Category: All Referrals

Public Dental Service

Scott McLaughlin

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 and 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

Podiatry Referral

Scott McLaughlin

MSK Podiatry (Biomechanic Clinic)

MSK podiatry provides diagnosis and treatment for a range of muscle and joint related foot and lower limb problems which may be due to development, posture, occupation and exercise, or due to long-term conditions such as Rheumatoid arthritis, Osteoarthritis.

Diabetes

The Podiatry Diabetes service provides assessment, diagnosis and treatment of low, medium and high risk patients with pathologies directly related to their Diabetes. This include active ulceration but excludes red flags such as Charcot foot, infection etc which should be directed to acute services which is found under the District Hospital in SCI Gateway.

General Podiatry

General Podiatry provides assessment, diagnosis and treatment for a range of foot pathologies and patients presenting with severe circulation problems with associated foot lesions.

Nail Surgery

General podiatry provides nail surgery procedures; partial or total nail avulsion.

Pain Service Referral

Scott McLaughlin

The pain clinic is held at the Buchanan Centre, Coatbridge.

The staff do not always have access to all hospital and electronic records and hence completion of the form will assist in patient management.

Please attach any relevant hospital clinic and investigation letters/reports from Docman

Please state if a patient requires ambulance transport. As there are no facilities for this at Coatbridge, ambulance patients will be seen at WGH.

ServicesLanarkshire Chronic Pain Service provides out-patient multi-disciplinary assessment and treatment for adults with chronic pain.
LCPS Aims & Objectives
The team consists of two consultants in pain medicine, two specialist nurses, one specialist physiotherapist and one clinical psychologist.

The Pain Management Programme is based at the Douglas Street Health Centre in Hamilton
Rehabilitative & psychological approach to pain self-management

The Pain Clinic, based at the Buchanan Centre (Coatbridge) and Wishaw General Hospital, has a more medical approach:
TENS, medication, acupuncture,
Diagnostic and medication advice and review
Occasionally other procedures will be arranged at the day surgery unit at Wishaw General Hospital
Who to referPatients over 16:

With pain for longer than 6/12
With a chronic painful condition

or

Whose pain is causing significant distress
Who have been fully investigated,
For whom no further investigation or treatment is planned,
Whose lifestyle is significantly disrupted,
Who find standard analgesia is ineffective and
Who accept, during discussion, that a cure may not be possible.

See Pain management algorithm
Who not to referPatients under 16 (without initial discussion with Yorkhill (Glasgow) paediatric chronic pain clinic
Patients who would not tolerate the journey reasonably well
Patients with back pain should initially be assessed through MSK or back pain service pathways

Patients with:

Red Flags
Pain for less than 6/12
Awaiting investigations or specialist opinion, or invasive treatment
Alcohol / drugs dependency
Somatisation disorder

Caution in relation to the following:-
Active mental health problems where initial referral to mental health service or medication may be more appropriate:

Depression: major
Post Traumatic Stress Disorder: major
Personality disorder: high level or primary
Somatisation Disorder
Bereavement: significant unresolved issues
Abuse: unresolved issues
Obsessive compulsive disorder: major
Eating disorder: major
Psychosis: active psychosis or delusions

See Pain management algorithm
ResourcesThe British Pain Society
The British Association Scotland
Pain Pathway Guidance for GPs
Pain Management manual
Patient information leaflets (PILs) See Patient support groups

Orthopaedic Referral

Scott McLaughlin

This referral will be vetted by a Lead Extended Scope Practitioner. The patient will then be seen by the most appropriate Health Care Professional. This may be, a Podiatrist, a Physiotherapist or a Doctor.

Should you wish the patient considered for joint surgery the following X Rays are appropriate:

  • HIP – AP Pelvis

 

Should you require further information, please contact Janie Thomson, Lead Extended Scope Practitioner, Musculoskeletal Project, 01355 585447.

Please do not refer to a named Consultant unless your patient has been seen previously for the same condition. This prevents delays in appointment

Orthopaedic Back Pain

Scott McLaughlin

This referral will be vetted by a Specialist Physiotherapist

Back pain referrals will be vetted by a Lead Extended Scope Practitioner. If there are any RED FLAGS, the referral will be fast tracked to a orthopaedic consultant.

  • Only 1% of Low back Pain requires further investigation
  • Lumbar spine X-ray is inappropriate in mechanical low back pain and will not be routinely carried out

Should you require further information, please contact Janie Thomson, Lead Extended Scope Practitioner, Musculoskeletal Project, 01355 585447.

CCI Guidelines

The CCI Referral Guidelines can be found at Back Pain Referral Pathways

Ophthalmology WET AMD Referral Guidelines

Scott McLaughlin
Disclaimer

Please note that this protocol is only for referrals from Community Optometry to Health Boards.

Wet AMD Fundus Images

When attaching a fundus image to this referral please bear in mind the following points:

  1. The total size of the attachment file must be less than 2MB.
  2. The image should ideally be sent in PDF format (or JPEG format if unable to save as a PDF)
  3. Please ensure each image shows the patient’s name before sending i.e. rename the file if necessary.

Please consult the manufacturer’s guidelines for the particular brand of camera for instructions regarding how to save images in the appropriate format prior to attachment.

Wet AMD OCT Scans

Please note that full OCT files are too large to be sent through SCI Gateway.

