This protocol should ony be used to refer patients with no suspicion of cancer.
If there is a suspicion of cancer, the patient should be referred using the guidelines and protocols in the Lanarkshire Cancer Referral Centre
Category: General Practice Referrals
General Practice referral guidelines
Stroke – TIA Fast Track Guidelines
This protocol should only be used to refer patients with NEW, SUDDEN ONSET, FOCAL symptoms/signs listed in this referral.
Please advise your patient not to drive for one month from the initial symptoms.
Please ensure that a contact telephone number is provided for the patient.
Stop Smoking Service Guidelines
Stop Smoking Service Referral
This referral is for use by dentists to refer patients to the NHS Lanarkshire Stop Smoking Service.
Please make your patient aware of the following note:
Your information will be stored on a Stop Smoking Service database and held securely by NHS Lanarkshire, this information will be used only in connection with this service. Anonymous information may be used for statistical and audit purposes.
| Stop Smoking Service Office | Co-ordinators | Areas Covered |
|---|---|---|
| Glenalmond Building Coathill Hospital Hospital Street Coatbridge ML5 4DN Tel: 01236 707714 Fax : 01236 707742 | Catherine Brown | NW Locality Coatbridge, Cumbernauld, Kilsyth and Airdrie. |
| Netherton House 94-104 Netherton Street Wishaw ML2 0DZ Tel: 01698 366979 Fax : 01698 366982 | Maureen Brown | NE Locality Motherwell, Bellshill, Viewpark, Wishaw, Newmains, Harthill, Shotts, Newarthill |
| Udston Hospital Farm Road Hamilton ML3 9LA Tel: 01698 723233 Fax : 01698 723133 | Jacqueline MacDonald | South Locality Hamilton, Blantyre, East Kilbride, Larkhall, Uddingston, Bothwell, Carluke, Lanark and Clydesdale Areas, Rutherglen, Cambuslang, Strathaven, Harthill, Shotts, Newarthill |
Sexual and Reproductive Health – STI Referral
Sexual & Reproductive Health
The departments of Sexual & Reproductive Health (formerly known as Family Planning) and Genitourinary Medicine merged in 2008 and are now known as the department of Sexual Health.
The administrative base is at Glenalmond House, Coathill Hospital, Coatbridge ML5 4DN and there are clinics every day across Lanarkshire. Most clinics are combined clinics and patients can be see and managed in a single clinic with both Genitourinary Medicine and contraceptive consultations.
There are still a few traditional Family Planning/Sexual & Reproductive Health clinics dealing with contraception mainly.
There is a dedicated appointment line which patients or GPs can refer into: 0845 618 7191.
This is open 9am – 4.45pm Monday to Friday.
There is a sexual health link on FirstPort under clinical service. This has links to protocols etc. Link to come
There is also a public website, Lanarkshire Sexual Health, which has up to date information on all clinics and on contraception and sexual transmitted infections.
Notes
Symptoms suggestive of an acute sexually transmitted infection (STI) (urgent)
We aim to offer an appointment within 48 hours to all clients who have symptoms suggestive of an acute STI eg genital ulcers, new onset vaginal discharge, urethral discharge, pelvic pain, testicular pain. However, we may not be able to offer them an appointment in their local clinic within this time frame.
It may be quicker for the patient to call the appointment line themselves: 0845 618 7191
For treatment if already diagnosed with acute STI: (urgent)
The following link takes you to a list of the recommended treatments (assuming no contraindications.) Please see protocol available on FirstPort for further guidance.
List of the recommended treatments
Sexual contact with someone who as Chlamydia, Gonorrhoea, Syphilis, Trichomoniasis, Epididymo-orchitis or PID (urgent)
Sexual contact with someone who has HIV (urgent)
If exposure has occurred less than 72 hours, please refer urgently to A&E or d/w Infectious Disease Consultant On-call as patient may be eligible for Post Exposure Prophylaxis After Sexual Exposure (PEPSE)
The window period for HIV is 3 months but many HIV infections show up by 4 weeks post exposure. Initial blood test can be done at that time.
Sexual Assault (urgent)
Women or men who make an allegation of sexual assault within the last seven days should be encouraged to self refer to Archway: Telephone: 0141-211-8175
The forensic examination can be carried out whether or not the woman or man wishes police involvement.
If the assault took place more than 7 days ago, the patient can be seen within sexual health for STI screening, Hepatitis B vaccination and further management.
We do NOT offer forensic examination.
