INFORMATION LOCUM INFORMATION PACK. Hillingdon Independent GP Group. June 2010 Version 1

Transcription

1 INFORMATION Hillingdon Independent GP Group LOCUM INFORMATION PACK June 2010 Version 1

2 FOREWORD This information pack has been compiled based on current practice in the borough of Hillingdon. The information has been gathered from discussions with local practitioners as well as the service providers within the borough. As procedures may vary slightly between different surgeries, this pack is only intended to be a guide. Every attempt has been made to keep this information pack as up to date as possible, however procedures do change and should you come across information that may be out-dated or incorrect when using this pack please bevi.dahele@gmail.com. Your feedback is also welcome. This is a live document and will periodically be updated to reflect changes. Thank you to everyone who has contributed to the development of this information pack and I hope that you find it useful. Yours sincerely Dr Bev Dahele (on behalf of the Hillingdon Independent GP group [HIGP]) Copyright Dr Bevinder Dahele. All rights reserved. 2

3 CONTENTS Click headings to follow link BOROUGH INFORMATION...5 RADIOLOGY...6 X-rays 6 Ultrasound 6 CT/MRI 6 DEXA scans 6 CARDIO-PHYSIOLOGY...7 ECG 7 24 Hour ECG Monitoring 7 24 Hour Blood Pressure Monitoring 7 Echocardiogram 7 PATHOLOGY...8 Pathology requesting 8 Pathology results 8 Phlebotomy 8 Samples 9 COMMUNITY SERVICES Physiotherapy 10 Occupational therapist 10 Speech therapist 10 Podiatry/ Chiropody referrals 10 Orthotics 11 Social Services 11 Child Protection 11 Health Visitors 12 Dietician 12 Elderly Day Hospital 12 Palliative care 12 District Nurses 13 Rapid response 13 Community Matron 13 School nurses 13 Ambulance 14 Acute and Out of Hours Services 14 Domiciliary visits for eye screening 14 Long term oxygen therapy 14 REFERRALS General Referrals 15 Emergency Referrals 15 Procedure for suspected DVT 15 Procedure for suspected PE 15 2 week rule referrals 16 Rapid Access Chest pain Clinic (RACPC) 16 TIA / Stroke Clinic 16 Ophthalmology 16 ENT 17 3

4 Tudor Centre (Sexual Health Clinic) 17 Infectious Diseases 17 Pain Management 17 Thyroid Lump Clinic 17 Breathlessness clinic 18 Psychiatry Referrals 19 Paediatric Referrals 20 Private Referrals 21 WOMENS HEALTH Early Pregnancy Assessment Unit (EPAU) 22 Antenatal Booking procedure 22 Termination of Pregnancy procedure 23 Family planning 23 Cervical Smears 23 Vaginal Ring Pessary Clinic 23 OTHER SERVICES Complex Wound Treatment Centre 24 Diabetic Specialist Nurses 24 OTHER INFORMATION USEFUL CONTACT INFORMATION Telephone Numbers 25 Addresses for Local Health Clinics 26 APPENDICES Appendix A: Hillingdon PCT Peripheral DEXA Scan referral form Northwick Park Hospital Axial DEXA Scan Referral Form Appendix B: Speech Therapy Referral Proformas Appendix C: Contacts for Safeguarding Children Team Appendix D: Palliative Care Guidelines Appendix E: Low Priority Conditions Appendix F: Rapid Access Chest Pain Clinic Referral Form Appendix G: CFACS Referral Form Appendix H: CDC Referral Form Appendix J: Hillingdon Consulting Rooms Telephone list Appendix K: Hillingdon Antibiotic Prescribing Guidelines Appendix L: Diabetes Specialist Nurses referral criteria and form DESMOND referral Appendix M: Semen analysis form Appendix N: Heavy Menstrual Bleeding & Vaginal Ring Pessary Care Pathways Appendix P: Cronic Pain Managenment Algorithm Appendix Q: Hillingdon Lipid Guidelines Appendix R: List of Red List Drugs Appendix S: HAGAM referral form 4

5 BOROUGH INFORMATION There are 2 main hospitals in the borough: 1. Hillingdon Hospital, Uxbridge Tel: :// 2. Mount Vernon Hospital, Northwood Tel: :// Both are part of the same trust Other nearby hospitals are: 3. Northwick Park Hospital, Harrow Tel: (GP admissions) :// 4. Ealing Hospital, Ealing Tel: :// 5. Watford General Hospital, Watford Tel: :// 5

