GP referral

The following suggestions are for guidance only. It is important for pharmacists to use their professional judgement regarding urgency.

Same day

• Individual is severely immunosuppressed or immunocompromised (this may include patients on chemotherapy or high-dose systemic corticosteroids)
• Individual is systemically unwell, but not showing signs or symptoms of sepsis
• Possible cancer suspected: unilateral (one-sided) polyp or mass or bloody nasal discharge present
• Foreign body inserted into nasal passages
• Significant/active epistaxis (nosebleeds)
• Persistent unilateral symptoms, such as nasal obstruction, nasal discharge or nosebleeds, crusting or facial swelling 
• Individual where treatment under this PGD is not indicated/permitted but upper respiratory symptoms are present and require further assessment.

Less urgent referral

• Individual with untreated localised infection involving the nasal mucosa, such as herpes simplex
• Recurrent sinusitis (four or more annual episodes without persistent symptoms in the intervening periods)
• Chronic sinusitis (sinusitis that causes symptoms that last for more than 12 weeks)
• Anatomic defect(s) causing nasal obstruction
• Co-morbidities complicating management such as nasal polyps
• Concurrent use of any interacting medicine as listed in drug interactions section of the PGD.