The School Nursing Service supports children and young people from ages 5 to 19 in mainstream schools as part of the Healthy Child Programme (D.H 2009).

They are led by specialist community public health nurses who are all qualified nurses or midwives with additional graduate-level training in the health needs of children and young people. Supporting the SCPHNs are a team of highly skilled community staff nurses, child health and wellbeing assistants, and school health assistants.

Training Sessions

The School Nursing Service is no longer providing yearly updates for Allergy (Anaphylaxis) and Asthma training on a routine basis. They now recommend schools source the resources and training via e-learning, available via the Anaphylaxis Campaign and Asthma UK.

• Visit Allergywise for schools (allergywise.org.uk) 
• Visit Anaphylaxis 
• Visit Education for Health, Asthma E-learning  
• Visit Asthma (org.uk)

In-person Training

The School Nursing Services will still provide face-to-face training in the instance of some new diagnoses or for cases that are more complex. Please email bht-schoolhealth-enquiries@nhs.net, so a member of the team can get in touch to discuss the most appropriate training level for your school and the child’s needs. All requests for face-to-face training will be triaged, and it is important to note:

• When the last date of the attendance at the BCC “Supporting Children in School with a Medical Condition” training was.
• Whether the e-learning modules have been accessed.

Training will be in small groups, and it can sometimes be beneficial to invite the parent/carer, child, and school key workers where appropriate. E-learning can be accessed throughout the year whenever necessary and is an ideal learning resource to update knowledge prior to school trips or other events.

The BHT Paediatric Outreach Nurse, supporting children with complex medical needs in mainstream schools, is also able to provide training on a variety of health conditions, e.g., epilepsy, feeding tubes, and catheterisation

Other Specialist Nurses may provide training on other conditions e.g. cystic fibrosis, diabetes, and stoma care. Please make contact with the child’s medical professionals via their parents/carers for this training.

The School Nursing service is one important component of the support available to school-age children and their families, to promote health and emotional wellbeing in Buckinghamshire, as part of the Department of Health’s Healthy Child Programme.

Buckinghamshire Health Trust supports children and young people in Buckinghamshire schools with medical, social, emotional, or physical needs, to help each person achieve their potential. This helps them to get the most from life and education and become responsible for their own health. The team works in partnership with children and young people, their families, and other health and education professionals in schools, clinics, and family homes. They also work with colleagues in health, care, and education services across Buckinghamshire to help shape children’s services.

The ever increasing demand for the service means they must ensure they make the best possible use of their highly skilled specialist nursing teams. In order to do this, Buckinghamshire Health Trust have reviewed their referral requirements and kindly requests that all referrals are completed according to these criteria. These allow the team to determine if they can offer the appropriate level of care and support for the child’s needs.

1. The referral must be on an electronic e-referral form via School Nurse Service Referral Form - Buckinghamshire Healthcare NHS Trust (buckshealthcare.nhs.uk).
2. Please include detailed information in each section of the referral. (NB. If further information is requested and they have not received this within 2 weeks of the request, the referral will be closed, and no further action will be taken)
3. The child or young person must be over 4 years 6 months and attending a mainstream school in Buckinghamshire. (EHE/NEET will be communicated with separately)
4. The child or young person cannot already be receiving similar care and support for the same reason from another service.
5. The referral must demonstrate that self-help strategies have been consistently implemented and there has been little positive, sustained change.
6. There needs to be evidence that the parent/carer has completed a parenting programme and has implemented the strategies; there has been little positive, sustained change.
7. The referrer/parent/carer has only made a referral to School Nursing and not another specialist service to request an assessment for the same reason at the same time.
8. Contact details are provided for the parent/carer/referrer.
9. For all children who have a Social Worker, it is necessary to have a copy of the latest plan. If this is not available, it will delay the assessment and triage process. This must be sent securely to schoolhealth-referrals@nhs.net where it will be added to the child’s records for review.

