OTC Red Flags: Referral Questions in the GPhC Exam

In GPhC minor ailment questions, the right answer is often a referral, not a product. We cover the red flags for the presentations you'll see most, how to use WWHAM and ASMETHOD, and a worked GPhC-style question.

By Umar Majid · 9 Nov 2026

In a GPhC minor ailment question, the right answer often isn't a product at all. It's recognising a red flag and referring the patient to the right place with the right urgency. The Board of Assessors' November 2025 feedback listed minor ailments as a low-performing theme, and said trainees must spot red flag symptoms that need urgent investigation or referral.

What are the examiners looking for?

The feedback sets out three expectations for minor ailments. You should give general advice and evidence-based treatment where it's appropriate, recognise that some conditions are self-limiting and need no treatment, and identify red flag symptoms that need urgent investigation and onward referral.

So for every OTC question, ask yourself three things. Is this safe to manage in the pharmacy? Does it need treatment at all? And if it needs referral, how urgently?

Red flags for the minor ailments you'll see most

Presentation	Refer urgently (same day, NHS 111 or 999)	Refer to the GP (book promptly)
Cough	Coughing up blood, chest pain, difficulty breathing, feeling very unwell	Lasting more than 3 weeks, unexplained weight loss, weakened immune system
Sore throat	Difficulty breathing or swallowing, drooling, stridor (999); very high temperature, dehydration, weakened immune system (urgent)	Not improved after a week, frequent sore throats, lump in the neck
Indigestion or heartburn	Vomiting blood or vomit that looks like coffee grounds (999)	Difficulty swallowing at any age, or aged 55 or over with weight loss plus upper abdominal pain, reflux or dyspepsia*
Diarrhoea (adults)	Blood in the stool, lasting more than 7 days, persistent vomiting, dehydration despite rehydration sachets; sudden severe abdominal pain or confusion (999)
Headache	Sudden and extremely painful onset, fever with stiff neck, rash that does not fade, numbness or weakness, seizure, confusion, head injury in the last 3 months (999 or A&E); with vomiting, visual problems, worse on coughing or bending, jaw pain on eating (urgent)	Not improving with self-care, or frequent headaches
Conjunctivitis	Eye pain, light sensitivity, changes in vision, very red eye, a baby under 30 days with red sticky eyes	Not cleared after 7 days, or a contact lens wearer with spots on the eyelids
Vaginal thrush		First episode, under 16 or over 60, pregnant or breastfeeding, more than 4 episodes in 12 months, weakened immune system, treatment has not worked
Lower UTI (women)	Fever or loin pain (possible pyelonephritis), signs of sepsis or serious illness	Outside the Pharmacy First UTI pathway, which covers women aged 16 to 64
Mouth ulcer		Unexplained ulcer lasting more than 3 weeks*

*These match NICE criteria for a suspected cancer pathway referral, so the patient needs to see the GP promptly, not in a few weeks.

Two age thresholds from NICE's suspected cancer guideline are worth memorising: unexplained haemoptysis at 40 or over and dyspepsia with weight loss at 55 or over. Both come up regularly in referral scenarios.

Using WWHAM and ASMETHOD

These mnemonics give you a checklist, so you don't miss an important question.

WWHAM	ASMETHOD
W: Who is the patient?	A: Age and appearance
W: What are the symptoms?	S: Self or someone else?
H: How long have they had them?	M: Medication
A: Action taken so far	E: Extra medicines
M: Medication being taken	T: Time persisting
	H: History
	O: Other symptoms
	D: Danger symptoms

WWHAM is quick and suits the counter. ASMETHOD is more thorough and makes you look for danger symptoms deliberately.

A word of caution, though. The Pharmaceutical Journal points out that relying on mnemonics alone can lead to wrong diagnoses, because they ask set questions in a set order. Use them as a starting point, then ask targeted follow-up questions based on the answers, and always safety-net. In the exam, that means reading every detail in the stem. The red flag is usually one short phrase.

A worked referral question

A 58-year-old man asks for "something stronger" for indigestion. He has had upper abdominal discomfort after meals for 6 weeks. He mentions his trousers have become loose, although he has not been trying to lose weight. He has no difficulty swallowing and takes no regular medicines.

What is the most appropriate action?

A. Recommend an alginate and review in 2 weeks
B. Recommend omeprazole 20 mg once daily for 14 days
C. Give lifestyle advice only
D. Refer him for an urgent GP appointment
E. Tell him to go to A&E now

Answer: D.

Why D? He's over 55, has dyspepsia and upper abdominal pain, and has lost weight without trying. NICE says people aged 55 or over with weight loss and upper abdominal pain, reflux or dyspepsia should be referred on a suspected cancer pathway for oesophageal and stomach cancer. He needs prompt assessment by his GP.

Why not the others? A, B and C treat the symptom and miss the red flag. E over-escalates: he has no signs of an acute emergency such as vomiting blood or severe pain.

The giveaway was "trousers have become loose". Underline anything like that in the stem.

Tips for referral questions

Age is often the clue, so check it against the thresholds above before you read the options. Duration matters too. A cough over 3 weeks, diarrhoea over 7 days and a mouth ulcer over 3 weeks all change the answer.

Match the urgency. The best answer is the safest appropriate route, not always the most dramatic one. And self-limiting is a valid answer, so reassurance and self-care advice can be correct.

Finally, check who the patient is. Babies, pregnancy, breastfeeding and immunosuppression all lower the bar for referral.

For where minor ailments sit among your other priorities, read high-yield therapeutics topics for the GPhC exam, and for the question formats, see SBA vs EMQ in the GPhC exam.

Common questions

Are minor ailments a big part of the GPhC exam? They're one of the themes the Board of Assessors flagged as low-performing in November 2025, so they deserve dedicated practice.

Should I use WWHAM or ASMETHOD? Either works as a checklist. ASMETHOD prompts you to look for danger symptoms, which suits referral questions.

At what age does indigestion with weight loss need referral? At 55 or over, when the weight loss comes with upper abdominal pain, reflux or dyspepsia.

When should a cough be referred? If it has lasted more than 3 weeks, or straight away if there's blood, chest pain or difficulty breathing.

Is "no treatment needed" ever the right answer? Yes. The Board notes that some conditions are self-limiting and don't need treatment.

Build your OTC confidence

Red flag questions come down to pattern recognition, and that comes from seeing lots of scenarios. Our OTC Course gives you one clear method for every presentation, with red flags and referral criteria made explicit.

Take the course on its own for focused revision, or get it as part of the Foundation Pharmacist Training Programme for full support: every Paper 1 and Paper 2 course, a 2,000+ question bank, a full timed mock paper, live study sessions, e-portfolio support and a 1:1 revision plan built around your rota. Every option includes 365 days of access from the day you join, so the earlier you start, the more of the year it covers.

See the OTC Course, see what's included in the programme or try OTC practice questions.