PCA(P)(2026)05 - New PGD for Treating Oral Candidiasis in Pharmacy First
Published: 26th March 2026
Introduction
This Circular advises Health Boards and community pharmacy contractors of a new Patient Group Direction (PGD) to be added to the NHS Pharmacy First Scotland service for the treatment of oral candidiasis (thrush).
Background
NHS Circular PCA (P)(2020) 13, issued on 1 July 2020, enclosed Directions for the Health Board Additional Pharmaceutical Services (NHS Pharmacy First Scotland) Directions 2020 which came into force as of 29 July 2020.
Six common clinical conditions, supported by PGDs, are currently included in the NHS Pharmacy First Scotland service: uncomplicated UTIs, impetigo, shingles, skin infections, hay fever and skin inflammation.
Details
The new nystatin PGD has been reviewed by the Scottish Antimicrobial Prescribing Group (SAPG) prior to being signed off by NHS 24 for use in all Health Boards.
Health Boards are responsible for local governance processes to approve, sign and publish this PGD. Boards are asked to complete this as soon as they can do so and by 31 May 2026 at the latest.
Community pharmacy contractors and pharmacy teams should ensure they are familiar with the new arrangements as detailed in this Circular.
Patient Group Direction
A PGD has been developed nationally for NHS Pharmacy First Scotland for the treatment of oral candidiasis using nystatin oral suspension. This PGD allows community pharmacy teams to treat additional patients who are not eligible for treatment with miconazole oral gel (or where stock of miconazole oral gel cannot be obtained).
Annex A to this circular provides a copy of the specimen PGD, assessment form and GP notification form which has been approved by NHS 24 to allow pharmacists as much time as possible to familiarise themselves with the relevant details. In the meantime, as local governance procedures must be followed even when a PGD is agreed nationally, Health Boards will each approve, sign and publish this PGD through the appropriate channels.
Once the relevant Health Board has published the PGD locally, an ‘Individual Authorisation Form’ should be completed by pharmacists delivering NHS Pharmacy First Scotland and submitted, where required, to each Health Board area that they work in according to the usual process.
Training
Community pharmacy contractors should ensure that their pharmacists complete the e-learning module “Oral thrush for NHS Pharmacy First Scotland”, now available on the NES TURAS Learn website.
IT roll-out
All Patient Medication Record (PMR) suppliers have confirmed that pharmacy IT software will support pharmacy teams to deliver this additional common clinical condition from 1st March 2026, but pharmacists should not use the ‘Oral Thrush’ Universal Claim Framework (UCF) module until the local PGD has been issued and the Individual Authorisation Form for this PGD has been completed.
Frequently Asked Questions (FAQs) - New PGD for Skin Inlammation (NHS Pharmacy First Scotland)
-
The service is being expanded to include oral candidiasis (thrush) through a new national PGD using nystatin oral suspension.
-
Each Health Board must approve, sign and publish the PGD locally through their governance processes no later than 31 May 2026.
-
Pharmacists must complete an Individual Authorisation Form and submit it to each relevant Health Board area as required.
-
The PGD allows treatment for people who are not eligible for miconazole oral gel, or where miconazole oral gel cannot be obtained.
-
Yes. Pharmacists must complete the “Oral thrush for NHS Pharmacy First Scotland” e-learning module on NES TURAS Learn.
-
Annex A of the circular provides the specimen PGD, the assessment form and the GP notification form.