6 RADIOLOGY X-rays These are performed at Hillingdon (THH) or Mount Vernon (MVH) Hospitals. Handwritten forms or computer printed forms can be used. Some practices may electronic forms which can be filled and printed out and given to the patient. Check with the practice to see what system they use and ensure forms have relevant practice and patient details. The request form can be given to the patient. There is direct access for routine x-ray with no need for an appointment. Details as are below: Hillingdon Hospital Mon Fri: 8:00am 4:45pm Mount Vernon Hospital Mon Fri: 9:00am 7:15pm Results are usually sent to the practice down the LINKS system or via fax/post as a hard copy report. Any outstanding reports can be obtained from the X-ray secretaries on Ultrasound These are performed at both hospitals and are usually by appointment only. Again complete the appropriate handwritten or computer form and send it to the ultrasound department at the hospital of choice. The department will then contact with patient with an appointment for their scan. Try to ensure accurate patient contact details to facilitate appointments etc. Urgent ultrasound requests can be discussed with the radiologist /sonographer Results are usually sent to the practice down the LINKS system or via fax/post as a hard copy report. Any outstanding reports can also be obtained from the X-ray secretaries on CT/MRI At present GPs do not have access to these tests and they are only available on specialist request. DEXA scans Mobile peripheral forearm DEXA scanning is available at certain clinics within the borough. Referral for this is by completing the proforma and sending it to the PCT who will then contact the patient with an appointment. The proforma should be available at the surgery in either electronic or paper format. (See Appendix A) Full axial DEXA scanning is available in the Medical Physics Department at Northwick Park Hospital. Referral for this is by completing the relevant form and sending it to the Department. This should also be available at the surgery. (See Appendix A) Northwick Park Medical Physics Department Tel: , Fax:

7 CARDIO-PHYSIOLOGY ECG Many practices will have this facility in-house so it is worth enquiring about this. Referral can be made to the hospital using the relevant hospital form or computerised form, complete with practice and patient details. The patient will normally need to book an appointment for a routine ECG at the hospital. The report of the ECG is usually sent to the practice. If there are acute changes normally they refer to A&E, otherwise the report is sent within 10 days to practice. Hillingdon Hospital: Tel: Mount Vernon Hospital Tel: Hour ECG Monitoring Refer via the Department of Cardiology at Hillingdon Hospital. 24 Hour Blood Pressure Monitoring Some practices may offer this service in-house. If not, referral is via the Department of Cardiology at Hillingdon Hospital. Echocardiogram Referral is via the Department of Cardiology at Hillingdon Hospital. Molly Teoh is the Senior Cardiac Nurse and can be contacted on Bleep 5551 Lisa Casey is a Heart failure Nurse and can be contacted on Bleep

8 PATHOLOGY The Pathology laboratories are based at Hillingdon Hospital and Mount Vernon Hospital. This includes Haematology, Biochemistry, Microbiology, Serology and Histopathology. Practice computer systems should be linked with the laboratories and all surgeries have daily transport of samples to the laboratory via courier. Times of collection may vary so it is best to check with the individual practice for specifics. Usually collection is after midday Monday - Friday. Certain samples (e.g. semen) will need to be delivered directly to the hospital laboratory at Hillingdon Hospital. Pathology requesting The Anglia ICE software is used in practices and in the borough hospitals to request pathology tests and view the results. This is the preferred method of requesting pathology tests but to access ICE one needs to have special access (i.e. unique login) on the computer system at the individual practice. If one does not have ICE access or if the system is down then pre-printed handwritten forms may be used. The pre-printed handwritten forms are in triplicate and it is important to ensure that the patient and practice details appear on all 3 pages. Some practices may also have their own electronic request forms which can also be used. Pathology results Results of tests requested by clinicians in the practice will be available on most EMIS based systems. Results of tests requested by Hospital based practitioners can be viewed via the Anglia ICE system (this is only available if one has ICE access). These results can be downloaded into the patient s GP record on EMIS. (If you have ICE access to view lab results using EMIS: on the main page, type MR-> N->R->T ) The Pathology Lab at Hillingdon Hospital can also be contacted to get outstanding results on Phlebotomy Phlebotomy services are provided at several sites across the borough. Some surgeries will have in-house phlebotomy. Those which do not, will be able to advise on the nearest site for phlebotomy. (See section on pathology requesting for details on how to request Blood Tests) Specify on the form if the test is routine/ urgent and inform the patient if they need to fast. Below is some information on the various phlebotomy sites and their timings: Walk-In service no appointment necessary: Hillingdon Hospital: Mon Fri: 8:00am 4:30pm Mount Vernon Hospital: Mon Fri: 8:00am 4:30pm Pre-booked Appointments: Hesa Centre (Hayes Town) Tel: Daily by appointment Eastcote Health Centre Tel: Tues, Thurs, Fri by appointment Northwood Health Centre Tel: Mon Fri 08:30-11:00 by appointment Yiewsley Health Centre Tel: Mon, Thurs, Fri 09:00-12:00 by appointment Oak Farm Clinic Tel: Tues by appointment only (walk in after am) Children s Blood test appointments can be made at Wendy ward, Hillingdon Hospital on