Referrals can be made to the BHT School Nursing service for the following:

• Being available to young people, parents/carers, and teaching staff to address any concerns about a child’s health 
• Safeguarding Children and Review Health Assessments for Children Looked After.
• Nocturnal Enuresis (night-time bed wetting) - GP referral only for over 7-year-olds.
• Early support for children with emotional health and well-being needs, e.g., sleep, behaviour
• Early Toileting advice and support
• Onward referral to other agencies​ if currently working with the child (as required)
• Relationships and Sex Education Training for Teachers with Bucks Council PSHE Lead for Primary Schools
• Supporting children and young people who have specific medical needs and providing relevant training aligned to Bucks Council – Supporting Children in School with a medical condition.
• The National Childhood Measurement Programme for children in Year R / 6 only – as scheduled
• Vision Screening for children in Year R – as scheduled.

Schools should consider keeping more than one emergency asthma kit, especially if covering more than one site, to ensure that all children within the school environment are close to a kit. They must not be locked away in a cupboard or an office where access is restricted.

Purchase an inhaler kit 

You can purchase inhaler kits online or via a local pharmacy. 

Pharmacists will need a request signed by the principal or headteacher (ideally on appropriately headed paper) stating:

• The name of the school for which the product is required
• The purpose for which that product is required, and the total quantity required

What the kit should include

An emergency asthma inhaler kit should include:

• A salbutamol metered dose inhaler
• At least two single-use plastic spacers compatible with the inhaler
• Instructions on using the inhaler and spacer/plastic chamber
• Instructions on cleaning and storing the inhaler
• Manufacturer’s information
• A checklist of inhalers, identified by their batch number and expiry date, with monthly checks recorded
• A note of the arrangements for replacing the inhaler and spacers, a list of children permitted to use the emergency inhaler, as detailed in their individual healthcare plans
• A record of administration (i.e. when the inhaler has been used)

Please make sure:

• Emergency inhaler kits should be maintained on a monthly basis
• Holders should be washed after use to prevent cross-contamination
• If there is a risk of contamination with blood, if the inhaler has been used without a spacer, then it should not be reused

School form templates

Medical form templates have been created as an aid to schools, their use is entirely voluntary.

• Template L should be completed by parents to consent to the use of the emergency inhaler
• Template M should be used by the school to inform parents that the dose has been given

Asthma inhalers

Since 1st October 2014, UK schools have been allowed to purchase a salbutamol inhaler without a prescription for use in emergencies when a child with asthma cannot access their own inhaler.

See the guidance for schools in England on using emergency inhalers (GOV.UK)

When purchasing an inhaler, please make sure:

• Spare reliever inhalers can be purchased from Pharmacists
• Inhalers should only be given to pupils already diagnosed with asthma, whose reliever is not in school or runs out
• Spare spacers should be purchased where necessary

It's good practice for schools to store an emergency anaphylaxis kit, which includes: 

• 1 or more Adrenaline Auto Injectors (AAI's) and instructions on how to use them
• A checklist of injectors (identified by their batch number and expiry date, with monthly checks recorded)
• A note on the arrangements for replacing the injectors
• A list of pupils to whom the AAI can be administered

This should be kept alongside an emergency asthma inhaler kit (containing a salbutamol inhaler device and spacer). This is because many food-allergic children also have asthma, and asthma is a common symptom during food-induced anaphylaxis.

Adrenaline Auto Injectors and EpiPens

Spare Adrenaline Auto Injectors (AAI's) can be purchased for emergency use for children who are at risk of anaphylaxis.

They should only be used on pupils:

• Known to be at risk of anaphylaxis
• Both medical authorisation and written parental consent for the use of the spare AAI have been provided

The spare/back-up device is not a replacement for a pupil’s own AAI(s).

Visit DFE Guidance on the use of adrenaline auto-injectors in schools (GOV.UK)

Purchase an anaphylaxis kit 

You can buy an anaphylaxis kit online or from a local pharmacist, without a prescription.

