This mythbuster has been updated to reflect latest good practice. Changes due to COVID-19 have been made to GP mythbuster 1: Resuscitation in GP surgeries.
What emergency medicines should be available in the practice and for GPs and Health Care Professionals (HCPs) doing home visits?
Home visit medicines
GPs and HCPs need the knowledge, skills, and equipment for managing medical emergencies. They need to be able to access a range of medicines for use in acute situations when on home visits.
HCPs will need appropriate authority to administer these medicines. GP mythbuster: 19 provides more information.
The drugs they should have access to depends on the practice and the type of home visit being undertaken. For example, the drugs required by a remote and rural GP may be different from drugs required by an inner-city GP.
The choice of what medicines to have access to is decided by the:
- medical conditions they are likely to face
- medicines they are confident in using
- storage requirements
- extent of ambulance paramedic cover
- proximity of the nearest hospital
- availability of a 24-hour pharmacy or in-house dispensary.
In the practice
Practices should consider where to manage a patient presenting with an emergency condition. They should make sure this place would be appropriate. Medicines in the practice to help manage medical emergencies should be stored in safe, appropriate conditions and known to staff.
This list is based on current practice. It is modified from:
- two Drugs and Therapeutics Bulletins in 2015
- stakeholder engagement with medical directors of several GP practices.
This is not intended to be either exhaustive or mandatory. The final decision needs to be taken in context so choices/omissions can be professionally justifiable, and appropriately risk assessed.
Suggested list of emergency drugs for GP practices
The list of medicines below is not exhaustive or mandatory. We expect practices to use this as a baseline. Practices should be able to show they have considered the risk and local context when deciding which medicines to stock, including emergency medicines which may be used in remote triage first approaches. Any assessment of risk should include the reasons why a particular medicine on the suggested list is not required or a substitute used. This should be kept under review.
|Adrenaline for injection||Anaphylaxis or acute angio-oedema|
|Antiemetic – for example cyclizine, ondansetron, metoclopramide or prochlorperazine||Nausea and vomiting|
|Aspirin soluble tablets||Suspected myocardial infarction|
|Atropine for practices that fit and remove intrauterine devices or perform minor surgery||Bradycardia / vasovagal syncope|
|Benzylpenicillin for injection||Suspected bacterial meningitis|
|Dexamethasone 5mg/2.5ml oral solution- requires date opened stick and new expiry once seal broken (or soluble prednisolone – NOTE off-label use)||Croup (children)|
|Diclofenac (intramuscular injection)||Analgesia|
|Glucagon (needs refrigeration. GlucaGen® Hypokit® has an 18 month expiry out of fridge - should be labelled with new expiry date) or alternative medicine to treat hypoglycaemia.||Hypoglycaemia|
|Glyceryl trinitrate (GTN) spray or unopened in date GTN sublingual tablets||Chest pain of possible cardiac origin|
|Midazolam (buccal) or diazepam (rectal)||Epileptic fit|
|Naloxone (see section below)||Opioid overdose|
|Opiates – diamorphine, morphine or pethidine ampoules for injection. (Water for injection may be required to reconstitute)||Severe pain including myocardial infarction|
Salbutamol either nebules with a nebuliser or inhaler with Volumatic and ipratropium bromide (children) - consider strengths stocked.
- Naloxone is a medicine used to reverse the effects of opiates.
- Providers who stock opiates either in the practice or in the doctors bag should also stock naloxone.
Other providers should risk assess the need to stock Naloxone based on their patient group. For example, do they provide services for patients with addiction or opiate related problems? It is mandatory to have adrenaline available where vaccines are being administered.
This list is not exhaustive. It may be necessary for a GP surgery to carry additional medicines based on the needs of the local population and local arrangements for services. For example district nurses, palliative care and substance misuse. This should be risk assessed.
When we inspect
We would expect to see evidence that an appropriate risk assessment has been carried out. This is to identify a list of medicines that are not suitable for a practice to stock, and how this is kept under review. There should be a process and system in place to check that drugs are in date and equipment is well maintained. It is part of our key lines of enquiry (KLOEs). In particular:
- Drugs and Therapeutics Bulletin Drugs for the Doctors Bag:1 Adults Volume 53 Issue 5
- Drugs and Therapeutics Bulletin Drugs for the Doctors Bag:2 Children Volume 53 Issue 6
- Anaphylaxis guidance (Resuscitation Council UK)
- Faculty of Sexual and Reproductive Healthcare: service standards for resuscitation