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Services A to Z

Planning treatment in a European Country   

If you are thinking about any sort of planned medical or dental treatment outside the UK, please discuss this fully with your GP, hospital consultant or dentist. Make sure you are fully informed as it is important to have the information you need to make the right choices. You will need to be fully informed about your European healthcare provider and the details of the treatment you are planning to have. You may also need to consider:

  • when you will be able to travel
  • how your medical notes will be exchanged between teams
  • arrangements for after-care or follow-up treatment either abroad or at home
  • how you would deal with any complaint or problem should something go wrong following your treatment abroad
S2 Scheme

All treatment under the S2 scheme requires Health Board approval before treatment can commence. Please click on the linked heading above for more information. 

EU Cross Border Healthcare Directive

The arrangements for reimbursing health care costs to people who live in Scotland and receive treatment in EEA states stopped on 31 December 2020 (EU Exit Implementation Period completion day). Click on link above for more information

This section covers tumours that grow inside the eye. Please see the different intraocular tumours below.

Uveal Naevus

a) What is a Naevus?

A naevus is the medical term for a “mole”. Like on the skin, this can also occur in the eye and is commonly spotted on routine examination by your optometrist. They can be found on the choroid, ciliary body or iris. This can be referred to as uveal naevus. You are more likely to get a naevus if you have white skin or blue eyes. They can sometimes grow during puberty and pregnancy. Although naevi are benign, very rarely they can turn into melanoma (cancer of the eye). For this reason your optometrist might examine your eyes routinely every year.

b) What are the symptoms?

Naevi in the eye generally do not cause symptoms. If, however, the naevus turns into melanoma patients may experience:

• Decreased vision

• Flashing lights

• Shadow in the vision

c) Will I need any tests?

Simple uveal naevi are monitored in the community by your opitcian. If examined in the eye clinic, photographs of the naevus help us to detect any changes at later visits. Other tests may include:

• Ultrasound scan

• Optical Coherence Tomography (OCT)

d) Will I need treatment for Naevus?

No treatment is needed for uveal naevus.

Eye Melanoma

a) What is Melanoma?

Eye melanoma is cancer of the eye. This is the most common type of eye cancer in adults. Most patients are between 55 and 65 years old when diagnosed. It affects up to 50 people a year in Scotland (between 500 and 600 people in the UK). Choroidal melanoma is the most common type of uveal melanoma, followed by the ciliary body, then iris. Uveal melanoma can spread to other parts of the body; some patients have spread, some don’t. The most common place for melanoma to spread to is the liver. This can happen many years after diagnosis. Unfortunately treating the tumour does not guarantee spread will not happen.

b) What are the symptoms of eye melanoma?

Eye melanoma may have no symptoms and may be picked up on routine examination by your optician. Some patients, however, may report:

• Decreased vision

• Flashing lights

• Shadow in the vision

Choidal, ciliary body and iris melanomas may have different symptoms.

i) Choroidal melanoma: 

Patients may experience a shadow in the peripheral vision or poor central vision. As the melanoma grows it may cause a retinal detachment. This may cause floaters, flashing lights or a curtain over part of the vision.

ii) Ciliary body melanoma:

As the ciliary body is behind the iris, small tumours may be not be visible at first. They can, however, grow and cause a shadow in the vision. Clouding of the lens, known as cataract, can develop resulting in blurred vision. Floaters can be caused if the tumour bleeds into the back of the eye. Glaucoma (raised pressure in the eye) may occur causing poor vision and eye pain.

iii) Iris melanoma

Iris melanomas may appear as a growing pigmented area on the coloured part of the eye. This can change the shape of the pupil or grow in front of the pupil causing the vision to go down. Like Ciliary body melanoma, glaucoma (raised pressure in the eye) may occur causing poor vision and eye pain.

c) What are the risks of getting melanoma?

The following features may increase your risk of developing ocular melanoma:

• Pale skin

• Red or blond hair

• Blue eyes

• Over the age of 50

• Large number of moles or freckles

d) Will I need any tests?

Certain tests help confirm the diagnosis and check how the tumour is behaving. Tests may include:

• Photograph

• Ultrasound scan

• Optical Coherence Tomography (OCT)

All patients have an ultrasound of their liver every year to make sure the melanoma has not spread or started to grow here. This is usually organised at your local hospital.

e) Will I need a biopsy?

A biopsy may be offered to confirm the type of tumour and likelihood of spread. This, however, has risks and may not provide enough tissue to give a definite answer. If we do decide to biopsy, options will be discussed in clinic.

f) What is the treatment of eye melanoma?

