NHS 111, GP or pharmacy? Where to go with a gut symptom

Start with how bad it is and how long it’s lasted. A pharmacist for a passing upset such as indigestion, bloating or a bout of diarrhoea. Your GP for anything that keeps coming back. NHS 111 when you need help today and can’t get your GP. And 999 or A&E for the emergency signs listed further down this page.

Sorting people by urgency is a skill, and it’s one I’d like you to have, because the wrong door costs time either way. Waiting a fortnight with something that needed seeing today is the dangerous mistake. Sitting in A&E for hours with indigestion is the tiring one.

When is a pharmacist the right place?

For a gut problem that’s recent, ordinary and not getting worse. A pharmacist can talk through what might be causing a stomach ache and what might help, including medicines for constipation and indigestion. They can also help with bloating.

With diarrhoea, see a pharmacist if you have signs of dehydration, such as dark, smelly pee or peeing less than usual, if you’re older or have a condition that raises your risk of dehydration, or if you need to stop diarrhoea for a few hours. With constipation, go to them once changes to your diet and routine haven’t helped.

Two limits are worth knowing. Pharmacy First, the scheme that lets pharmacists supply prescription medicine without a GP appointment, covers seven conditions, and none of them is a gut problem. And a pharmacist who can’t help can refer you to a GP or another health professional, which is the system working, not a wasted trip.

When should I book a GP appointment?

When a symptom has settled into a pattern. The NHS’s own lists for a routine GP appointment include:

• “you think you might have IBS (irritable bowel syndrome) and have had symptoms for over 4 weeks”
• “you feel bloated regularly”
• “you’ve tried changing your diet but keep feeling bloated”
• you are “regularly constipated”, or constipated and “it’s not getting better with treatment”
• you “keep getting indigestion”
• you notice “sudden changes” in how you poo

If you’re going, take dated notes. A seven day symptom log gives a GP more to work with than a description from memory, and what to tell your GP about gut symptoms covers the conversation itself.

When should I use NHS 111 instead of waiting?

When you need help today and can’t get it from your GP, during the day or when the surgery is closed. You can answer questions about your symptoms at 111.nhs.uk or in the NHS App, or call 111. The online service is for people aged 5 and over, so call for a child under 5. Calling is also the better route if you have complex problems caused by an existing condition, or a care plan from your doctor.

Depending on your answers, 111 might send you to A&E, an urgent treatment centre, an out of hours GP or your own surgery, book a callback from a nurse, point you to a pharmacist, or tell you how to look after yourself at home. If you’ve been offered a callback you’re in a queue, and you only need to contact 111 again if your symptoms change or get worse.

Ask for an urgent GP appointment or get help from NHS 111 if:

• “you have lost a lot of weight for no reason”
• “you’re bleeding from your bottom or have bloody diarrhoea”
• “you find a hard lump or swelling in your tummy”
• “you have shortness of breath, noticeable heartbeats (palpitations) and skin that’s paler than usual”
• you have a stomach ache and “it gets much worse”, “it does not go away or keeps coming back”, “you have problems with swallowing food”, “you’re pregnant” or “you have diarrhoea that does not go away after a few days”
• “your poo is black or dark red”

With diarrhoea or vomiting, the NHS says to call 111 now if you “keep being sick and cannot keep fluid down”, or have “diarrhoea for more than 7 days or vomiting for more than 2 days”.

In Scotland the equivalent is NHS 24 on 111, in Wales it’s NHS 111 Wales, and in Northern Ireland nidirect has the details. Text relay users can call 18001 111, and you can ask for an interpreter when you call.

What about an urgent treatment centre?

It sits between your GP and A&E. Urgent treatment centres deal with urgent problems that aren’t life threatening, and stomach pain, vomiting and diarrhoea are among the common problems they see. You can often get tests such as blood tests there. You don’t need to be registered with a GP, and 111 online can sometimes book you an arrival time so they know you’re coming.

When is it 999 or A&E?

When it could be life threatening. In the NHS’s words, call 999 or go to A&E if:

• “a stomach ache came on very suddenly or is severe”
• “it hurts when you touch your stomach”
• “you’re vomiting blood or your vomit looks like ground coffee”
• “your poo is bloody or black and sticky and extremely smelly”
• “you cannot pee”
• “you cannot poo or fart”
• “you’re bleeding non-stop” from your bottom, or “there’s a lot of blood”, for example “the toilet water turns red or you see large blood clots”

Don’t drive yourself to A&E. Ask someone to drive you, or call 999 and ask for an ambulance, and bring any medicines you take.

What if I can’t tell which it is?

Use 111. Not being sure whether you need 999 or A&E is exactly what it’s for, and it can direct you to the right place. If you have signs of a life threatening illness, don’t stop to check: call 999.

One last thing, in case you’re talking yourself out of going. A symptom you’ve had for months that has changed, such as bloating that now won’t go away, is new information, and new information is a reason to book. If bloating is your main symptom and you’d like help deciding on a next step, the bloating quiz takes about a minute.