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Efforts are made to ensure the accuracy and agreement of these guidelines. However, we cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties
We have an immediate access clinic for lumps and suspected malignancy in head and neck. Direct access by GPs. We offer a consultation/assessment with cytological diagnosis where considered appropriate.
The emergency clinic or 'hot clinic - This runs daily (am and pm Mon to Thurs, am only Fri) and is staffed by the trainees, alongside a consultant clinic for support. It is best accessed by GPs contacting the on call SHO via the UHB switchboard and requesting an appointment.
Please contact the Outpatient booking office for next available clinic on 0117 342 5860. The GP is responsible for informing the patient of the date/time of appointment and the patient should either be given a referral letter or a letter headed 'for access to clinic' should be faxed to the department to 0117 342 5117.
The Bristol Balance Clinic
Referral Guidelines for Vestibular Assessment/ Rehabilitation
The Balance Clinic at UHB provides a full diagnostic and treatment service for patients with vestibular disorders. It is run by ENT consultants, clinical scientists, audiologists, and physiotherapists with an interest in balance disorders.
There are 3 clinics at UHB in which patients with balance disorders can be seen:
1. The Direct Access Vertigo Clinic:
This is a direct access clinic that allows for the complete assessment and treatment of patients with a clear peripheral (i.e. inner ear) cause for their symptoms. The clinic is run by audiological scientists with input from an ENT consultant where necessary. Any patient presenting with isolated rotatory vertigo brought on by, or worse with, movement can be referred directly to the balance clinic. This includes:
Benign Paroxysmal Positional Vertigo (BPPV). Typically this is rotatory vertigo lasting 30 – 60 seconds with movements e.g. turning over in bed. Repositioning movements are often effective.
Acute Vestibular Failure (Labyrinthitis). This is acute onset severe vertigo, often with nausea and vomiting, that can last 48-72 hours. Most patients will then compensate over several weeks, and return to normal balance function. Those that do not improve may benefit from targeted vestibular rehabilitation.
Other rotatory vertigo where the diagnosis is unclear but there are no other otological or medical symptoms (see below).
2. The ENT Clinic
This is the default option for patients with balance disorders and ismost appropriate for those with vertigo in conjunction with asymmetric or sudden hearing loss, tinnitus, otalgia, otorrhoea, or significant medical co-morbidities. This includes patients with suspected Meniere’s disease or vestibular migraine.
3.The Complex Balance Clinic
This is a multi-disciplinary clinic with an ENT consultant and clinical scientist working together. Patients are referred into this clinic from either the direct access vertigo clinic or the ENT clinic (or following triage of the initial referral). The complex balance clinic is reserved for those with more complicated balance problemse.g. where the diagnosis is unclear, initial treatment has been unsuccessful, or there is a particularly complicated history. Children with imbalance may also be seen in this clinic.
Please note that cardiology/ neurology referral should be considered for patients with primarily cardiovascular or neurological symptoms.
Many thanks for considering the Bristol Balance Clinic for your patient. We welcome feedback or queries about the service.
The Urgent Care Centre provides all the services of a Walk-in Centre with the addition of being able to refer for on-site x-rays and other diagnostic tests. No appointment is necessary, patients can just turn up to during opening hours (as listed below).
Can treat both adults and children for conditions such as sprains and strains, cuts and grazes and minor burns and scalds. Able to assess suspected broken bones. Do not x-ray chest, back, faces/head, ribs or hips, only limbs.
Opening times: Every day from 8am - 8pm.
Telephone no: 0117 342 9692
Urgent Care Centre South Bristol NHS Community Hospital Hengrove Promenade Hengrove Whitchurch Lane Bristol BS14 0DE
The EPAC is an emergency clinic for women with bleeding and/or pain in early pregnancy up to 18 weeks gestation. Where possible, please refer to your local hospital or booking hospital for continuity of care.
Opening times - Monday to Friday 8.30am to 4.30pm. Strictly by appointment.