In treating eye melanoma, our aim is remove or destroy the tumour and keep as much normal vision as possible. Unfortunately, removing the tumour does not guarantee spread will not happen later in life. Treatments may include:

  • Plaque radiotherapy
  • Proton beam radiotherapy
  • Laser (Transpupillary thermotherapy)
  • Photodynamic Therapy (PDT)
  • Removal of eye (enucleation)
  • Removal of tumour (local resection)

g) Is treatment always needed?

Very rarely we may choose not to treat. If the patient is frail, elderly, or has other serious medical illnesses we may decide to watch instead. Every patient is different. After discussion in clinic we will arrive at the right and best treatment option for you.

h) How likely is the melanoma to spread?

Risk of melanoma spreading (metastasising) to other parts of the body depends on the three factors outlined below.

i) Clinical tumour stage

Clinical tumour stage is based on how the tumour looks when examined in the clinic and the size of the tumour. The larger the tumour, the longer it is likely to have been there and the more likely it has had a chance to spread elsewhere in the body. If the tumour has grown quickly in size or grown through the wall of the eye, again this increases the risk of tumour spreading.

ii) Histology

This refers to how the tumour cells look under the microscope. Tumour tissue from biopsy or after the eye is removed is sent to the laboratory and examined by our pathologist. If the tumour cells appear large and round (epithelioid) then there is high chance of tumour spreading. If the cells appear long and narrow (spindle) then chance of spread is far less.

iii) Genetic typing

This refers to the arrangement of DNA in our cells (the basic building blocks for life). Our cell behaviour is controlled by DNA, which is stored in our genes. These genes are found in chromosomes, which are thread like structures found in every cell of our body. We have a total of 23 pairs of chromosomes. Each chromosome has long arms (coded by the letter q) and short arms (coded by the letter p). Tumour tissue is sent to the genetics laboratory where it is analysed. If a single chromosome 3 is missing from melanoma cells, this is called “monosomy 3”. This means the melanoma is very likely to spread. If chromosome 8q has gained a longer arm, again, this increases the chance of the melanoma spreading. If both “monosomy 3” and 8q gain are present then this there is an even stronger chance of tumour spread. If, however, there is a gain in chromosome 6p, this is protective and decreases the likelihood of metastasis.

i) Will I need any tests to check for spread?

We will perform an ultrasound scan (USS) of the liver every 6 months to check for spread of the melanoma. If we suspect there is spread on USS, we will organise an MRI scan of the liver to look at this in closer detail. 

Some patients find having an USS every 6 months too stressful and worrisome. If this is the case we can perform the USS every 12 months instead. 

j) What happens if the eye melanoma spreads to different parts of the body?

This can be scary and upsetting. If spread of disease has been picked up we involve other health professionals at our MDT (multidisciplinary team) meeting. Our clinical team consists of a radiologist, pathologist, and a medical oncologist. Collectively we will decide on the right tests and treatments for you as an individual. Accepting and coming to terms with the diagnosis can be challenging. For this reason, we have specialist ophthalmic nursing staff in the clinic who are here to council and help you through this difficult time.

Uveal Metastasis

a) What is uveal metastasis?

Cancer starting elsewhere in the body can spread to the eye, in particular, the uveal tract. This is called uveal metastasis. In the uveal tract the choroid is the most common sight for cancer to spread to, followed by the iris, then the ciliary body. In men cancer most commonly spreads to the eye from lung cancer, and in woman from breast cancer. This is most common in adults aged 55-65. Other sites for cancer to start before spreading to the eye include the kidneys, gastrointestinal tract, and the skin.

b) What are the symptoms of uveal metastasis?

Commonly there are no symptoms and the uveal metastases are noticed on routine examination. Some patients, however, may experience:

• Decreased vision

• Flashing lights

• Shadow in the vision

Sometimes the tumour causes the retina to detach, this is where the back lining of the eye comes away. This may cause floaters, flashing lights, and a curtain over the vision.  

c) Will I need any tests?

As well as taking pictures of the eye, we may perform:

• Ultrasound Scan

• Optical Coherence Tomography (OCT)

• Blood tests

If we suspect the cancer has spread to the eye from else where in the body, we may arrange scans to look for cancer. This may include:

• Chest X-ray

• CT scan

• PET CT scan

• MRI scan

d) What is the treatment for uveal metastasis?

