Shaping better health
REMEDY : BNSSG referral pathways

Advice & Guidance Service and FAQs

Checked: 23-08-2018 by vicky.ryan Next Review: 22-03-2019

Gynae Top Tips

The Gynaecology Top Tips for GPs (powerpoint) were compiled for a Bristol wide education session, by Dr Tim Percival, Dr Nicola McGuinness (GP, The Family Practice), Caroline Overton (Consultant Gynaecologist UHBristol) and Phil Smith (Consultant Gynaecologist, North Bristol NHS Trust).

The tips cover:

  • Vulval/vaginal symptoms

  • Recurrent candidiasis

  • Vulvodynia/vulval vestibulitis

  • Lichen sclerosus et atrophicus

  • Problematic bleeding

  • Early pregnancy problems

  • Pelvic pain

  • Severe endometriosis

  • Secondary amenorrhoea

  • Endocrine enquiry

  • PCOS

  • PMS

  • Urinary incontinence

  • Abnormal bleeding on HRT

  • Post menopausal bleeding.


These Case Studies (word doc) have also been compiled by the former North & West Primary Care Gynaecology Service.


Advice and Guidance Service

University Hospitals Bristol and Southmead Hosptial are now both providing advice and guidance services for patients aged 16 and over in gynaecology, which can be requested via eReferral.

The BNSSG Referral Service may also advise referring GPs to use this service, when appropriate, during the triage of gynaecology referrals to outpatient clinics.

NBT Advice and Guidance Service

Please note that the service is not provided for the chasing of existing referrals or for second opinions.

Please see the Gynae A&G Steps - Southmead (word doc) for further guidance on how to submit a request through e-Referral.

UHB Advice and Guidance Service

This service should be utilised where advice is required on the management of a patient that may avoid the need for referral. It should not be used where immediate advice is required, in which case the on call teams should be contacted in the usual way.

Requests for advice and guidance should be submitted vie e-RS (please see the Gynaecology A&G Steps - UHB (word doc) for guidance on how to submit a request through e-Referral) and meet the following criteria:

  • Ongoing management of a patient (patients not currently under review or referred to either UHBristol. For requests for patients currently under review or referred, please write to the responsible consultant).

  • Advice on a treatment plan.

  • Advice on the appropriateness of a referral for their patient (e.g. whether to refer, or what the most appropriate alternative care pathway might be).

  • The most clinically appropriate service to refer a patient into.

The UHB gynaecology team will provide advice on the following:

  • Frequency of pessary changes.

  • Use of Vagifem in postmenopausal women.

  • Provision of and referral to physiotherapy.

  • Side effects with anticholinergics for detrusor over activity, alternatives.

  • Need for USS in menstrual dysfunction.

  • Menstrual disorders: initial management and investigation.

  • Use of steroids in vulval disorders, including when to refer in to secondary care.

  • Post op questions about need for smears after hysterectomy, need for follow up, post op pain/urination/complications.

  • Pre-referral advice on cysts/infertility/paediatric adolescent gynaecology.

  • Fibroids – initial management/pre-referral service

  • Pelvic Pain – initial management

  • Uncomplicated HRT advice.