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Overview
Patient presenting with
signs and symptoms of acute sore throat
Patient presenting with...
NHSE PATHWAYS
NHSE PATHWAYS
Consider the risk of deterioration, red flags or serious illness.
Thorough consultation required for children.
Consider the risk of deterioration, red flags or serious illness....
  • Does the patient have signs or symptoms indicating possible scarlet fever, quinsy or glandular fever? (refer to NICE CKS for list of symptoms)
  • Does the patient have signs and symptoms of suspected head/neck cancer? E.g. persistent mouth ulcers or an unexplained lump in the neck.
  • Is the patient immunosuppressed?
Does the patient have signs or symptoms indicating possible scarlet fever, quinsy or glandular fever? (refer to NICE CKS for list of...
YES
YES
NO
NO
NICE CKS
NICE CKS
NHSE PGDs
NHSE PGDs View PGD in right panelView PGD in right panel
Digital PGD
 Digital PGD
Onward referral
  • General practice
  • Other provider as appropriate
Onward referral...
NO
NO
YES
YES
FOR ALL PATIENTS:
FOR ALL PATIENTS:...

Content sourced and adapted from NHS Pharmacy First – Clinical Pathways and Patient Group Directions (PGDs) on the NHS England website, licensed under the Open Government Licence v3.0.

Content sourced and adapted from NHS Pharmacy First – Clinical Pathways and Patient Group Directions (PGDs) on the NHS England website, licensed under the Open Government Licence v3....
  • Suspected Epiglottitis
    • 4Ds: dysphagia, dysphonia, drooling, distress
    • Do not examine the throat of anyone with suspected epiglottitis as this may precipitate closure of the airway
  • Severe complications suspected (such as clinical dehydration, signs of pharyngeal abscess)
  • Stridor (noisy or high pitched sound with breathing)
...
Consider calculating NEWS2 Score ahead of signposting patient to A&E or calling 999 in a life threatening emergency
Consider calculating NEWS2 Score ahea...
Gateway Point
Gateway PointSelf-care and pain relief
Onward referral
  • General practice
  • Other provider as appropriate
Onward referral...
Use FeverPAIN Score to assess: 1 point for each
  • Fever (over 38°C)
  • Purulence
  • First Attendance within 3 days after onset of symptoms
  • Severely Inflamed tonsils
  • No cough or coryza (cold symptoms
Use FeverPAIN Score to assess: 1 point for each...
FeverPAIN Score 0 or 1
FeverPAIN Score 0 or 1
FeverPAIN Score 2 or 3
FeverPAIN Score 2 or 3
FeverPAIN Score 4 or 5
FeverPAIN Score 4 or 5
  • Antibiotic is not needed
  • Offer over the counter treatment for symptomatic relief
  • Drink adequate fluids
Antibiotic is not needed Offer ove...
Ask patient to return to Community Pharmacy after 1 week if no improvement for pharmacist reassessment
Ask patient to return to Community...Self-care and pain relief
  • Antibiotics make little difference to how long symptoms last
  • Withholding antibiotics is unlikely to lead to complications
Antibiotics make little difference...
Ask patient to return to Community Pharmacy if no improvement within 3-5 days for pharmacist reassessment
Ask patient to return to Community...
Gateway Point
Gateway Point
RETURNING PATIENT
RETURNING PATIENT
After pharmacist reassessment, patient can be offered antibiotics if appropriate based on clinician global impression
After pharmacist reassessment, pa...
Gateway Point
Gateway Point
Shared decision making approach using TARGET RTI resources and clinician global impression
Shared decision making approach usi...
Mild symptoms: consider pain relief and self care as first line treatment
Mild symptoms: consider pain relief...
Gateway Point
Gateway Point
Severe symptoms: consider offering an immediate antibiotic
Severe symptoms: consider offering...
Offer phenoxymethylpenicillin (if no allergy) for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care
Offer phenoxymethylpenicillin (if no a...
Reported penicillin allergy
(via National Care Record or Patient/Carer)
Reported penicillin allergy...
If pregnant
 If pregnant
Offer clarithromycin for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care
Offer clarithromycin for 5 days (subj...
Offer erythromycin for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care
Offer erythromycin for 5 days (subjec...
YES
YES
If symptoms do not improve after completion of treatment course
 If symptoms do not improve after completion of treatment course
Sore throat
Sore throat
NHS
NHS
Acute Sore Throat (For adults and children aged 5 years and over)
Acute Sore Throat Context: UK Pharmacy First Scheme Acute Sore...
Exclude: pregnant individuals under 16 years
Exclude: pregnant individuals under 16 ye...Text is not SVG - cannot display