Treatments may include:

• Radiotherapy (external beam radiotherapy or plaque radiotherapy)

• Chemotherapy

• Radiotherapy and chemotherapy

The treatment choice depends on where the cancer has started from in the body.  Discussion with our medical oncologist will helps us choose the best treatment for you. 

Choroidal Haemangioma

a) What is choroidal haemangioma?

Choroidal haemangiomas are benign tumours that grow in the blood vessel layer beneath the retina called the choroid. They are either circumscribed or diffuse. Circumscribed means there is no underlying medical condition. Diffuse choroidal haemangiomas, however, are commonly found in a condition called Sturge-Weber syndrome. The vision is more likely to be affected in this type. Although not as common, haemangiomas can be found in the iris and ciliary body. This can sometimes cause glaucoma.

b) What are the symptoms of choroidal haemangioma?

Commonly there are no symptoms and your optician finds them on routine examination. Sometimes, however, the choroidal haemangioma can leak fluid underneath the retina at the back of the eye. This may cause:

• Blurred vision

• Distortion

• Hypermetropia (change in perscription making you long sighted)

• Flashing lights If there is a lot of fluid leakage at the back of the eye, this can cause a retinal detachment. This may cause floaters, flashing lights, and a curtain over the vision.

c) Will I need any tests?

Some tests can help us confirm the diagnosis and see if the haemangioma is leaking fluid. These may include:

• Ultrasound Scan

• Optical coherence tomography (OCT)

• Fundus fluorescein angiography (FFA)

• Indocyanine green chorioangiography (ICG)

d) What is the treatment for choroidal haemangioma?

If there are no symptoms, no treatment is required. If, however, the haemangioma is growing, leaking or starting to affect the vision, we may use the following treatments:

  • Photodynamic therapy (PDT)
  • Laser (Traspupillary thermotherapy)
  • Plaque radiotherapy
  • Proton Beam Radiotherapy

e) Is treatment of choroidal haemangioma successful?

Laser photocoagulation helps seal the leaking blood vessels. Unfortunately, fluid can build up again. PDT and Transpupillary thermotherapy have both shown great successful in stopping leakage from choroidal haemangiomas. If the retina has detached, however, giving these treatments can be too difficult. Radiotherapy treatment may be preferred in these cases. The longer fluid is at the back of the eye or the retina is detached, the smaller the chance of having complete recovery of vision after treatment.

f) Will choroidal haemangioma spread to other parts of the body?

No. This is a benign tumour and does not metastasise.

Eccentric Disciform Degeneration

a) What is eccentric disciform degeneration?

Eccentric disciform degeneration is an abnormal growth of blood vessels underneath the retina. These vessels are very fragile and can bleed or scar over. This is not a type of cancer although the degeneration can look similar to melanoma or other cancers of the eye. This mainly occurs in elderly people with up to half of patients having macular degeneration. Other names for this condition include peripheral exudative haemorrhagic chorioretinopathy (PEHCR), extra-macular disciform degeneration and peripheral age related retinal degeneration.

b) What are the symptoms of Eccentric Disciform Degeneration?

There may be no symptoms. If leakage from the abnormal blood vessels track down to the macula (the centre of the back of the eye) then blurring or distortion of the vision may occur. Sometimes this can cause a retinal detachment. This may cause floaters, flashing lights, or a shadow in the corner of the vision. When looking at the back of the eye in the clinic the abnormal area appears flat irregular and red or pale.

c) What are the risks of getting eccentric disciform degeneration?

The following features increase your risk of getting this condition:

• Over 70 years of age

• Female

• High blood pressure (hypertension)

• On medicine that thin the blood (Anticoagulant therapy)

• Short or long sighted (Myopia or hypermetropia)

d) Will I need any tests?

To confirm eccentric disciform degeneration and exclude cancer we may have to perform a few tests. These may include:

• Photographs

• Optical Coherence Tomography (OCT)

• Ultrasound scan

• Fundus Fluorescein Angiography (FFA)

These tests may be repeated at future appointments and help us pick up changes.

e) What is the treatment for eccentric disciform degeneration?

Monitoring in the eye clinic is sometimes all that is required. This condition regularly gets better without treatment. Laser photocoagulation treatment can be used in the clinic to seal off the leaking blood vessels and prevent the swelling and leakage getting worse.

Understanding conditions affecting the eye can be difficult. We hope this labelled diagram will help describe different parts of the eye that can be affected by cancer.

