Minor Ailment Service Formulary Reference: MASF/1 Supersedes: MAS Version 6 Page 1 of 18
SECTION PAGE INTRODUCTION 3 1 GASTRO-INTESTINAL SYSTEM 5 1.1 Dyspepsia and gastro-oesophageal reflux disease 1.2 Infant colic 1.3 Acute diarrhoea 1.4 Constipation 1.5 Haemorrhoids 2 RESPIRATORY SYSTEM 7 2.1 Hayfever 2.2 Cough and nasal congestion 3 CENTRAL NERVOUS SYSTEM 8 3.1 Pain 3.2 Acute migraine and associated symptoms 3.3 Travel sickness 4 INFECTIONS 9 4.1 Fungal infections 4.2 Viral infections 4.3 Parasitic infections 5 URINARY-TRACT DISORDERS 10 5.1 Cystitis 6 EYES 11 6.1 Eye infection 6.2 Seasonal and perennial allergic conjunctivitis 6.3 Dry eyes mild to moderate 7 EAR 12 7.1 Ear wax removal 8 MOUTH 12 8.1 Oral ulceration and inflammation 8.2 Teething 8.3 Oral Thrush 9 SKIN 13 9.1 Acne 9.2 Eczema/ allergy 9.3 Boils APPENDICES Appendix 1 MASF amendment form 15 Appendix 2 Minor Wound Guidance 17 Appendix 3 Pharmacy First Service 18 Reference: MASF/1 Supersedes: MAS Version 6 Page 2 of 18
INTRODUCTION Minor Ailment Service (MAS) aims/ purpose The aim of the MAS is to support the provision of direct pharmaceutical care on behalf of the NHS by pharmacists to members of the public presenting with a common illnesses, which in some cases are self-limiting. The core objectives for MAS are to: improve access to healthcare consultations, advice, medicines and appliances for common or minor illnesses; promote pharmaceutical care through the community pharmacy setting; assist in managing the demand on the time of other members of the primary healthcare team by shifting the balance of care from GPs and nurses to community pharmacists where appropriate; help address health inequalities. The Scottish Government NHS Circular July 2016 provides further details on the revised service specification for the Minor Ailment Service (MAS) and can be viewed at: http://www.sehd.scot.nhs.uk/pca/pca2016(p)12.pdf Prescribing for Minor Ailments The national formulary for the Minor Ailments Service (MAS) is based on the BNF and is the reference point for payment purposes for products provided under the MAS. The formulary is available to community pharmacists, and includes all Pharmacy (P) and General Sales List (GSL) medicines that are not blacklisted, dressings and appliances from Part 2 of the Drug Tariff, selected items from Part 3 of the Tariff, such as bug busting kits, and any Prescription-only Medicines (POMs) which are underpinned by a series of Patient Group Directions (PGDs). The following items are excluded from the MAS formulary: Homeopathic/ herbal treatments POMs unless covered by NHS Ayrshire & Arran Patient Group Directions (PGDs) Nicotine replacement therapy Emergency hormonal contraception Orlistat (Alli ) Simvastatin Azithromycin (Clamelle ) Blacklisted items. The latest list of blacklisted medicines can be found on the Community Pharmacy Scotland website www.communitypharmacyscotland.org.uk and then searching for blacklisted and disallowed items. NHS Ayrshire & Arran Minor Ailment Service Formulary (MASF) The NHS Ayrshire & Arran MASF has been updated using prescribing data and from input from Community Pharmacists, Community Pharmacy Advisers, Formulary Management Group and the Medicines Utilisation Unit. The aim of the NHS Ayrshire & Arran MASF is to: Provide a formulary list which complies with the NHS Ayrshire & Arran Joint Formulary (current edition available at http://www.nhsaaa.net/services-a-toz/prescribing/) Reference: MASF/1 Supersedes: MAS Version 6 Page 3 of 18