9 Oral Glucose Tolerance Tests (OGTT) are by appointment only and patients need to be provided with the request form to take to their appointment: Hillingdon Hospital: Tel: Mount Vernon Hospital Tel: Certain practices may perform the OGTT in-house so it is worth enquiring about this as the hospital OGTT appointments can take up to 6 weeks or more. Samples For all samples sent from the surgery please ensure that the relevant patient details are on the specimen. For urine bottles advise ensure that the lids are properly replaced so the sample is not leaking. Practices should have a refrigeration facility to house samples overnight where necessary. Certain practices prefer stool samples to be delivered directly to the laboratory and it is best to confirm in-house procedures and advise patients accordingly. There are specific instructions for semen samples. In addition to the pathology request form there is a secondary form which needs to be completed in order for the laboratory to process the sample. Copies of this should be available in the surgery (Appendix M) Specimen bottles for 24 hour urine collections can be collected from the laboratory by the patient. Cervical smear samples are processed at Northwick Park Hospital See section on Cervical Smears for specifics 9

10 COMMUNITY SERVICES Physiotherapy Hospital Referrals for physiotherapy need to be done on the blue proforma, complete with patient details and practice stamp and then send to the hospital directly. Community and Domiciliary referrals are done on either a special referral form which may be electronic or filled in by hand. Completed forms are sent to Elers Road Clinic where the physiotherapy appointment booking centre is located. Below is a list of clinics in the community where physiotherapy services are offered. Referral forms should be complete with patient details (including preferred language), practice stamp, clinician s signature and clearly indicate the venue preference. It is best to check with your surgery which is the nearest clinic and to verify patient contact details before referring. Physiotherapy is provided at the following sites: Elers Road Clinic (Hayes) Tel: , Fax: Westmead Clinic (Ruislip) Tel: Eastcote Health Centre (Eastcote) Tel: Church Road Clinic (Uxbridge) Tel: Uxbridge Health Centre (Uxbridge) Tel: , Laurel Lodge Clinic (Hillingdon) Tel: The Warren Clinic (Hayes) Tel: Harefield Health Centre (Harefield) Tel: Hillingdon Hospital (Uxbridge) Tel: Mount Vernon Hospital (Northwood) Tel: Domiciliary physiotherapy is also available for housebound patients and this should be specified on the form. Occupational therapist Hospital based Occupational therapy is for inpatients only and deals with discharge planning etc. Hillingdon Hospital: Tel: Community Occupational Therapy is referred to via letter to Social Services at the Civic Centre in Uxbridge. Speech therapist For adult referral -refer directly via letter to the Department of Speech and Language Therapy at Hillingdon Hospital. For children -can refer to paediatric speech therapy - based at Hillingdon hospital or the community clinic based at Eastcote Health Centre / Minet Clinic - There are referral proformas for the different age groups which should be available at the surgery (See Appendix B) Podiatry/ Chiropody referrals The Podiatry Booking Office is based at the Contact centre at Elers Road Clinic. Patient Phone line Tel:

11 Staff enquiry line Tel: To refer - Complete a Foot Health Assessment form or send a referral letter to the Podiatry contact centre. Clinics providing chiropody/podiatry services are: Eastcote Health Centre (Eastcote) Tel: Harefield Health Centre (Harefield) Tel: Hesa Primary Care Centre (Hayes) Tel: Ickenham Clinic (Ickenham) Tel: Minet Clinic (Hayes) Tel: Uxbridge Health Centre (Uxbridge) Tel: , Westmead Clinic (Ruislip) Tel: NHS podiatric surgery is available at West Middlesex Hospital (refer via Choose & Book for this) Podiatry services available on the NHS are limited. Referrals are triaged at the contact centre. If in doubt the appropriateness of the referral should be discussed. Some practices may offer minor surgical services so it is worth checking what treatments may be provided in-house before referring. If <70yrs and not diabetic no chiropody services available on NHS to see privately If >70yrs and not diabetic can be referred to Chiropody for certain problems Diabetic patients can be referred for Chiropody A list of local chiropodists is available in yellow pages.yell.com Orthotics Patients can be referred directly to this service which is based at Hillingdon Hospital, via referral letter to the department. Social Services The Social Services department is based at Civic Centre, Uxbridge. More information can be accessed from the Hillingdon council website on Elderly Social Services: Tel Mental Health approved Social worker: Tel: Children s Social Worker: See Appendix C Child Protection Hillingdon has its own Safe-guarding Children Team. The team consists of various health care professionals. Jenny Reid is the Lead Nurse. Tel: , Regular training courses for health care professionals in Safe-guarding Children are locally available. Appendix C has further contact details in specific areas of Safe-guarding Children. 11