  • Cornea- this is the clear window at the front of the eye that enables us to see properly.
  • Conjunctiva- this is “the skin” of the eye, which helps protect us from infections.
  • Lens- this helps focus the light on the back of the eye.
  • Iris- this is the coloured part of the eye which changes shape and controls the amount of light entering the eye
  • Ciliary Body- This is responsible for producing fluid called “aqueous” inside the eye. It also helps change the shape of the lens so we can focus when reading.
  • Vitreous- this is the “jelly” inside the eye.
  • Choroid- this pigmented layer covers the whole of the back of the eye. It absorbs excess light entering the eye and helps stop symptoms of glare.
  • Retina- this layer has the photoreceptors of the eye (like the film of a camera). It captures images from the outside world and sends them to the brain.
  • Optic Nerve- This nerve connects the eye to the brain.

The choroid, cilary body, and the iris make up the uveal tract. This is where melanomas (cancer of the eye) can grow.

Intraocular Tumours
Conjunctival Tumours
Orbital Tumours
Eyelid Tumours
About Us

The Scottish Ocular Oncology Service is run in The Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow. We are funded by the National Services Devision, NHS Scotland.

Our main role is to diagnose and treat intraocular melanoma. We do, however, manage other tumours and conditions affecting the eye and receive referrals from all of the health boards in Scotland.

To deliver the best service to our patients we work closely with other healthcare professionals including medical oncology, radiology and pathology. We meet on a weekly basis to discuss and plan the best treatment for each patient. Although treatment is mostly carried out in Glasgow, we do have links with the Douglas Cyclotron Unit at Clatterbridge on the Wirral in Cheshire. This is the only UK centre that performs proton beam radiotherapy, which is a specialist treatment for intraocular melanoma. We frequently organise patients to travel down and receive treatment here.

Our Scottish Ocular Oncology Service has developed and grown well over the years and we are proud to offer our services nationwide.

Contact Us

Post: 

Susan Ewan
Ocular Oncology Administration Coordinator
Ophthalmology Out Patient Department
Gartnavel General Hospital
1053 Great Western Road
Glasgow
G12 OYN

More Information

Diagnosis Types
Events
Investigations
Publications
The Team
Treatments
Travel and Accommodation
Metastatic Surveillance
for Eye Melanoma
Referral Guidelines for Ophthalmologists

Why pharmacists should be involved

The community pharmacist is a trusted source of information and advice for their patients and about 90% of the adult population visit a community pharmacy at least once a year. This presents an important opportunity for pharmacists and their staff to motivate and empower their customers to improve their health.

Health Improvement covers a wide range of topics some examples are discussed below and the topics boxes give a little more detail.

Health Improvement targets for Scotland can be found by linking into the Scottish Executive’s website

For further information for pharmacy staff in NHSGGC click here

Stopping smoking

Stopping smoking is one of the most important health improvement interventions. Community pharmacy can supply nicotine replacement therapy or varenicline with behavioural support to help patients stop smoking.

Advice on healthy living

Pharmacists can provide the right advice on healthy living and signpost patients to the best resources to achieve their health improvement goals.

Reduce health inequalities

Community pharmacy offers the Pharmacy First Service (PFS) which encourages people to go to their local pharmacy for support with minor and acute health conditions. Pharmacies undertake a NHS PFS consultation and provide advice, treatment or referral to another healthcare professional if appropriate. 

Managing long term conditions


Many long term conditions require health improvement interventions in addition to medicines which might be prescribed.

Mental health

Good mental health is of key importance to maintaining good general health. Pharmacists should know where to signpost patients for appropriate support as they may need more assistance in managing their daily living requirements. Also patients suffering from poor mental health may need more support to make important lifestyle changes.

For any enquiries regarding Pharmacy Public Health Improvement please contact ggc.pharmacyhit@nhs.scot

Alcohol Awareness

Approximately 1 in 8 men and 1 in 24 women have some degree of alcohol dependence. Excess drinking puts long term health at significant risk. Excessive alcohol consumption is associated with an increased risk of a range of illnesses that collectively contribute to a massive impact on morbidity and mortality.  Please see Alcohol Consumption Questions and the Fast Alcohol Screening Test (FAST) 

For more information visit

  • Drinkaware A Charity promoting responsible drinking.
  • Alcohol Focus Scotland – is the national charity working to reduce alcohol harm.
  • DrinkSmarter  A Scottish Government practical website with many handy tools, supporting healthier drinking habits. 
  • Glasgow Council on Alcohol (GCA) Providing support, counselling, advice, information, group work and training for those affected by alcohol misuse. 
  • Alcohol Change UK :  A charity campaigning for effective alcohol policy and improved services for people whose lives are affected by alcohol-related problems. 
  • Al-Anon Family Groups provide support to anyone whose life is, or has been, affected by someone else’s drinking, regardless of whether that person is still drinking or not.