Criteria for referral
Early pregnancy pain and/or bleeding in early pregnancy between 6 weeks and 17 weeks and six days from last menstrual period (LMP), from five weeks if ectopic is suspected.
A positive pregnancy test is mandatory (either GP or home test)
Patient's name, date of birth, address and phone number
Cases NOT suitable for EPAC
An unstable patient with severe bleeding and / or pain. Please refer to the on-call gynaecology SHO for admission
Negative pregnancy test. Please refer to the GP, Emergency Department or on-call gynaecology SHO
Postnatal. Please refer to the on-call gynaecology SHO
Previous ectopic (no symptoms). Please refer to the Ultrasound Department (Southmead on 0117 959 5121 or St Michaels Hospital on 0117 342 5347)
Reassurance scans after a previous miscarriage or for dating
EPAC clinic information Appointments are available every weekday morning and some weekday afternoons. Weekends are for emergencies only by prior arrangement. Please refer to the on-take hospital and speak to the gynaecology SHO on call.
St Michaels Hospital: Ward 78 (24 hours) Tel no: 0117 342 7789 or 0117 342 5279 EPAC clinic Tel. no: 0117 342 7790 (Monday to Friday, 8am to 12.30pm for EPAC) for Emergency Gyanecology 1pm - 4.30pm (last appointment 3pm). Fax no: 0117 342 5776
Consultant in charge - changes daily Vicky Reace and Hazel Endean - Midwife / Nurse Practitioners
Local administrative information
South Bristol Community Hospital (Hengrove)Direct access – without appointment plain X-rays
Main Reception: 0117 342 9696
Open core hours (09.00-17.00) Monday to Friday
Send patient with a GP request
Waiting times are usually approximately 20 minutes for x-rays. However there could waits in excess of 30mins at the busiest times of 10.30am to 2pm.
Patients can also attend the X-ray Department, Bristol Royal Infirmary - Open (09.00-16.00) Monday to Friday)
Obs & Gynae Requeststo be directed to St Michael’s Hospital, Southwell Street, Bristol 0117 342 5347
Bus services serving Hengrove Park -First services 36, 50, 51, 75, 76, 515 serve Hengrove Park. (In addition, ABUS service 52 operates within ½ mile of the site).
For South Bristol NHS Community Hospital, Hengrove Promenade, Bristol BS14 0DE / Bristol Royal Infirmary, Marlborough St, Bristol, BS2 8HW
Can be booked via ICE or paper referral but appointment booked first.
Monday - Friday 0117 342 9695 8.30am to 7.30pm
Saturday & Sunday (for booking appointments only if not via ICE) 0117 342 9695 08.30am - 7.30pm
Please follow the preparation instructions as stated below:
Upper Abdomen Do not eat or drink for 6 hours before the appointment time
Aorta No Preparation
Renal tract (kidneys and bladder) Please fill your bladder prior to your appointment (drink 1 pint of water approx. 1 hour before your allotted time)
When you arrive
The waiting room serves not only the Ultrasound rooms but some X-ray rooms as well, so it may appear as though some patients are being called out of turn.
We will endeavour to see to see you at your allotted time, however, please appreciate some examinations are more complex and may take longer than expected; your patience would be appreciated.
What does an ultrasound scan involve?
Ultrasound is the use of sound waves to produce an image. The sound waves cannot be heard but they are sent into the body and their ‘echo’ detected again after they have been reflected by the internal organs. In order to allow these sound waves to pass through the body a jellylike substance is applied to the appropriate area of the skin and then the ultrasound probe is moved over that area on the body. The operator will apply a little pressure to your abdomen to improve image detail. The images are viewed on a screen and you will be asked to breathe in and hold your breath at various intervals during the examination.
X-rays do not generally give adequate information when imaging the soft tissue organs, whereas an ultrasound scan often shows the structure of the internal organs in good detail.
Ultrasound is regarded as a safe procedure, and is the same type of examination preformed on pregnant women during their obstetric care.
