomplicated UTI

Please note the following changes to the Lothian versions of these PGDS compared to the national specimen:

For Trimethoprim and Nitrofurantoin:

A statement has been added about referring to East Region Formulary for information on first or second choice medicines

A note in the patient advice section that said to avoid double voiding has been amended (removed avoid)

 For Trimethoprim :

A statement has been added to the interactions section “Take particular care to consider serious interactions with medicines that may be supplied through other routes, for example methotrexate or clozapine.”

• PGD for Trimethoprim (review date August 2027)
• PGD for Nitrofurantoin (review date August 2027) 
• UTI patient assessment form PDF
• UTI patient assessment form WORD
• GP Notification Form

Skin Infection

• PGD for Flucloxacillin 
• Skin infection patient assessment form
• GP notification form

Shingles 

• PGD for Aciclovir 
• Shingles patient assessment form
• GP notification form

Hayfever 

Please note the following changes to the Lothian versions of these PGDs compared to the national specimen

An interactions section has been added to the PGDs :We have included clinically significant drug interactions and where an interaction is identified with concurrent medication the PGD should not be used. We have included the following statement in each PGD:

All concurrent medications must be checked for interactions, and a detailed list of drug interactions is available in the SPC, which is available from the electronic Medicines Compendium website: www.medicines.org.uk and BNF website www.bnf.org

• NHS Scotland guidance regarding the retention of documents guidance has now been updated . The updated reference has been added to each PGD Records Management Code of Practice for Health and Social Care v4.0. There is reference to a table within each PGD and this statement has been removed as there is no table in the documents.

Individual PGDs

• Beclometasone 50mcg nasal spray

1. 1.3 – Pulmonary tuberculosis and individuals taking/using oral, inhaled, topical or parenteral corticosteroids are exclusions.
2. 1.3 – Addition of interactions section and advice re the possibility of systemic effects with concomitant use of strong CYP3A inhibitors- exclusion.

• Fexofenadine 120mg tablets

1. 1.3 – Use in breastfeeding – excluded under the NHS Lothian PGD as manufacturer advises avoid.
2. 1.3 – Addition of interactions section and a requirement to check for drug interactions. Interaction with antacid is not an exclusion (follow advice section).
3. 3.1 – Advice that although unlikely to affect driving or use machines it is advisable to check the individual response before driving or performing complicated tasks.

• Mometasone 50mcg nasal spray

1. 1.3- Additional exclusions – Nasal septum perforation, epistaxis, individuals currently taking oral, inhaled, topical or parenteral corticosteroids for any indication (to reduce the risk of adrenal insufficiency) , untreated bacterial, fungal or systemic viral infections, nasal polyps
2. 1.3 – Pulmonary tuberculosis moved from cautions to exclusions section as per BNF
3. 1.3 – Addition of interactions section- co-treatment with CYP3A inhibitors, including cobicistat-containing products is expected to increase the risk of side effects.
4. 3.1 – Addition of common side effects; altered smell sensation; taste altered.

• Olopatadine 1mg/ml eye drops

1. These haven’t been moved from caution to exclusions but we consider altered visual acuity, chemical exposure, anticoagulation, and compromised cornea should be exclusions and there should also be guidance in the checklist for pharmacists. We have added a statement to section 1.4 “Where there is diagnostic uncertainty / unable to treat seek advice from or consider referral to a local community optometrist”
2. 1.4 – Interactions: Olopatadine is unlikely to result in metabolic interactions with other concomitantly administered active substances.

Checklist changes

• For all PGDs where an interaction exists with a concurrent medicine do not supply under the PGD (exception fexofenadine and antacids – see advice section)
• Beclometasone 50mcg nasal spray – pulmonary tuberculosis and taking /using oral inhaled, topical or parenteral corticosteroids are exclusions
• Fexofenadine 120mg tablets – breastfeeding is an exclusion
• Mometasone 50mcg nasal spray – Additional exclusions -nasal septum perforation, epistaxis, individuals with immunodeficiency, pulmonary tuberculosis, untreated bacterial, fungal or systemic viral infection, taking /using oral inhaled, topical or parenteral corticosteroids
• Olopatadine 1mg/ml eye drops – Addition of:
• Is the red eye caused by another reason e.g., accompanied by purulent discharge, altered visual acuity, wearing of contact lenses, chemical exposure, anticoagulation or is the cornea compromised? If YES do not treat with this PGD, consider alternative treatment and if unable to treat/unsure of diagnosis refer to GOS Specialist service Optometrist if required.

• PGD for Beclometasone 
• PGD for Olopatadine 
• PGD for Mometasone 
• PGD for Fexofenadine 
• Hayfever patient assessment & GP notification form

Inflammatory Skin Conditions

PGD for Hydrocortisone 1% cream/ointment (Review date January 2028)

Inflammatory skin conditions patient assessment & GP notification form

Oral Thrush

Please note the following changes to the Lothian version of this PGD compared to the national specimen

1. Under Authorisation: addition of the statement: However, if the PGD is past the EXPIRY DATE it cannot legally be used to supply medication.
2. Section 1.4. Cautions / need for further advice / circumstances when further advice should be sought from a prescriber : addition of the statement “However, the manufacturer advises that it should be used during pregnancy only if the potential benefits to be derived outweigh the possible risks involved, as it is not known whether nystatin can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity.”

PGD for Nystatin oral suspension(Review date March 2028)

Oral thrush patient assessment form

Updated JN 27/04/26