 Key points for community pharmacy

  • Offer advice on sensible drinking
  • Give advice on prescription and Over the Counter (OTC) medicines about interactions with alcohol.
  • Signpost patients to local services offering support
  • Further Information, Resources and Support (including “Alcohol Before, During and After Leaflet) Alcohol and Pregnancy Leaflet 

Some pharmacies may

  • Offer alcohol brief interventions using a FAST tool
Cancer

It is estimated that 1 in 3 people in Scotland will develop some form of cancer during their lifetime.

This is a wide ranging topic and there are many different types of cancer. Some are more likely to occur in females e.g. cervical and breast cancer while others in men e.g. prostate cancer.

Many forms of cancer can now be successfully treated if they are identified in their early stages and we now have screening for the commonly occurring breast, bowel and cervical cancers.

Some cancers such as melanoma (skin cancer) may be prevented by health protection measures such as avoiding the sun and using sunscreens. Smoking cessation remains one of the most important health improvement measures to avoid developing cancer.

For more information visit

  • Scottish Cancer Index provides links to cancer related websites specific to Scotland.  
  • Cancer Research UK  Helpline 0808 800 4040  Mon – Fri 9-5pm
  • Bowel cancer UK providing support and advice. Telephone: 020 7940 1760
  • Bowel screening in Scotland | NHS inform information at this website
  • Breast Cancer Care providing information and assistance for those affected by breast cancer. Freephone Helpline 0808 800 6000.  
  • Sun Smart   This Cancer Research UK website provides a wealth of information including, information on skin cancer, sunburn and how it damages your skin, advice on protective measures to take – applying sunscreen, staying in the shade, wearing protective clothing and sunglasses, and advice on protecting children from the sun.    
  • Asthma + Lung UK provides advice on all diseases affecting the lungs including lung cancer. 
  • Leukaemia Care provides support for people with leukaemia, lymphomas and related disorders. Tel: Helpline: 08088 010 444 or chat via WhatsApp on 07500068065
  • Lymphoma Action provides support for those affected by Hodgkin’s disease and non-Hodgkin’s lymphoma. Tel. Helpline no: 0808 808 5555
  • Macmillan Cancer Support is a national charity providing expert care and support for people living with cancer. Tel. Helpline: 0808 808 0000
  • Maggies Centre provides support organisation for those affected by cancer. One of the centres is in Glasgow.   
  • Marie Curie Cancer Care. Dedicated to the cure of people affected by cancer and the enhancement of their quality of life through its caring services, research and education.  Telephone Support Line: 0800 090 2309
  • Oesophageal Patients Association Telephone: 0121 704 9860 (Mon – Fri 9am – 5pm)
  • Orchid: Fighting Male Cancer  Good range of leaflets on testicular and prostate cancer.  National male cancer helpline: 0808 802 0010
  • Prostate Cancer UK Telephone:  Helpline: 0800 0748383 

 Key points for community pharmacy

  • Signpost patients to appropriate support organisations.
  • Many quality, free resources can be ordered to support Community Pharmacy through the patient resources link http://quick-guide-for-patient-resources-v62-jul-23.pdf (scot.nhs.uk)
  • Be alert to red flag symptoms such as a persistent cough which might suggest a patient should be referred to their GP for investigation.
  • Encourage patient’s participation in national screening programmes e.g. cervical screening whenever possible.
  • Only sell a minimum of SPF 15 sun protection products. 
Healthy Lifestyle… at any age

Many factors go together to improve an individual’s health. Their health needs change through life as they get older and different issues might impact on men’s and women’s health. However, a healthy lifestyle is important at any stage of an individual’s life.

Diet and nutrition, exercise, smoking cessation and managing alcohol intake are modifiable lifestyle factors that can be addressed to improve health.

Other factors may not be readily addressed by individuals but rely upon society working together to promote healthy living and working environments.

Health inequalities arise when individuals or communities are not empowered to make healthy lifestyle choices.

For more information visit

 Child Health

 Health in older age

 Healthy Living 

Community Pharmacy – Signpost patients to appropriate support organisations.

Beware of your patients particular needs. Check out your locality’s health profile.