Provide a list of medicines which are evidence based and cost effective. Provide prescribing notes to facilitate consistency in practice. provide a smaller range of medicines, allowing prescribers to become more familiar with their indications and contra-indications. In the interests of good prescribing practice, prescribers are requested to conform to the recommendations contained within this formulary. The use of the GSL and P medicines listed in the formulary is confined to the licence for these products, except where the medicine is supported by a PGD. Products may only be used in those age groups specified by the licence. The NHS Ayrshire & Arran MASF should be used in conjunction with advice given in the most current BNF. There may be additional symbols to specify choice of therapy e.g. 1 indicates the first line choice recommended within that medicine class. The formulary will be reviewed every two years or sooner if major changes are required. General advice to ensure correct payment under MASF is: Prescribe by generic name, except where indicated. Ensure you have dispensed and endorsed the OTC Pack size (as listed in this Formulary this matches the Pack size in SDT Part 7B where an entry exists) Where a product requires to be prescribed by brand name, this has been indicated in the Minor Ailment Services Formulary. Contractors are advised to monitor up to date advice from Community Pharmacy Scotland www.communitypharmacyscotland.org.uk/. Requests for amendments (additions or deletions) to the NHS Ayrshire & Arran MASF Requests can be made by completing the form in appendix 1 Useful contacts Allan Thomas Lead Pharmacist Public Health and Community 01292 513831 Allan Wilson Community Pharmacy Adviser, North H&SCP 01475 687501 Joyce Mitchell Community Pharmacy Adviser, East H&SCP 01563 575459 Reference: MASF/1 Supersedes: MAS Version 6 Page 4 of 18
SECTION 1 GASTRO-INTESTINAL SYSTEM 1.1 Dyspepsia and gastro-oesophageal reflux disease Aluminium and magnesium containing antacids 1 Mucogel liquid 500ml Compound alginates 1 Peptac liquid 500ml Ulcer healing drugs 1 Ranitidine tablets 75mg 6/ 12 1.2 Infant colic QUANTITY Simeticone (Infacol ) liquid 40mg/ml 50ml 1.3 Acute diarrhoea QUANTITY Antimotility drugs 1 Loperamide capsules 2mg NB: In adults and children over 12 years. Maximum strength 2mg, maximum dose 4mg and maximum daily dose 12mg 12 Oral rehydration therapy 1 Dioralyte Oral Powder 6/ 20 1.4 Constipation QUANTITY Bulk forming laxatives 1 Ispaghula Husk 3.4G/ 3.5G (supply and endorse Fybogel granules) NB: Ensure adequate fluid intake. Not to be taken immediately before going to bed. 30/ 60 Stimulant laxatives 1Senna syrup 7.5mg/5ml 100ml 1 Senna tablets 7.5mg 30 Bisacodyl tablets 5mg 28 Glycerol suppositories 4g (adult) 12 Osmotic laxatives Lactulose solution 300ml/ 500ml Reference: MASF/1 Supersedes: MAS Version 6 Page 5 of 18
1.5 Haemorrhoids QUANTITY Soothing haemorrhoidal preparations 1 Anusol cream 23g 1 Anusol ointment 25g 1 Anusol suppositories 12 Compound haemorrhoidal preparations with corticosteroids (for patients with severe symptoms) 1 Anusol Plus HC ointment 15g 1 Anusol Plus HC suppositories 12 Reference: MASF/1 Supersedes: MAS Version 6 Page 6 of 18