12 Health Visitors Health Visitors are allocated to patients based on the street address of the patient. They are based at the various local clinics further information on how to contact / refer to the health visitor should be available from the individual surgeries. Dietician Some practices have dieticians who conduct clinics at the surgery and it may be possible to book appointments directly. If this is not available then referral can be made via letter to the Dietetics and Nutrition department at Hillingdon Hospital. It is best to check with the surgery as to their criteria and procedure for referral to the dietician. Elderly Day Hospital This is a useful service for certain patients who are elderly with complex problems, who need to be seen by the Care of the Elderly team. Appropriateness of referral can always be discussed with the team at the contact numbers below. Referral is by phone / letter / fax to the relevant hospital Hillingdon Hospital: Tel: Fax: Mount Vernon Hospital Tel: Fax: Palliative care Palliative care is based at Mount Vernon Hospital. The Macmillan Nurses are also based at Hillingdon Hospital Tel: /6 Syringe driver prescription forms should be available at the individual practices. Harmoni currently covers out of ours care for Hillingdon patients. Harmoni Palliative care handover forms should be completed for all palliative care patients so that they have access to quick care out-of-hours. Forms should be readily available in all practices. Complete the form and fax to fax: A note should be made in the patient s records that this has been done. Palliative care symptom control guidelines are available to assist you (Appendix D) 12

13 District Nurses District Nurses are based at various health centres in the borough and are able to provide various services to housebound patients such as bloods tests, dressings, etc. It is best to ask at the surgery what method is used to contact/refer to the district nurses. There is a contact centre for District Nurse Referrals which is based at Elers Road Clinic, they will take the referral details and pass onto the District Nurses. Tel: The messaging service for the District Nurses is based at Laurel Lodge, which can be used to leave a message for the District Nurses about particular patients under their care Laurel Lodge Tel: Referrals are usually faxed and the relevant fax number can be obtained from the practice. Rapid response This is a team of healthcare professionals who are very helpful in situations where hospital admission may be prevented and to facilitate hospital discharge. It is a multidisciplinary team comprised of nurses (including community matrons), occupational therapists, physiotherapists, social workers etc. They are able to assess patients at home and follow up for a maximum of 10 days. They endeavour to contact the patient within 2 hours of referral and do have specific referral criteria. They liaise closely with the Elderly Day Hospital in Hillingdon Hospital and are based at Ickenham Clinic. Referral to them is as follows: Telephone patient details to contact centre (09:00am 00:30am) Fax patient summary +/- referral letter to Can speak to member of team on or to discuss details / appropriateness of the referral. Community Matron These nurses are based at Ickenham Clinic (Tel: ) and manage complex patients with the following: >65yrs old >2 admissions via A+E in the past year 2 or more Chronic Diseases on 8 drugs or more Each Community Matron has an allocated area and your practice should be able to inform you of how to refer to their relevant matron. School nurses Based at various health centres across the borough. Enquire at the surgery about how to contact/ refer to the school nurse. 13

14 Ambulance Tel: (by pass no for emergencies - blue light) Tel: (routine call 3-4hrs) This is to be used for immediate and routine ambulance services. Blue light ambulance can be accessed via 999 It is important to make a note of the reference number given by operator in case of any delay. Acute and Out of Hours Services There is an 24 hour Accident & Emergency Department at Hillingdon Hospital. :// Emergency referral to on-call specialities is discussed below in the Referrals section. Mount Vernon Hospital has no A&E Department but does have a Minor Injuries Unit (09:00 20:00 daily) :// There is also a Walk-in centre in Hayes town at the HESA clinic open 08:00 20:00 daily. Out of hours care for the borough is provided by Harmoni and this is accessed via NHS Direct: Domiciliary visits for eye screening Some local opticians offer domiciliary visits for eye checkups. They may help with fundoscopy and diabetic screening. The PCT run retinopathy screening service also does domiciliary visits. Beware of national companies who promote glasses Long term oxygen therapy HOOF forms can usually be found within the practice. Complete and fax to company providing home oxygen (patient needs to have been seen by specialist and evaluated in order to receive oxygen therapy) 14