Long Term Health Conditions

The effective management of long term health conditions (LTHC) can greatly improve a patient’s health and wellbeing. Examples of these conditions include epilepsy, cardiovascular disease, diabetes asthma and chronic obstructive pulmonary disease (COPD).

In addition to taking appropriate medication LTHC patients are often asked to make lifestyle changes such as smoking cessation or alcohol reduction. But at the same time they may be struggling with psychological issues caused by the impact of their diagnosis.

So in addition to understanding the clinical management of patients and the guidelines that are in place for these it is important to consider the patient as a whole and understand their attitudes to their condition and its management.  

For more information visit

Key points for community pharmacy

  • Signpost patients to appropriate support organisations.
  • Know when to call for medical assistance in the event of a heart attack and how to deliver basic resuscitation (CPR) for patients who have collapsed. Details of suitable courses may be found at St Andrews Ambulance Brigade
  • Advise on use of inhaler devices for asthma and COPD patients

 Some pharmacies may

  • Offer health screening such as blood pressure or glucose monitoring
Mental Health

Mental health is a complex topic affecting a significant percentage of people in the UK at any one time. Issues might include depression (including postnatal depression) bipolar affective disorders, stress, anxiety disorders, phobias, eating disorders, schizophrenia and others. Some individuals may suffer from a combination of symptoms.

The management of patients suffering mental health problems may range from self help approaches to in patient care at a psychiatric specialist hospital or facility.

Regardless of how patients are managed, good mental health is underpinned by a healthy lifestyle. Good diet, smoking cessation, exercise, sleep hygeine and alcohol management will not necessarily cure a patient but they will significantly contribute to their recovery.

For more information visit


Key points for community pharmacy

Palliative Care Services

This service is provided by a network of 70 pharmacies across the NHS Greater Glasgow & Clyde area. These pharmacies maintain

  • a stock of specific core medicines
  • provision of advice and useful contact numbers for specialist palliative care advice
  • a support network to other pharmacies within their localities. 

Some participating pharmacies are available to dispense out-of-hours urgent prescriptions. This can be arranged through NHS 24. A courier service protocol is available to ensure timely supplies of medicines to palliative care patients in emergencies. The aim is for the first pharmacy contacted (regardless of being a part of the Palliative Care network or not) to ascertain the urgency of the prescription and resolve any supply issues, in order to avoid patients, carers, or nurses needing to phone or visit multiple pharmacies. All community pharmacies are provided with a list of the network pharmacies for this purpose and the specific core medicines list. For more details on the Palliative Care Service, click here  or contact: Palliative Care Specialist Pharmacists on the below telephone numbers: 07876 478140 or 07880 786659 or 07775 012560

Quit Your Way

NHSGGC are responsible for a wide range of tobacco projects including the “Quit Your Way” Pharmacy Service.

Suitable pharmacotherapy (Nicotine Replacement Therapy [NRT] or varenicline) together with personalised advice and support is provided from the community pharmacy for usually up to 12 weeks.

For further details, please contact any participating pharmacy or the Quit Your Way Pharmacy Team (T:0141 201 4945 or e: ggc.pharmacyhit@nhs.scot)

Resources

View and order resources

Public Health Resources Directory

This aspect of Pharmacy Public Health deals with the planning for, and managed introduction of new medicines. The Scottish Medicines Consortium  is responsible for providing advice on the clinical and cost-effectiveness of all new medicines and important new indications for existing medicines.

The NHS GGC prescribing website provides useful links to the local Medicines Formulary, medicines policies and associated resources.  

Why pharmacists should be involved

The community pharmacist is a trusted source of information and advice for their patients. This is particularly important for those issues which can have high media attention e.g. introduction of a new vaccine or an outbreak of an infectious disease.

Further information and advice can be found in the Health Protection Topics section of this website.  Examples of topics included are:-

Infection Control

Knowledge of infection control principles is important to protect yourself and your patients.

And

Immunisation and Storage of Vaccines

Advice on safe storage of vaccines which must be stored in the ‘cold chain’ between  2oC and 8oC at all times.

Communicable Disease, Outbreak Control and  Emergency Planning

Pharmacists can recognise symptoms of a notifiable disease in order to appropriately refer patients

Understand how an outbreak is being managed to be able to offer appropriate advice and reassurance to the public.

Maintain Business Continuity Plans to ensure minimal impact on the delivery of patient care in the event of an emergency situation.

Screening for Health Protection  

Pharmacists can encourage uptake of screening programmes against several cancers e.g. cervical, breast cancer and  bowel. More information may be found on the Screening – Health topics – Public Health Scotland website.   