The examination will be performed by a Radiographer who specialises in ultrasound examinations.
Each scan takes approximately 20mins. On occasion an x-ray is also required to complement the ultrasound examination.
When the scan is completed you may leave immediately, and the report will be sent to your GP within 10 days, unless it is urgent when the report will be telephoned to your GP.
After the examination you may eat and drink normally.
Bus services serving Hengrove Park from April 2011.
First services 20, 36, 51, 75, 76 and 90 serve Hengrove Park.
UH Bristol has redesigned its Rapid Access Chest Pain clinic service for people with new onset or increasing cardiac chest pain.
The clinics run every weekday morning Monday to Friday, 9-12 (last appointment 12 noon) on a first come, first-served basis using the new referral form which patients should bring with them.
Patients are asked to attend with a list of current medications and relevant past history. Following assessment in the clinic (clinical history and risk profiling), onward tests and investigations are arranged and a template letter sent to GP informing of onward plan.
This clinic is not intended for complex cardiology patient’s with multiple co-morbidities who should still be referred to general cardiology outpatient clinics.
(level 5 BHI, access from main Bristol Royal Infirmary or via Horfield Road entrance)
Local administrative information
Active diabetic foot problems which are non-life or limb threatening to be referred to a multidisciplinary foot care service within 1 working day, for triage within 1 further working day. The local services are as follows, so refer accordingly to available services, or via A&E to the acute on-call team if appropriate, to meet the need of the patient;
Southmead Hospital; Has a joint diabetes consultant and podiatry clinics foot care service that operates every day, between the hours of 8 – 5pm. Staff usually see booked patients between 8 – 12am. There are two full MDT clinics per month. Referral to this service can be made by faxing a written referral to: 0117 414 9402 Faxes are triaged by the on call nurse for priority. If you wish to speak to the diabetes secretary please call: 0117 414 6422
Bristol Royal Infirmary; Has a joint diabetes consultant and podiatry clinics foot care service that operates Tuesday, Thursday and Friday mornings. There is one full MDT clinic per month. Referrals to this service can be made by faxing a written referral to: 0117 342 0279 Or leaving a message on: 0117 342 2175
Weston General Hospital; Has an MDT foot care service which operates every Tuesday morning.Please note that is not a hot foot clinic and therefore urgent referrals should only be sent within 48 hours of the clinic.If you need to make an urgent referral, please consider one of the other services described in this section.
From November 2016, all referrals should be made via e-referrals using the same process as that used for 2WW referrals.
Create the UBRN, select the speciality ‘Diabetic Medicine’ and clinic type ‘Podiatry and Foot’ and then select Weston Hospital and BOOK a dummy appointment.
Ensure you attach the new Diabetic Foot form at the same time so the trust can contact the patient.
Where possible, please attach a photo of the condition of the foot to the referral form in order to help the service prioritise the patient’s care.
The previous format of drop-in access spirometry with assessment of bonchodilator response service has changed. It has been replaced with a bookable service whereby an ICE or paper request can be made for these sts to be performed. These are reported wihtin seven days and results sent back to the referring doctor.
We are also able to perfom a rang of other tests if required. These include lung volumes, gas transfer, hypoxic challenge (fitness to fly), skin prick tests and six minute walk tests. These can also be requested via ICE or letter to the Respiratory Clinical Physiologists.
For more information please contact the clinic co-ordinator on 0117 342 2616 who will assist with your query.
Local administrative information
Inclusion criteria:Any adult patient with acute respiratory symptoms who is threatening admission.
Haemodynamically unstable patient - should be sent to ED
Suspected lung cancer - refer via 2WW
Suspected TB - refer to specialist TB clinic
How to access service:
Fax referral to 0117 3422921
Tel: 0117 342 4101 / 0117 342 2615
Ensure patients telephone number is included. They will be contacted by phone and given appointment time. Attach a copy of patients current medications.
Service runs Monday - Friday9.00 till 12.30 Capacity for this emergency/admission avoidance clinic is limited and appointments may need to be prioritised.