A supplier will need a request signed by the principal or head teacher (ideally on appropriate headed paper) stating:

• The name of the school for which the product is required
• The purpose for which that product is required
• The total quantity required

A template letter can be found in the DFE guidance for schools on creating a policy around the use of emergency auto-injectors (AAI) (GOV.UK)

A number of different brands are available in different doses depending on the manufacturer.  Please speak to your local pharmacist about which brand you should keep in school.

Buying multiple kits and where to store them

We recommend buying more than one kit. Keep one near the central dining area and another near the playground. This helps to make sure they are always close by. 

When buying multiple kits, make sure:

• They are not locked away in a cupboard or an office where access is restricted
• Spare AAI devices are kept separate from the pupil's own prescribed AAI and are clearly labelled

Updating your medicines policy

Your medicines policy should be amended to include AAI(s), ora  separate policy can be implemented to include:

• Arrangements for the supply, storage, care, and disposal of spare AAI(s)
• A register of pupils who have been prescribed an AAI(s) (or where a doctor has provided a written plan recommending AAI(s) to be used in the event of anaphylaxis)
• Written consent of use from the pupil’s parent/legal guardian as part of a pupil’s healthcare plan
• Use of spare AAI is used only where both medical authorisation and written parental consent have been provided
• Appropriate support and training for staff
• Keeping records of use of any AAI(s), informing parents/carers that it has been administered, whether this was the school’s spare AAI or the pupil’s own device

What to do in an emergency

When dialling 999, give clear and precise directions to the emergency operator, including the postcode of your location.

If the pupil's condition deteriorates and a second dose of adrenaline is administered after making the initial 999 call, make a second call to the emergency services to confirm that an ambulance has been dispatched.

Send someone outside to direct the ambulance paramedics when they arrive, and tell the paramedics: 

• if the child is known to have an allergy
• what might have caused this reaction e.g. recent food
• the time the AAI was given

Statutory guidance was issued by the Department for Education in 2014. This relates to the support that pupils with medical conditions should receive at school.

This statutory guidance applies to:

• Governing bodies of maintained schools (excluding maintained nursery schools)
• Management committees of PRUs
• Proprietors of academies

Visit DFE Statutory Guidance for Supporting Pupils at School with Medical Conditions (GOV.UK)

Visit DFE Supporting Pupils with Medical Conditions: Other Useful Resources (GOV.UK)

All schools are required by law to have a medicines policy in place. 

The policy will need to include:

• School responsibilities
• School staff training and support
• The child's role in managing their own medical needs
• Individual healthcare plans
• Managing medicines on school premises
• Record keeping
• Safe storage of medicines
• Disposal of medicines
• Hygiene and infection control
• Arrangements for managing day trips, residential visits and sporting activities
• School's arrangements for common conditions
• Liability and indemnity
• Complaints
• Suggested procedures for administering medicines

Medical form templates have been created as an aid to schools; their use is entirely voluntary. 

Medical form templates (Download) 

Schools are free to adapt them as they wish to meet local needs, to design their own templates, or to use templates from another source.

A "school medicines book" is a record book used in schools to document the administration of medications to students. It serves as a comprehensive record of all medication given, including details like the student's name, the medication, the dosage, the time and date it was administered, and any relevant notes. This book helps ensure safe and accurate medication management within the school environment.

To order a medicines book, please email transactionhub@buckinghamshire.gov.uk

A medicine book costs £7.

Spare Pens in Schools

A one-stop resource for anyone who wants to know about anaphylaxis and adrenaline auto-injector 'pens' in schools.

Spare pens in schools.uk

Allergy UK

Allergy UK is the leading national charity providing support, advice and information for those living with allergic disease.

Allergyuk.org

Asthma UK

Asthma UK is the leading national charity providing support, advice and information for those living with Asthma.

Asthma.org

Diabetes UK

Diabetes UK supports and campaigns for those affected by or at risk of diabetes.

Diabetes.org