For any enquiries regarding health protection please contact:

PharmacyPublicHealth@ggc.scot.nhs.uk

Blood Borne Virus

Three blood borne viruses are the main cause for concern in Scotland, Human Immunodeficiency Virus (HIV), Hepatitis B and Hepatitis C.

There is an effective vaccine only for Hepatitis B.  However, there are few effective treatments for Hepatitis C and HIV.  

More information

Key points for community pharmacy

 Some pharmacies may

  • Offer support for dried blood spot testing for Hepatitis C and HIV.
  • Dispense antiviral medicines for Hepatitis C.
  • Provide ‘Injecting Equipment’ to prevent spread of disease.
Communicable Disease

Public Health Protection Unit – NHSGGC in NHSGGC has a key role in monitoring and responding to the incidence of notifiable diseases e.g. meningitis.

For more information visit

 Key points for community pharmacy

  • Recognise and refer patients with symptoms suggesting a serious or notifiable disease to the GP or acute services as necessary.
  • Compliance with prophylactic therapy e.g. tuberculosi
Community Pharmacy & Infection Control

The NHS GGC Community Pharmacy Infection Control Guidelines  provide basic advice.

To reduce the incidence of infection due to antimicrobial resistance in the population, NHSGGC has launched https://clinicalguidelines.nhsggc.org.uk/adult-infection-management/ to be followed in primary care and the prescribing support team has developed a non-prescription pad to encourage patients to seek non antibiotic remedies for viral infections.

More Information

 Key points for community pharmacy

  • Provide antibiotic stewardship.
  • Offer advice to patients on appropriate infection control techniques to reduce spread of disease such as norovirus or influenza.
Health Screening

The NHS GGC Public Health Screening Unit is responsible for a range of health screening programmes.

  Key points for community pharmacy

  • Encourage patients to participate in screening programmes.
Immunisation Programmes

Immunisation is one of the most effective health interventions.

There are several formal immunisation progammes in the UK. They are Childhood, Adult and Seasonal Influenza.

More Information

 Key points for community pharmacy

  • Encourage patients to engage with national and childhood programmes.  

 Some pharmacies may

  • Offer travel and influenza vaccination clinics.
Outbreak Control

Public Health Specialists from NHS GGC Public Health Protection Unit – NHSGGC are involved in identifying and managing outbreaks of disease. They will liaise with infection control teams for example in the case of a norovirus outbreak in an institution or with local authorities if an outbreak is linked to a food supplier in an E. coli outbreak. 

Chemical Biological Radiological and Nuclear (CBRN) outbreaks

Local authorities and health boards are required to have plans in place to manage accidental events such as major oil or chemical spills or deliberate terrorist acts. A specialist on line training module is available from TOXBASE

More Information

  Key points for community pharmacy

  • Provide reassurance to patients.
  • Keep Business Continuity Plans up to date.
Patient Group Directions (PGDs)

Patient Group Directions (PGDs) are legal documents that enable suitably qualified healthcare professionals to administer and supply medicines (P or POM) in a defined clinical situation where the patient may not be individually identified before presenting for treatment. The individual using the PGD must have signed and been authorised to use the PGD prior to administering or supplying any medicines named in the document.

NHS GGC uses PGDs to allow nursing staff and Health Visitors to administer vaccines for the routine child immunisation programme and travel in specialist clinics. 

More Information

  • Information about working under PGDs National health Education Scotland NES

 Key points for community pharmacy

  • Community pharmacy PGDs authorised for use in NHS GGC may be obtained from the Community Pharmacy Development team or GGC PGD administration at Clarkston Court, 56 Busby Road, Clarkston, Glasgow G76 7AT
    Telephone No. 0141 232 1728.
Seasonal Influenza

Individuals are most likely to catch influenza in the winter months. The season runs from October to the end of February occasionally into March, peaking in December/January.

Seasonal influenza can affect anyone. It is an acute viral infection of the respiratory tract. There are three types of influenza virus: A, B and C. Influenza A and influenza B are responsible for most clinical illness.

It is difficult for an individual to develop long term immunity to influenza as the make up of the viral strains change slightly on a regular basis. So vaccination against seasonal influenza has to be undertaken annually.

More Information

The government resource Immunisation against infectious disease – ‘The Green Book’

In the United Kingdom immunisation for influenza for certain groups including ‘at risk’ patients is provided on the NHS and in Scotland the Chief Medical Officer (CMO) will send a letter detailing which groups are eligible for vaccination. Letters from the CMO are available here. 