SECTION 2 RESPIRATORY SYSTEM 2.1 Hayfever QUANTITY Non sedating antihistamines 1 Cetirizine tablets 10mg 30 1 Cetirizine oral solution 1mg /1ml 200ml 2 Loratadine tablets 10mg 30 2 Loratadine syrup 5mg/5ml 100ml Sedating antihistamines NB: Drowsiness may affect performance of skilled tasks (e.g. driving); sedating effects enhanced by alcohol. 1 Chlorphenamine tablets 4mg 30 1 Chlorphenamine syrup 2mg/5ml 150ml Other anti-inflammatory preparations 1 Sodium Cromoglicate eye drops 2% 5ml/ 10ml Steroid Nasal Spray 1 Beclometasone nasal spray 50 micrograms (prescribe as brand or supplier) 100 or 180 doses 2.2 Cough and nasal congestion QUANTITY Aromatic Inhalations Menthol Crystals Cough Suppressants NB: See guidance in BNF /BNFC when prescribing for children. Supply in original patient pack Pholcodine linctus 5mg/5ml (see BNF guidance on age) Pholcodine Paediatric linctus 2mg/5ml (see BNF guidance) Expectorants and demulcent cough preparations Simple SF Linctus (over 12 years of age) Simple Paediatric sugar free linctus 5g 200ml 100ml 200ml Dispense up to 200ml Systemic Nasal Decongestants Pseudoephedrine elixir 30mg/5ml ((over 6 years of age) 100ml Pseudoephedrine tablets 60mg 12 Topical Nasal decongestants Xylometazoline nasal drops 0.1% Xylometazoline nasal spray 0.1% Xylometazoline paediatric nasal drops 0.05% (over 6 years of age) Sodium chloride nasal drops 0.9% 10ml 10ml 10ml 10ml Reference: MASF/1 Supersedes: MAS Version 6 Page 7 of 18
SECTION 3 CENTRAL NERVOUS SYSTEM 3.1 Pain QUANTITY Non-opioid analgesics Paracetamol tablets 500mg 32 Paracetamol SF suspension 120mg/5ml 100ml Paracetamol SF suspension 250mg/5ml 100ml Non-steroidal anti-inflammatory drugs (oral) Ibuprofen tablets 200mg 24 Ibuprofen tablets 400mg 24 Ibuprofen SF suspension 100mg/5ml 100ml/ 150ml Non-steroidal anti-inflammatory drugs (topical) 1 Ibuprofen gel 5% 30g/ 50g Weak opioids with paracetamol 2 Co-Codamol tablets 8/500 (2 nd line agent after paracetamol) 30 3.2 Acute migraine and associated symptoms QUANTITY Mild to Moderate Migraine Aspirin tablets 300mg (over 16 years of age) 32 Ibuprofen tablets 400mg 24 Paracetamol tablets 500mg 32 Severe Migraine 1 Sumatriptan 50mg tablets 2 Migraine induced nausea and vomiting Prochlorperazine maleate buccal tablets 3mg 8 3.3 Travel sickness QUANTITY Hyoscine hydrobromide tablets 300 micrograms 12 Hyoscine hydrobromide tablets 150 micrograms 12 Cinnarizine tablets 15mg 15 Reference: MASF/1 Supersedes: MAS Version 6 Page 8 of 18
SECTION 4 INFECTIONS 4.1 Fungal infections QUANTITY Vaginal Candidiasis Clotrimazole vaginal tablets 500mg 1 Clotrimazole 2% cream (Canesten Thrush Cream ) 20g Clotrimazole vaginal cream 10% (Canesten Internal Cream ) 5g Clotrimazole Combi creams 10% plus 2% 5g +10g Clotrimazole pessary plus cream Combi (500mg, 2%) 1 + 10g Fluconazole capsules 150mg (endorse brand) 1 Athlete s Foot 1 Clotrimazole cream 1% 20g 2 Miconazole cream 2% 15g 2 Miconazole spray powder (Daktarin Aktiv ) 100g Terbinafine cream 1% (only if other treatments ineffective) 7.5g 4.2 Viral infections QUANTITY Cold Sores 1 Aciclovir cream 5% 2g Warts and Verrucae Glutarol solution 10% Occlusal solution26% Salatac gel 10ml 10ml 8g 4.3 Parasitic infections QUANTITY Threadworms NB: All family members should be treated at the same time, even if they have no symptoms, to prevent reinfection. Mebendazole tablets 100mg (Ovex / Pripsen ) 1 Mebendazole suspension 100mg/5ml (Ovex ) 30ml Head lice NB: If a course of treatment (two applications, one week apart) fails to cure, a different insecticide should be used for the next treatment. (Refer to NHS Ayrshire & Arran Head Lice Policy) Malathion liquid 0.5% (Derbac M ) 50ml/ 200ml Dimeticone lotion 4% (Hedrin ) 50ml/ 150ml Dimeticone dual formula spray 92% (NYDA ) Bug Buster Kit (Kit contains 3 Bug Buster combs, 1 Nit Buster comb, 1 wide toothed comb and a protective cape) 50ml 1 Reference: MASF/1 Supersedes: MAS Version 6 Page 9 of 18