15 REFERRALS General Referrals Note: The PCTs are trying to cut down referrals to secondary care and the tendency is to, where possible, manage conditions in house, using GPwSI or community clinics. It is important that GPs do familiarise themselves with referral process of the surgery. We recommend you ask for this while booking sessions and request surgery to provide you with up to date information. Some practices may have the facility for you to dictate the referral which will then be typed by the secretary. In other practices you may be required to type your own referral. Referrals are now done via the Choose and Book process. If you do not have a smartcard and are not on the Choose and Book system check with the practice to see how they wish you to do your referrals. (Training can be obtained on this process by contacting the Hillingdon PCT). Some urgent referrals can be made via letter which is faxed to the specialty office at the hospital depending on clinical necessity. Hillingdon PCT Consultant to Consultant referral screening panel( C2C panel) All internal consultant to consultant referrals in Hillingdon Hospital are screened by a GP panel at Hillingdon PCT. If the panel decides the condition could be managed by GPs, the referral would be diverted to practice for appropriate management. Hillingdon PCT exceptions committee Any low priority conditions like uncomplicated varicose veins or ganglions are referred to exceptions committee by Hillingdon hospital and C2C panel. The exceptions committee usually declines any intervention from secondary care unless the case is supported by additional information by GPs and hospital consultants. It is important that freelance GPs familiarise themselves with low priority conditions while considering referrals to avoid any delays in patient care. (See Appendix E) Emergency Referrals Contact the relevant specialty at the desired hospital and discuss the referral. It is important to check when referring where to send the patient (eg to the Emergency assessment uni / to A&E etc). The referral letter can be given to patient to present when they reach hospital or faxed to the relevant number where the receiving team can get it. If it is a handwritten letter then make sure there is a copy taken to be scanned into the patient s records. Procedure for suspected DVT Refer same day to medical team on call at THH for Doppler assessment and anticoagulation if indicated Procedure for suspected PE Refer same day to on call medical team at THH for assessment and anticoagulation if indicated. Familiarise yourself with the protocol for calling ambulance from Surgery (also see above section on ambulance) 15

16 2 week rule referrals Most practices will have the relevant proformas for this in paper or electronic version. Complete the proforma, ensure correct patient contact details and hospital choice are indicated and sign the form. The form is then faxed to the relevant hospital - fax numbers are available on the last page of each referral form. The completed form should be faxed within 24 hours of the decision to refer the patient. Rapid Access Chest pain Clinic (RACPC) This Clinic is based at Hillingdon Hospital Complete proforma and fax to the number on the form ensuring correct patient contact details (See Appendix F). If the patient is already under the cardiologist s care they should be referred urgently back to the consultant s clinic and not to the RACPC. If the patient is having chest pain which needs immediate attention (i.e. indicating they maybe having an MI or ACS) then they need to go to hospital via Ambulance (999) as there are specific protocols in place which may indicate that patient needs to be redirected to Harefield Hospital for angioplasty. Familiarise yourself with the practice procedures regarding this as well as the location in the practice of Aspirin and other emergency medication. TIA / Stroke Clinic The TIA clinic is run at Hillingdon by Dr Andrea Parry. There is a new electronic referral form which should be available on the computer system at the practice, which also helps to decide the speed with which to refer the patient and relevant contact numbers. It is important to complete the form on the computer and fill in all the relevant fields. The Stoke Specialist nurse can be contacted on Tel: Bleep For suspected stroke refer the patient directly to on call medical team at Hillingdon Hospital ideally patients should have investigations within 24 hrs. Procedures for managing acute stroke are changing and there are provisions now for patients within 4-5 hours of onset of symptoms to be taken via 999 ambulance to a Hyperacute Stroke Unit (HASU) for thrombolysis. Once stabilised then the patient will be transferred to the local rehabilitation unit. Ophthalmology For queries you can contact on call Hillingdon Eye Clinic (only in-hours) on Tel: / Emergencies -> Western Eye Hospital, Marylebone Road, London NW1 5QH, Tel: Moorfields City Hospital, 162 City Road, London EC1V 2PD, Tel: There is an urgent eye Watford General Hospital, Tel: These clinics are run daily. To refer to this service the patient will need a referral letter and it is prudent to call the clinic to verify that they are running an urgent clinic on the day in question. Routine ophthalmological referral is as per the normal practice process. 16