Genital warts (routine)
If appropriate, please prescribe topical treatments in the first instance. Only cryotherapy can be used in pregnancy. If Podophyllotoxin has been ineffective after 4 weeks of use, please advise patients to attend a sexual health clinic. If Imiquimod has been ineffective after 4 weeks of use please ask patient to attend a sexual health clinic. However, if Imiquimod has started to take effect further treatments can be prescribed (maximum of 16 weeks in total).
It is good practise to offer an STI screen to all patients attending with genital warts.
Recurrent genital herpes (routine)
A HSV positive swab is required to confirm diagnosis prior to initiation of antiviral prophylaxis.
Suppressive antivirals are usually started in patients who have greater than 6 outbreaks of HSV/ per year.
Asymptomatic testing for STIs (routine)
This can usually be offered within Primary Care. For a male, a First void urine (after having not passed urine within the past hour) into a white topped universal container can be sent for Chlamydia and Gonorrhoea testing.
For females, a self obtained low vaginal swab (patient inserts swab 5cm into the vaginal and rotates for 15 seconds before placing it into container) can be sent for Chlamydia and gonorrhoea testing. Urine is not a good method of testing for these infections in women.
Blood samples can be sent in two yellow top tubes to microbiology for HIV and Syphilis testing.
Blood Borne Virus testing – Hepatitis B, C and HIV (routine)
This can usually be offered within Primary Care by sending 3 blood samples in yellow top tubes to microbiology.
Hepatitis B Immunisation (may need urgent referral depending on reason for referral)
We offer Hepatitis B Immunisation for the following groups :
- Sexual assault within past 6 weeks
- Post or pre sexual contact with someone who has Hepatitis B
- Men who have sex with Men
- Sex workers
- Clients who have regular contact with sex workers
- IVDU
- Partners of IVDUs
- Clients with multiple partners
We do not offer hepatitis B immunisation for travel purposes.
Sexual and Reproductive Health – Partner Notify
Sexual & Reproductive Health
The departments of Sexual & Reproductive Health (formerly known as Family Planning) and Genitourinary Medicine merged in 2008 and are now known as the department of Sexual Health.
The administrative base is at Glenalmond House, Coathill Hospital, Coatbridge ML5 4DN and there are clinics every day across Lanarkshire. Most clinics are combined clinics and patients can be see and managed in a single clinic with both Genitourinary Medicine and contraceptive consultations.
There are still a few traditional Family Planning/Sexual & Reproductive Health clinics dealing with contraception mainly.
There is a dedicated appointment line which patients or GPs can refer into: 0845 618 7191.
This is open 9am – 4.45pm Monday to Friday.
There is a sexual health link on FirstPort under clinical service. This has links to protocols etc. Link to come
There is also a public website, Lanarkshire Sexual Health, which has up to date information on all clinics and on contraception and sexual transmitted infections.
Sexual and Reproductive Health – Contraception
Sexual & Reproductive Health
The departments of Sexual & Reproductive Health (formerly known as Family Planning) and Genitourinary Medicine merged in 2008 and are now known as the department of Sexual Health.
The administrative base is at Glenalmond House, Coathill Hospital, Coatbridge ML5 4DN and there are clinics every day across Lanarkshire. Most clinics are combined clinics and patients can be see and managed in a single clinic with both Genitourinary Medicine and contraceptive consultations.
There are still a few traditional Family Planning/Sexual & Reproductive Health clinics dealing with contraception mainly.
There is a dedicated appointment line which patients or GPs can refer into: 0845 618 7191.
This is open 9am – 4.45pm Monday to Friday.
There is a sexual health link on FirstPort under clinical service. This has links to West of Scotland Protocols
There is also a public website, Lanarkshire Sexual Health, which has up to date information on all clinics and on contraception and sexual transmitted infections.
Contraception Referral Notes:
Chlamydia testing in women requesting Intrauterine Contraception
It is good practice to perform a Chlamydia test prior to fitting an Intrauterine Device in women under the age of 25 years and women over 25 years old with a new sexual partner in the past year or more than 1 partner in the last year or if their regular partner has other partners. A self obtained vulval vaginal swab for Chlamydia should be taken prior to referral. If this is not done, this will be done at the time of fitting of the device, however, it may be that the fitting of the device is deferred if the women has symptoms etc.
Additional Information
Patients who request an intrauterine system (IUS) for Gynaecological reasons and are not requiring contraception, should be referred to Gynaecology.