Crab/Pubic Lice NB: A different insecticide should be used if a course of treatment (two applications, one week apart) fails. Permethrin (Lyclear dermal cream) 30g Malathion liquid 0.5% (Derbac M ) 50ml/ 200ml Scabies Permethrin (Lyclear Dermal Cream) Malathion liquid 0.5% (Derbac M ) 30g 50ml/ 200ml SECTION 5 URINARY-TRACT DISORDERS 5.1 Cystitis QUANTITY Potassium citrate effervescent tablets (Effercitrate ) 12 Potassium citrate oral solution 200ml Reference: MASF/1 Supersedes: MAS Version 6 Page 10 of 18
SECTION 6 EYES 6.1 Eye infection QUANTITY Propamidine lestionate eye drops (Brolene ) 10mls Propamidine isetionate eye ointment (Brolene ) 5g #Chloramphenicol eye drops (PGD in place) 10mls Chloramphenicol eye ointment (Golden Eye Ointment) 4g 6.2 Seasonal and perennial allergic conjunctivitis QUANTITY #Sodium cromoglicate eye drops 2% 5ml/10ml 6.3 Dry eyes mild to moderate QUANTITY #Carbomer 980 0.2% (Clinitas Carbomer Eye Gel) 10g 1 #Hypromellose 0.3% eye drops 10ml #Liquid Paraffin Eye Ointment (Lacrilube )-preservative free 3.5g #Sodium Hyaluronate eye drops 0.03% (Hylo Fresh )-preservative 10ml free. Bottle can be used for up to 6 months after opening) Sodium Hyaluronate eye drops 0.1% (Hylo Tear -preservative free. 10ml Bottle can be used for up to 6 months after opening) Eyecare Ayrshire Service Items marked with # reflect those drugs that are included in the Eyecare Ayrshire Formulary. Under the General Ophthalmic Service (GOS) contract all Optometrists can make supplies or write written orders for and P or GSL eye drops and a small number of POM preparations, to treat a range of common eye conditions. Their training and mandatory levels of equipment and diagnostic agents makes them the obvious first port of call for patients with any eye condition. Under the EA service, non IP Optometrists will provide the patient with a signed order for items from the EA formulary, to take to the community pharmacy for dispensing under the terms of the Eyecare Ayrshire service specification. Claims for items supplied under the Eyecare Ayrshire service must be made using the EA form submitted each month to the Pharmacy Team, NOT by using the MAS prescription form. Reference: MASF/1 Supersedes: MAS Version 6 Page 11 of 18
SECTION 7 EAR 7.1 Ear wax removal QUANTITY Olive oil ear drops 10ml Sodium Bicarbonate 5% Ear Drops 10ml SECTION 8 MOUTH 8.1 Oral ulceration and inflammation QUANTITY 1 Benzydamine mouthwash 0.15% 300ml 1 Benzydamine spray 0.15% 30ml 1 Chlorhexidine mouthwash 0.2% 300ml Hydrocortisone mucoadhesive buccal tablets 2.5mg 20 8.2 Teething QUANTITY Bonjela Teething Gel 15g Calgel Teething Gel 10g 8.3 Oral thrush QUANTITY Miconazole Oral Gel 15g Reference: MASF/1 Supersedes: MAS Version 6 Page 12 of 18
SECTION 9 SKIN 9.1 Acne QUANTITY Benzoyl peroxide 5% Gel (endorse as Acnecide 5%) 30g 9.2 Eczema/ Allergy QUANTITY Emollients (moisturisers) 1 Hydromol ointment 125g/500g/1kg 2 Epaderm ointment 125g/500g/1kg Liquid paraffin and White soft paraffin 50/50 500g Aveeno cream (for face) 100ml/300ml Doublebase gel (excludes Dayleve gel) 100g/500g QV cream 100g/500g/1.05kg Zerobase cream 50g/500g Emollient Bath and Shower preparations QV wash QV bath oil Hydromol bath and shower emollient Bath- shower preparations with antimicrobials Oilatum plus bath additive Dermol 500 lotion Dermol 600 Bath Emollient Barrier Preparations Conotrane cream Sudocrem cream Zinc and Castor Oil ointment Topical local anaesthetics and antipruritics Calamine Aqueous cream Eurax Cream Levomenthol 1% in aqueous cream 250ml/500ml 200ml/500ml 350/500/1 litre 500mls 500mls 600mls 100g/500g 60/125/250/400g 500g 100ml 30g/100g 100g/500g Topical corticosteroids Mild Corticosteroid Quantity 1 Hydrocortisone 1% cream 15g Moderate Corticosteroid Clobetasone 0.05% cream (prescribe as Eumovate Eczema & 15g Dermatitis ) Mild topical corticosteroid with antimicrobials Canesten- hydrocortisone cream 15g Daktacort HC cream 15g Reference: MASF/1 Supersedes: MAS Version 6 Page 13 of 18