CT information must be sent as a screenshot or a report covering the area of retina in question in PDF format (or JPEG format if you are unable to save as a PDF).

The points above also apply to OCT information.

Please consult the manufacturer’s guidelines for your particular brand of OCT scanner for instructions regarding how to save reports/images in the appropriate format prior to attachment.

Reference:
Lead Clinician:
Review Date:

Vascular General Referral

Scott McLaughlin

General Vascular Referral

Please Note: This referral must only be used for general vascular referrals where no other referral form is available.

There are specific referral forms available for the following:

  • Aortic Aneurysm
  • Leg Ischaemia
  • Carotid Artery
  • Varicose Veins

Where any of these presenting problems are suspected, the relevant referral form should be completed.

Leg Ischaemia

Most patients with recent onset intermittent claudication will improve spontaneously – especially if they are encouraged to correct known risk factors (e.g. smoking, cholesterol, hypertension, obesity, low activity level). Furthermore timely attention to secondary prevention will reduce mortality and morbidity due to cardiac and cerebro-vascular disease in this high-risk group.

Patients with mild to moderate intermittent claudication do not require invasive vascular interventions.

Patients with suspected mild to moderate intermittent claudication may be referred to the local Community Claudication Clinic (via SCI Gateway) for confirmation of the diagnosis, cardiovascular risk factor assessment and appropriate counselling.

The Community Claudication Clinic

Our service has been set up in eight clinics across Lanarkshire for patients with suspected intermittent claudication (i.e. early peripheral arterial disease). We offer initial assessment and management by a Vascular Nurse and onward referral to the Vascular Physiotherapist and local services as appropriate.

NB We are unable to provide patient transport to the Community Claudication Clinic.

Fasting blood sugar, fasting lipids and full blood count, prior to referral, would facilitate patient management.

Patients with severe intermittent claudication, not improved by a regime of smoking cessation, walking exercise, antiplatelet treatment, statin, weight reduction etc. may be referred for Hospital Vascular OP Clinic assessment.

Patients with suspected critical limb ischaemia (rest pain, arterial ulcers, necrosis) should initially be discussed by contact with one of the Vascular Secretaries at Hairmyres Hospital in hours on Hairmyres 01355 584743. Appropriate arrangements will be confirmed by return call.

In the case of suspected ACUTE limb ischaemia with possible immediate limb threat (e.g. failed perfusion and sudden diminished sensation and movement): please refer as an emergency via ERC to the receiving surgical team.

Aortic Aneurysm

Patients with aortic aneurysm > 5cm, even without related symptoms, should be referred as an urgent case to the Hospital Vascular OP Clinic. Smaller aortic aneurysms may be referred as routine cases.

Patients with suspected symptomatic abdominal aortic aneurysm (i.e. recent onset or increasing back pain, acute tenderness of the aneurysm, distal embolism) should be referred as an emergency via ERC to the receiving surgical team

Carotid Artery Disease

Patients with suspected carotid artery disease should be referred urgently to the Stroke Service via SCI Gateway if they present with symptoms of stroke, TIA, or amaurosis fugax.

Varicose Vein Guideline

Scott McLaughlin

General Guidelines

Priority will be given to patients with critical limb ischaemia (rest pain, arterial ulcers, necrosis), symptomatic carotid stenosis and aortic aneurysm – who are likely to require surgical or radiological intervention.

 

Varicose Veins

NHS Lanarkshire does not offer treatment for thread veins or reticular veins or any cosmetic treatment for varicose veins.

Referral Criteria For Varicose Veins
(MANDATORY FIELDS AT LEAST ONE REQUIRED)

  • Open or healed varicose ulcer
  • Active varicose eczema (unresponsive to topical steroids and compression)
  • Recurrent superficial thrombophlebitis requiring NSAID therapy and compression
    • (* Phlebitis/thrombophlebitis is defined as acute onset, tender, hard, lumpy veins due to thrombosis. It is Not just painful veins. Standard treatment is NSAIDs and compression, not antibiotics. Patients should not be referred on first episode unless there is clinical evidence of thrombosis extending up to the groin)
  • A history of venous haemorrhage where there is a likelihood of further bleeding

Aortic Aneurysm

Patients with suspected aortic aneurysm, even without related symptoms, should be referred as an urgent case to the Vascular OP Clinic.
Patients with suspected symptomatic abdominal aortic aneurysm (i.e. recent onset or increasing back pain, acute tenderness of the aneurysm, distal embolism) should be referred as an emergency to the Receiving Surgical Team.

Leg Ischaemia

Most patients with recent onset intermittent claudication will improve spontaneously – especially if they are encouraged to correct known risk factors. Furthermore timely attention to secondary prevention will reduce mortality and morbidity due to cardiac and cerebro-vascular disease in this high-risk group. Patients with mild to moderate intermittent claudication do not require invasive vascular interventions. If you have access to ABPI measurements, then that may help confirm the diagnosis.

Patients with severe intermittent claudication, not improved by a regime of smoking cessation, walking exercise, antiplatelet treatment, statin, weight reduction (as required) should be referred for vascular OP Clinic assessment.

Carotid Artery Disease

Patients with suspected carotid artery disease should be referred urgently if they present with symptoms of stroke, TIA, or amaurosis fugax.