17 ENT Emergency referrals can try Ear Hillingdon Hospital if in-hours, Tel: hour on call service based at Northwick Park refer here if likely to need admission or if out of hours (Northwick Park GP emergency admissions - Tel: better to use this number as it takes a very long time to get through via the switchboard!) Routine referral is as per the normal practice process. Tudor Centre (Sexual Health Clinic) This is the Genito-urinary medicine department based at Hillingdon Hospital. There is a Walk-in service hence no appointments are needed. Patients can also be referred directly to the specialty via referral letter. Times: Mon: 8:30 11:00; 15:00 17:30 Tue: 8:30 11:00; 13:45 16:00 Wed: 8:30 10:30; 13:45 16:00 Thurs: 13:45 18:00 Fri: 8:30 10:30 Tel: Infectious Diseases There is an Infectious Diseases Department at Northwick Park Hospital who can be contacted to discuss cases / referred to via letter / Choose and Book process. They are able to advise and see patients urgently as needed. The team can be contacted via the NPH GP admissions line on Tel: Pain Management The Chronic Pain Service is based at Hillingdon Hospital. They provide various alternative therapies such as Acupuncture and TENS therapy. The Pain Clinic is run by the Department of Anaesthetics. The Clinical Psychology Department also runs a Pain Management Programme which is a multidisciplinary service offering 2 different programmes. There is an 8 week Pain management programme and a 4 week Pain coping strategies programme. They are group programmes involving CBT (cognitive behavioural therapy) and are run in English, Punjabi, Hindi, Urdu, Gujrati. For other languages, interpreters are required. Referral can be done via the ICE system or via referral letter to the service. Contact: Simon Dupont, Clinical Psychologist, Greenacres Centre, Hillingdon Hospital. Tel: Thyroid Lump Clinic This special clinic runs on a Monday. It is specifically for patients who have a normal Thyroid function but have a lump in the thyroid region. Referral is via letter which can be posted / faxed to the Mr Babu s (Consultant Surgeon) secretary on Should the patient have an abnormal TFT then referral to the Endocrinologist is recommended 17

18 Breathlessness clinic This is a multidisciplinary team of Clinical psychologists, Respiratory nurses, physiotherapists and Occupational therapists. They will see moderate severe COPD patients cope with breathlessness. It is a 5 week group clinic involving non-pharmacological techniques aimed at helping these patients cope and improving their quality of life. Patients need to be able to speak English and referral is via letter to the Clinical Health Psychology Department. Tel: Fax:

19 Psychiatry Referrals Outpatient Adult Mental Health is provided by the Community Mental Health Teams (CMHT). There are 3 main teams in the borough and patients are referred based on the address of their GP. Check with your practice which CMHT covers their patients. Referral to this service is via letter direct to the relevant CMHT Mill House covers Uxbridge, Ickenham areas Pembroke Centre covers Ruislip, Eastcote, Northwood Mead House covers Hayes, Hillingdon and West Drayton. Elderly Psychiatry is based at the Woodlands centre and referral again is via letter direct to them. Some practices may have a computerised proforma for referral to the Woodlands Centre so do check for this in the surgery Inpatient services are based at Hillingdon Hospital at the Riverside centre for adult psychiatry and the Woodlands Centre for elderly psychiatry (>65yrs). Emergency referrals. There is an A+E psychiatric liaison service at Hillingdon Hospital and referral is done by contacting the on call psychiatry team or the A+E liaison team via the hospital switchboard (Tel: ) The CRISIS team also has input for acute psychiatric problems and also follow up patients recently discharged from inpatient services. Child and Adolescent Psychiatry is provided by CFACS (Child, family and adolescent services). They deal with children up to the age of 16/18yrs. They are based in Uxbridge. Referral is by completing their specific proforma and faxing it to their department. The proforma should be available at the surgery. (See Appendix G) Private Psychiatric referrals can be done the main private hospitals nearby are: Cygnet hospital in Ealing ( :// Cygnet Hospital in Harrow (formerly known as Bowden House Clinic) ( :// Counselling is provided by the PCT and is based at Mount Vernon Hospital Counsellors do come to various practices within the borough so it is useful to check if this is the case at your surgery. Referral to the service is via referral letter directly to the Primary Care Counselling Service (PCCS) at Mount Vernon Hospital. The waiting times are normally high. There is a good community counselling service run by a charity in Uxbridge. There is normally a fee but this is means tested. The patients are seen and assessed quickly. :// HDAS (Hillingdon Drug and Alcohol Services) This service is based in Uxbridge and deals with patients with substance abuse issues. Referral to HDAS for detox programmes and assessment for addiction treatment is via referral letter direct to the service. HAGAM (Hillingdon Action Group for Addiction Management) is a part of the HDAS services and they have a specific referral form (see Appendix S) More information on these services can be found on :// :// 19