Patients on Nexplanon commonly get nuisance bleeding patterns. Patients with no contra-indications to the combined pill may use Combined Oral Contraceptive (COC) for up to three months while they have the Nexplanon in-situ, provided they have a pregnancy test which is negative. This is an off label use of the COC but is recommended by the Clinical Effectiveness Unit (CEU) of the Faculty of Sexual & Reproductive Health (FSRH).
The following priority conditions are not suitable for SCI Referral and women should self-refer via the Appointment Line: 0845 618 7191
Emergency Contraception
Women requiring emergency contraception can be prescribed Levonelle which is free in many community pharmacies in NHSL. Women presenting after 72 hours or more i.e. 72 hours since unprotected sexual intercourse can use oral emergency hormonal contraception called EllaOne. This works up to 120 hours after unprotected sex. EllaOne is available in the sexual health services or on prescription via the GP. As EllaOne is four times the price of Levonelle, it is only used between 72 – 120 hours after the unprotected sex. EllaOne can be used in young (under 16’s) vulnerable chaotic clients who are mid cycle and who do not wish an Intrauterine Device (IUD).
Women who wish the most effective method of emergency contraception need counselled re-fitting of an Intrauterine Device (IUD) as this is 99% effective in preventing pregnancy. An IUD can be fitted up to five days after unprotected sexual intercourse or up to five days after the earliest possible ovulation (i.e. up to day 19 on a 28 day cycle).
The Protocol for Emergency Hormonal Contraception is available on West of Scotland Protocols website, where you can also view the Emergency Hormonal Contraception protocol.
Termination of Pregnancy
Women who require a termination of pregnancy can be referred to the Sexual Health Service where the GP does not offer referral to women’s health unit. They will be seen within 48 hours if they ask for an emergency appointment.
Recent Sexual Assault (within last 7 days)
Women or men who make an allegation of sexual assault within the last seven days should be encouraged to self refer to Archway:
Telephone: 0141-211-8175
The forensic examination can be carried out whether or not the woman or man wishes police involvement.
Renal Referral Guidelines
| Renal Medicine | Consultant | Direct Line to Secretaries |
|---|---|---|
| Monklands Hospital | Dr W. G. J. Smith | 01236 712640 |
| Monkscourt Avenue | Dr M. F. Hand | 01236 712641 |
| Airdrie | Dr I. R. Shilliday | 01236 712582 |
| ML6 0JS | Dr J. P. Traynor | 01236 713167 |
| Switchboard | 01236 748748 | |
| Fax Number | 01236 712179 |
Background
The renal unit is mostly centred at Monklands although we have some clinics at Wishaw and Hairmyres. It is likely that your patient will be reviewed at Monklands first. Background info on the renal unit is available via the FirstPort website. This also includes access to our guidelines including CKD guidelines and advice on the use of ACE inhibitors and ARBs. These are held in the Renal Documents Library on FirstPort
Referral Process
We have two categories of referral – routine and urgent. A routine patient will be seen in approximately 9 weeks. An urgent referral should be made if you think the patient may need to be admitted and we would prefer the urgent referral is coupled with a phone call at the time of referral to discuss the case.
Reasons for Referral
For outpatient review (or at least discussion) include:
- Stage 4 and 5 CKD (i.e. eGFR < 30 ml/min on two measurements three months apart)
- Significant proteinuria i.e. ACR > 70 (or > 30 if under 55 years)
- Difficult to control hypertension
- Stage 3 CKD if under 55 years old or > 10ml/min loss of renal function over a 12 month period
To make the first visit much more meaningful it would therefore be extremely useful if the following investigations could be ordered at the time of referral (unless already available):
Essential
- Renal ultrasound – (Please refer all patients unless they have had a recent scan via Clinical Radiology to HH, MDGH and WGH on SCI Gateway. Choose the option Renal Scan- referred to renal clinic)
This will then trigger an USS which will include Renal size, renal cortex, aorta and presence or absence of hydronephrosis. If hydronephrosis is found, then a bladder USS will be undertaken.