We aim to see all patients within 48 hours of referral.
The Avon Tuberculosis Clinic accepts referrals of all patients with suspected tuberculosis (TB). In addition, contacts of patients with TB are fered screening. Referrals are accepted for patients wiht possible latent or active TB infection, including referrals from Occupational Health and tertiary referrals from other departments, particularly those regulary using immunosuppresive medication.
Please use the link to get further information including TB referral pathways:-
The Pathology Day Unit activity is part of the planned day care stream within the Ambulatory Care Unit (ACU). We carry out a wide spectrum of procedures, such as Dynamic Function Tests (glucose tolerance test, short synacthen test, pituitary function tests, water deprivation test), blood transfusions and iron infusions.We also offer a phlebotomy service for tests with complex sample requirements or where samples require immediate separation (e.g. Homocysteine, Gut Hormones, Renin Aldosterone Ratio).We accept referrals from GPs. We endeavour to accommodate individual requirements.
We are currently located on A413, Ambulatory Care Unit , level 4 of the Queens Building. The unit is open Monday -Friday from 08.00am until 20.00.
Should you wish to discuss a specific referral, please ring Dr Bayly directly: 0117-342 2853
Local administrative information
GP Support Unit
The GP Support Unit (GPSU) is staffed by local GPs working in the Bristol Royal Infirmary (BRI) between 10.00 and 19.00 Monday to Friday. It is run by BrisDoc Healthcare Services that also provides out of hours GP cover and walk-in centres.
We are located within the Ambulatory Care Unit (ACU) on level 4 (Queen's Building) of the BRI. Use the main lifts / stairs to level 4, and follow signs for Ambulatory Care Unit (opposite the Queen's day unit). There is off road parking close to the BRI or in the Trenchard Street NCP car park. Parking and drop off is often easier if you bring someone with you, and we would recommend that you are accompanied on your visit to GPSU.
Aim of service
GPSU's function is to find alternative ways to manage patients without necessarily having to admit them into hospital. This is commonly known as "Ambulatory Care".
Accessing the service
To access the service patients must be referred to GPSU by their own GP or another health care professional (e.g. Community Matron) where an admission to hospital is being considered and or, the patient's clinical presentation requires more time and investigations than your GP has access to. The GPSU does not run a standard GP service and does not see walk-in patients.
A proportion of patients seen by GPs need quick access to investigations that are available in the Bristol Royal Infirmary. In some cases prompt access to blood tests and x-ray tests can help a GP make a diagnosis and start the patient on the right treatment course.
The service is not suitable for patients that are immobile or require nursing support.
What happens in the Unit
In the majority of cases, patients managed by GPSU are assessed, treated and discharged back into appropriate community services or to their home. Often this will involve the use of high level hospital investigations on the day of assessment. Some patients may be referred into same day or next day specialist clinics.
If your GP refers you to the GPSU, you should expect to be at the GPSU for at least half a day to have all of your tests and investigations. Some patients may be at the GPSU for most of the day. If it is clear that same day discharge is not going to be achievable after initial assessment and investigations, the GPSU team will arrange for the patient to be admitted for an overnight stay in hospital.
South Bristol Urgent Care Centre (UCC)
BrisDoc's GP Support Unit also provides remote medical support for the Nurse-Led Urgent Care Centre (run by Bristol Community Health) at the new South Bristol Community Hospital in Hengrove between 10.00 and 16.00 Mondays-Fridays (Urgent Care GP support is provided on site 1600-2000 weekdays and 08.00-20.00 weekends and bank holidays).
All patients that attend this UCC are initially treated by an Advanced Nurse Practitioners. Where further medical advice is required that cannot be obtained from the patient's usual GP, the patient's case may be referred to a BrisDoc GPSU doctor who may be on-site or at our BRI base.
For more information on South Bristol Community Hospital and the Urgent Care Centre, please visitwww.briscomhealth.org.uk.