20 For other psychiatric information Hillingdon MIND produced a publication entitled Mental Health. This useful resource has contact numbers for various support groups and organisations that can help people with mental health problems and may be found within the surgery MIND have stopped producing this but one may be able to obtain a copy by contacting them directly. Useful contacts: LINK (young person s counselling 14-25yrs) HDAS (drug and alcohol) CRUSE (Bereavement counselling) RELATE (Relationship counselling) MIND (general mental health issues) Mead House: Mil House: Pembroke Centre: Crisis Team: Psych Liaison Team: Emergency Social Worker Riverside Centre: Woodlands Centre: Further useful information on the mental health services in the borough especially regarding more specialised departments such as Eating Disorders etc. can be found on :// Paediatric Referrals For emergency referrals contact the on-call Paediatric team and send the patient with a letter. (Children under the age of 1yrs presenting direct to A+E are seen by the Paediatric on-call team anyways, but it is always good practice to discuss referral with the team before sending the patient). Routine referrals to paediatric outpatients are done via the normal referral process. Child Development Centre (CDC) (CWANS Children with additional needs) The Child Development Centre is based at Hillingdon Hospital. There are specific criteria for referral to this service and these can be found with their referral form. On the referral form there is a consent page which parents/guardians will need to complete before you can send the referral form to the CDC. Once completed the form should be posted to the CDC (address is on the referral form) Most surgeries should have a copy of the referral form. Additional copies can always be requested from the CDC. (See Appendix H) 20

21 Private Referrals There are several private hospitals in the area. Referrals are normally done by a private referral letter which is then given to the patient to take to their appointment. Please find below a list of the nearest services. Hillingdon consulting rooms The Consulting rooms are based at Hillingdon Hospital. Most of the Hillingdon consultants are able to see patients privately in the consulting rooms. Tel: Individual consultant contact details are available in Appendix J :// BMI Healthcare This provider has 2 hospitals in the vicinity Clementine Churchill Hospital This is located in Harrow and more details can be accessed at :// Bishopswood Hospital This is located in Northwood at the back of Mount Vernon Hospital More details can be accessed at :// Spire Healthcare This provider has 2 hospitals in the vicinity Spire Bushey Hospital This is located in Bushey, Watford, north of the borough. More details can be accessed at :// Spire Thames Valley Hospital This is located is Wexham, Buckinghamshire, West of borough More details can be accessed at :// Bowden House (Psychiatric) Harrow

22 WOMENS HEALTH Early Pregnancy Assessment Unit (EPAU) The EPAU will scan pregnant women up to 14 weeks gestation who fit their clinical criteria (generally PV bleeding with abdominal discomfort) The EPAU accepts referrals via phone / fax. Tel: Fax referral letter detailing LMP, EDD, clinical details, patient contact details to Give patient a completed and signed Ultrasound request form which they should take to the appointment. The EPAU will contact the patient directly so it is important to leave the correct telephone contact details for the patient. The EPAU is located on First floor, Maternity Building, Hillingdon entrance to Marina ward If you are suspecting an ectopic pregnancy contact the On-call Gynaecology team at THH first via switchboard on Antenatal Booking procedure Please check with the practice about their specific procedure for this. In general proceed with booking as soon as patient attends confirming pregnancy to ensure appointments for scanning etc at appropriate times. Complete the booking referral form for North West London which should be available on the computer. Ensure it is filled out correctly with contact details and hospital choice. State any medical needs / concerns on booking forms so these can be addressed early. The Booking form should be faxed to relevant number. (In case of Hillingdon hospital Fax: ) Fill in the antenatal template on EMIS system as appropriate for the individual practice. Complete a FW8 form for prescription exemption this is then sent by post and the patient will receive their prescription exemption card in due course. Give patient Blue folder (if available), Emma s diary, information on smoking cessation and antenatal screening as appropriate for the patient. Addition antenatal information: Once referred to the hospital, patients will have their dating scan between 11-14weeks, booking appointment with the hospital antenatal clinic about 16weeks and their anomaly scan between weeks. Many surgeries will have the community midwife holding sessions in the practice to see the antenatal patients from 24 weeks onwards you should check with the practice to see what their procedure is for this. MAT B1 forms can be issued from 21 weeks onwards (previously was from 26 weeks) Healthy Start and Sure Start forms can be obtained from the midwife or patients can order them via the relevant websites: :// :// DG_