Shampoos and scalp preparations Capasal Shampoo Ketoconazole shampoo 2% (prescribe as Nizoral Anti-dandruff ) Polytar liquid Sebco scalp ointment 250ml 60ml/100ml 150ml/250ml 40g/100g 9.3 Boils Magnesium Sulfate Paste BP 25g/ 50g Reference: MASF/1 Supersedes: MAS Version 6 Page 14 of 18
APPENDIX 1 Minor Ailment Service Formulary (MASF) amendment form Pharmacists wishing to request that a product be added or deleted from the NHS Ayrshire & Arran MASF should complete the information below and return the completed form to: Tracy Love, Principal Pharmacist, Medicines information, University Hospital Ayr, Dalmellington Road Ayr KA6 6DX or the completed form can be emailed to medicines.information@aaaht.scot.nhs.uk Medicine details Medicine, brand where applicable Formulation Strength and pack size Manufacturer (where applicable) Request details Addition or removal from MASF Is the medicine currently include in NHS Ayrshire & Arran Joint Formulary (http://www.nhsaaa.net/servicesa-to-z/prescribing/) Rationale for request? Please also include any comments about its indications for use/ reasons for removal For additions, proposed place in therapy (first/ second line choice, or specific patient group) Should this medicine replace an existing MASF choice? (state medicine to be replaced and reason) Approximately how many patients per month would receive this from your pharmacy if it were included in the MASF Any other relevant information Addition/ removal (deleted as appropriate) Reference: MASF/1 Supersedes: MAS Version 6 Page 15 of 18
Pharmacist details and declaration of interests Requesting Pharmacist name Address: Contact telephone number/ email address Requesting pharmacist signature Date On receipt of a completed MASF amendment form, a declaration of interest in the pharmaceutical industry form will be sent/ emailed to the requesting pharmacist. This must be completed and returned before the request can be considered. Alternatively, this form can be requested in advance and submitted with the MASF amendment form. To to obtain a copy of the NHS Ayrshire & Arran Code of Practice for Medicines Governance on Declarations of Interests in the Pharmaceutical Industry, please contact Medicines Information, University Hospital Ayr on telephone: 01292 614506 or email: medicines.information@aaaht.scot.nhs.uk Reference: MASF/1 Supersedes: MAS Version 6 Page 16 of 18
APPENDIX 2 Minor Wound Guidance Available as a separate appendix. Can be accessed from: http://athena/adtc/dtc%20%20clinical%20guidelines/masfa1.pdf Reference: MASF/1 Supersedes: MAS Version 6 Page 17 of 18
APPENDIX 3 Pharmacy First Service Supplied only under NHS Ayrshire & Arran PGD as part of the Pharmacy First service and following completion of required training. Use either CPUS prescription form (not the MAS prescription form, using cipher 99996) or Universal Claim Framework (UCF) process within your PMR system. Once UCF is universally available this will be the only method used. Urinary Tract Infections (women aged between 16 and 64 years) Trimethoprim 200mg Tablets 6 Impetigo Fusidic Acid 2% Cream 15g Reference: MASF/1 Supersedes: MAS Version 6 Page 18 of 18