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Nigel's surgery 9: Emergency medicines for GP practices
This mythbuster has been updated to reflect latest good practice.
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.
Therefore the choice of what to include in the GP's bag is determined 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 and ensure that this place would be appropriate. Drugs should be held in the practice to help manage medical emergencies
This list is based on current practice modified from two Drugs and Therapeutics Bulletins in 2015.
This is not intended to be either exhaustive or mandatory. The final decision needs to be taken in context so that choices/omissions can be professionally justifiable.
Suggested list of emergency drugs for GP practices
| Drug | Indication |
|---|---|
| Adrenaline for injection | Anaphylaxis or acute angio-oedema |
| Antiemetic – cyclizine, 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 / cefotaxime 1g for Injection. | Suspected bacterial meningitis |
| Chlorphenamine for injection | Anaphylaxis or acute angio-oedema |
| Dexamethasone 5mg/2.5ml oral solution | Croup (children) |
| Diclofenac (intramuscular injection) | Analgesia |
| Furosemide or bumetanide | Left ventricular failure |
| Glucagon (needs refrigeration) or Glucogel | Hypoglycaemia |
| Glyceryl trinitrate (GTN) spray or unopened in date GTN sublingual tablets | Chest pain of possible cardiac origin |
| Hydrocortisone for injection - soluble prednisolone | Acute severe asthma, severe or recurrent anaphylaxis |
| Midazolam (buccal) | Epileptic fit |
| Naloxone (see section below) | Opioid overdose |
| Opiates – diamorphine, morphine or pethidine ampules for injection | Severe pain including myocardial infarction |
| Salbutamol either nebules with a nebuliser or inhaler with volumatic ipratropium bromide (children) | 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 e.g. do they provide particular services for patients with addiction or may patients present with opiate related problems.
On inspection
We would expect to see evidence that an appropriate risk assessment has been carried out 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:
- 15 November 2018