If a renal mass is found, radiology will automatically self refer for CT and access the lab browsers for the eGFR (blood for this should have been taken as part of the renal referral process). Information regarding diabetes and metformin use should be included in the referral
The initial report will be sent to primary care as if there is a mass or obstruction this should be referred through to Urology. Renal team will have direct access to the reports in clinic so do not need the reports forwarded. With a clinic waiting time of 6-8 weeks, the USS will always be done before the patient is seen in clinic
Bloods
- Renal Profile( Request RENP), CRP, FBC. ( RENP=UE (including Bic), bili, ALT, AST, ALP, GGT, Ca, Alb, PO4)
Urine
- Urine for Albumin/Creatinine Ratio (the labs accept the abbreviation ˜ACR)
Non Essential
- All ages ‘vasculitic screen’
- Rheumatoid factor (RF), anti-nuclear antibodies (ANA), ANCA and C3 C4
If over 40 years old
- Serum electropheresis and immunoglobulins (can be requested SEP and IgGs on the request form) and urine for Bence Jones protein (BJP)
On the main referral page several items are coded as mandatory fields. We hope you will be willing to put up with the minor frustration this might cause you to ensure that our mutual patient’s journey through the clinic system is made as meaningful and quick as possible.
Rapid Access Chest Pain
This protocol should only be used where the following conditions apply
- The patient has experienced recent onset of suspected stable angina.
- The patient is experiencing deterioration of stable angina.
****** This protocol should not be used where the following conditions apply ******
- Patients suspected of having unstable angina (frequent and recurrent chest pain at rest or on minimal exertion, lasting 15 – 20 minutes) or acute MI (these patients should be referred to the on call team for admission)
- Patients who are attending a Cardiology Clinic (these patients should be referred to the Cardiology Consultant for an urgent appointment)
- Patients with decompensated heart failure (these should be referred to the Cardiology Clinic)
- Patients with known or suspected valvular disease (these should be referred to the Cardiology Clinic)
- Patients with new, uncontrolled or symptomatic arrhythmia (these should be referred to the Cardiology Clinic)
Rapid Access Atrial Fibrillation
Referral Criteria
- Rapid Access Atrial Fibrillation Clinic (RAAFC) for patients with:
- Recent newly diagnosed atrial fibrillation.
- Confirmed by 12 lead ECG.
- ECG must be attached to referral.
Exclusion criteria:
- Known long standing AF
- Known or suspected valvular disease
- Known alcohol abuse with liver impairment
- Left ventricular systolic dysfunction/ cardiomyopathy.
- Decompensated heart failure.
- If exclusion criteria present these patients should be referred to a cardiology clinic.
Contraindication to anti coagulation therapy :
- haemorrhagic stroke; significant bleeding.
- conditions in which risk of bleeding is increased, e.g. history of gastro-intestinal bleeding, peptic ulcer, recent surgery, recent ischaemic stroke, bacterial endocarditis, uncontrolled hypertension. ( BNF May 2013)
RAAFC will appoint within 10 working days of receiving SCI referral.
Diagnosis will be confirmed.
Stroke risk will be assessed
Treatment as per AF protocol will be initiated/recommended
Follow up at RAAFC if appropriate.
Referral on to cardiology if appropriate.
Discharge to primary care if appropriate.
Public Dental Service (for GP use)
Who can we treat under the Public Dental Service?
The Public Dental Service’s treatment role is now focused on:
- providing treatment to patients with special care requirements.
- the provision of dental services that are not routinely available in general dental practice (such as dental treatment under general anesthetic for children and adults with special needs).
- accepting referrals of patients (special care adults, vulnerable children and children with behavioural management problems) from independent contractor general dental practitioners andv other Health Care Professionals.
- accepting referrals of patients with complex medical needs that cannot be treated in general dental practice.
- accepting referrals of anxious children and severely anxious adults for dental treatment under sedation.
- the provision of care for socially excluded groups such as prisoners, and those who are unable to leave their home.
The other main roles for the Public Dental Service continue to be prevention, epidemiology and teaching.
While the vast majority of referrals are perfectly acceptable, the more information we can have about a patient before we see them, the better able we are to help them.
Patient Charges
The Public Dental Service has to charge patients for the dental treatment provided (unless the patient is exempt from charges) and work under the same rules and regulations as independent contractor general dental practitioners. Patient charges must be collected unless the patient is exempt.
Normal charging arrangements will apply when a PDS dentist provides general dental services. Patients are required to pay 80% of the cost of their NHS dental treatment up to a set maximum per course of treatment (currently £384), unless they are in one of the groups entitled to free NHS dental treatment or help with the cost of dental treatment.
Contact the Public Dental Service
The Dental Office, Glendoe Building, Coathill Hospital, Hospital Street, Coatbridge ML5 4DN
Telephone: 01236 707711
Lead Clinician: Michael Devine,
Director of Public Dental Services,
NHS Lanarkshire.
Review Date: January 2016