Egg allergy isn’t always an absolute contraindication for receiving flu vaccine. The British Society for Allergy and Clinical Immunology website advises on managing individuals with egg allergy

An e learning course for healthcare professionals undertaking immunisation is available. Registration is required to undertake this course.

NHS Inform has key patient information on all types of immunisation

NHS GGC: Immunisation – NHSGGC

 Key points for community pharmacy

  • Encourage at risk patients to attend for vaccination
  • Advise on management of symptoms
  • Some pharmacies offer private flu vaccination clinics
Sexual Health

Sandyford co-ordinates a wide range of sexual health services in NHS GGC.

The Free Condoms web-site provides, support for practitioners involved in condom distribution, information on how to sign up as a distribution point, where to find condom distribution points and general advice on condom use and products offered

It is important that pharmacists and their staff understand what they should do if they have any concerns about a child and sexual health issues. Access information at NHS GGC Child Protection Unit’s website 

More Information

  Key points for community pharmacy

  • Be able to recognise and differentiate between symptoms of sexually transmitted diseases.
  • Refer all men consulting with symptoms of discharge or thrush infections to Sandyford or their GP.
  • Be aware that there is no charge for vaccine supplied by a Sandyford Clinic.
  • Supply of emergency hormonal contraception or bridging contraception under PGD.
Substance Misuse

Pharmacists play an important part in providing information and advice about substances liable to misuse controlling the availability of medicines, and the associated risks and in providing harm reduction programmes e.g. methadone and the supply of injection equipment.  

More Information

 Key points for community pharmacy

  • Give advice on wound care and management, safer injecting practices and remind clients of the importance of safe disposal of syringes.
  • Know which pharmacies are ‘Injecting Equipment Providers’
  • Be able to sign post clients to other services as necessary.
  • Know how to deal with needle stick injuries
Travel

Two websites are highly recommended for those living in Scotland seeking travel health guidance. Fit for Travel which gives the most up to date information for the public and the professional site TRAVAX.

Access to TRAVAX requires registration but it is free for Community Pharmacists in Scotland to register.

More Information

Key points for community pharmacy

  • Provide patients with pre-travel advice.
  • Encourage the use of sunscreen with a minimum SPF15. 
  • Advise on the carriage and storage of medicines abroad e.g. insulin. 
Vaccine Storage

NHS GGC Guidelines on Vaccine Storage and Handling are available in the NHSGGC Guidelines Repository

More Information

 Key points for community pharmacy

  • Remind patients collecting travel vaccine of the storage requirements. It is preferable that they collect vaccine immediately before their appointment for administration.

For queries about the service please contact the Queen Elizabeth University Hospital Biochemistry Department on 0141 354 9060.

About the service

The Scottish Biologic Drug Monitoring Service is delivered by the Biochemistry Dept. within the Lab Medicine Building on the Queen Elizabeth University Hospital site, Glasgow.

The service currently delivers Infliximab and Adalimumab levels and their respective total anti-drug antibodies (ADA) for optimising care predominantly in gastroenterology patients with inflammatory bowel disease. The service uses both WHO standards for drug levels and a patient pool sample for ADA assay to monitor performance. It is involved in sample exchange with other laboratories.

The service employs a reflex ADA testing strategy based on drug level result. When a drug level result is within or higher than the therapeutic target range, and when ADA level has previously been undetectable, reflex ADA testing is not routinely performed. Since the introduction of reflex ADA testing approximately 50% adalimumab samples and 37% infliximab samples have not had a reflex ADA test performed.

There may be some clinical scenarios where ADA titres are desirable even when drug level results are therapeutic. Requests for additional ADA testing should be indicated clearly at the time of test request or can be arranged by contacting the lab directly.

During 2019 there were 2821 Infliximab and 2920 Adalimumab samples analysed from health boards across Scotland.

TDM tests should be requested according to local biochemistry/immunology laboratory requirements. The previously used paper request forms are no longer required. Local teams are encouraged to collate data related to TDM use and outcomes as this may be required to sustain future rounds of service funding.

Specific Rheumatology guidance

Specific Gastroenterology guidance

Vedolizumab drug level and antibody testing

Vedolizumab drug level testing is now available. The utility of testing drug and anti-drug antibodies for vedolizumab has yet to be fully ascertained. Target drug levels for vedolizumab have not been clearly established. The current evidence is covered in these articles:

Vedolizumab testing is not part of the nationally commissioned TDM service. The cost per sample is £20.

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