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Nigel's surgery 9: Emergency medicines for GP practices
This mythbuster has been updated to reflect latest good practice. Changes due to COVID-19 have been made to Mythbuster 1 Resuscitation in GP surgeries.
What emergency medicines should be available to GPs in their practices and in the doctor’s home visit bag?
The doctor’s bag
GPs need the knowledge, skills, and equipment for managing medical emergencies. They also need to carry a range of drugs for use in acute situations when on home visits.
Exactly which drugs they should carry is dependent on the practice. 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 to include in the GP's bag is decided by the:
- medical conditions they are likely to face
- medicines they are confident in using
- storage requirements
- shelf-life
- extent of ambulance paramedic cover
- proximity of the nearest hospital
- availability of a 24-hour pharmacy
In the practice
Practices should consider where a patient presenting with an emergency condition would be managed. They should make sure this place would be appropriate. Drugs in the practice to help manage medical emergencies should be held in safe and appropriate storage conditions.
This list is based on current practice. It is modified from two Drugs and Therapeutics Bulletins in 2015, and 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 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 had considered the risk in relation to decisions made taking into account their local context. Any assessment of risk should include the reasons why a particular medicine on the suggested list is not required. This should be kept under review.
| Drug | Indication |
|---|---|
| Adrenaline for injection | Anaphylaxis or acute angio-oedema |
| Antiemetic – cyclizine, ondansetron, metoclopramide or prochlorperazine | Nausea and vomiting |
| Aspirin soluble tablets | Suspected myocardial infarction |
| Atropine for practices that fit coils or perform minor surgery | Bradycardia |
| Benzylpenicillin for injection | Suspected bacterial meningitis |
| Chlorphenamine for injection | Anaphylaxis or acute angio-oedema |
| Dexamethasone 5mg/2.5ml oral solution- requires date opened stick and new expiry once seal broken | Croup (children) |
| Diclofenac (intramuscular injection) | Analgesia |
| Furosemide | Left ventricular failure |
| 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 |
| Hydrocortisone for injection and/or soluble prednisolone | Acute severe asthma, severe or recurrent anaphylaxis |
| 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. |
Asthma |
Naloxone
- 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? May patients present with opiate related problems?
Additional medicines
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.
On inspection
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.
This comes under key line of enquiry S4 in our healthcare assessment framework.
More information
- Last updated:
- 23 December 2020