23 In emergencies: Patients <18weeks gestation will be seen in THH A+E Patients >18weeks gestation will be seen in the maternity unit there is antenatal triage (in-hours) which can be contacted to refer the patient for same day assessment if needed. Tel: , if out of hours best to contact the antenatal ward or the on call Obstetric Registrar. Termination of Pregnancy procedure The Hillingdon PCT has an arrangement with Marie Stopes for TOP procedures. Check with your practice as to how they approach this in-house as the individual procedure may vary from practice to practice. In general referral is usually by completing a Marie Stopes referral form (attaching HSA1 is not necessary, you can just cross it and Marie Stopes will take care of it). The patient then contacts the Marie Stopes booking centre to arrange an appointment. Family planning Contraception is available in most practices each will vary with regard to the extent of services provided so you should familiarise yourself with what services are offered in-house. Family planning clinics also operate in the borough and these can be found :// For Female sterilisation counsel and refer to Gynaecology if patient is insistent For Male sterilisation counsel and refer via Marie Stopes by letter or completing the vasectomy proforma (ask at the practice if the latter is available) Cervical Smears Always confirm the procedure in the practice as each practice may vary with regard to this. As a general guide: Take smear and complete template on EMIS Complete the cytology request form (preferably on computer or by hand) Place smear and form in specimen bag and give to reception to send to Northwick Park Hospital Advise patient that they should receive a home regarding the result. If they do not receive this within 2-3 weeks, they should contact the surgery to chase the result. Vaginal Ring Pessary Clinic This service is provided at Uxbridge Health Centre in a weekly clinic where ring pessaries can be fitted by GP referral and also where Mirena IUS are fitted where clinically indicated. (Care pathways in Appendix N) 23

24 OTHER SERVICES Complex Wound Treatment Centre This team is based at the HESA clinic in Hayes. They have strict referral criteria and more information on this can be obtained by contacting them at the HESA Clinic on Tel: Diabetic Specialist Nurses This team of nurses is based at the HESA clinic in Hayes. They have strict referral criteria and more information on this is available in Appendix L. They also run the DESMOND course which is a structured education programme for newly diagnosed patients with Type 2 Diabetes. OTHER INFORMATION At both Hospitals other specialized clinics exist. As mentioned previously if you feel you need to refer a patient and are not sure how to proceed it is best to liaise with colleagues in the surgery where you are working to find out how and where to refer. We have also included copies of the following documents: 1. Hillingdon PCT Antibiotic Prescribing guidelines which were issued in Jan 2008 as a helpful guide when prescribing (see Appendix K ) 2. Chronic Pain Management Algorithm (see Appendix P) 3. Hillingdon Lipid Guidelines (see Appendix Q) 4. Red list Drugs (see Appendix R) These are medications not prescribed in primary care Statement of fitness to work: As of 6 th April 2010 The DWP has given new guidance on medical sick notes. The forms have replaced the Med3 and Med5 forms. Guidance on completing these can be obtained via the DWP website on: :// 24

25 USEFUL CONTACT INFORMATION Telephone Numbers Hillingdon Hospital Switchboard Northwick Park Switchboard Northwick Park GP admissions line Ealing Hospital Switchboard Mount Vernon Hospital Switchboard Watford General Hospital Switchboard Hillingdon PCT Kirk House Ealing PCT Civic Centre, Uxbridge

26 Addresses for Local Health Clinics Further information at :// Eastcote Health Centre, Devonshire Lodge, Abbotsbury Gardens, Eastcote, HA5 1TG Tel: Fax: Elers Road Clinic, Elers Road, Hayes, UB3 1NY Tel: Fax: Harefield Health Centre, Rickmansworth Road, Harefield, UB9 6JY Tel: Fax: Hesa Primary Care Centre, 52 Station Road, Hayes, UB3 4DS Tel: Fax: Ickenham Clinic, Community Close, Long Lane, Ickenham, UB10 8RE Tel: Fax: Laurel Lodge Clinic, Harlington Road, Hillingdon, UB8 3HD Tel: Fax: Minet Clinic, Avondale Drive, Hayes, UB3 3NR Tel: Fax: Northwood & Pinner Community Unit, Medical Block, Mount Vernon Hospital, Rickmansworth Rd, Northwood Tel: Fax: Northwood Health Centre, Neal Close, Acre Way, Northwood HA6 1TH Tel: Fax: Oak Farm Clinic, Long Lane, Hillingdon, UB10 9PB Tel: Fax: Uxbridge Health Centre, Chippendale Waye, Uxbridge, UB8 1QJ Tel: Fax: The Warren Health Centre, Uxbridge Road, Hayes, UB4 0SF Tel: Fax: Westmead Clinic, Westmead, South Ruislip, HA4 0NT Tel: Fax: Wood End Park Clinic, Judge Heath Lane, Hayes, UB3 2PB Tel: Fax: Yiewsley Health Centre, 20 High Street, Yiewsley, West Drayton, Middlesex, UB7 7DP Tel: Fax: