Soft tissue sarcomas referral

All suspected soft tissue sarcomas should be referred to the BSS for investigation and management. This can be done via the two-week cancer wait system directly to the plastic surgical team at Southmead Hospital Bristol. Otherwise cases can be referred directly to the MDM for discussion.

Download: [attachments]

Soft-tissue sarcoma should be suspected if:

• Any soft tissue mass >5cm diameter
• Any deep, hard or fixed mass
• Any enlarging or painful soft tissue mass

Bone sarcomas referral

Suspected primary bone tumours should be referred directly to the Oxford Bone Tumour Service at 

If you are in doubt about how to proceed the cases can be discussed at the BSS MDM first if requested.

Did you know that the long-term effects of head injury affect one family in 300?
The physical difficulties can be obvious, but many problems - emotional, communication and cognitive - are often hidden.
The Head Injury Therapy Unit is a specialist rehabilitation outpatient service for people who have sustained a brain injury.
The team comprises of:
•  Physiotherapy
• Occupational Therapy
• Speech & Language Therapy
• Clinical Neuropsychology
• Rehabilitation Support Workers
A structured goal-orientated approach is used which is tailored to your needs and we work closely with families and carers to support carry over of rehabilitation at home and in the community.

North Bristol NHS Trust provides a comprehensive rheumatology service for common inflammatory disorders such as rheumatoid arthritis as well as specialised services like complex osteoporosis, connective tissue diseases and transition services for young people.

We have a specialised multidisciplinary team and care pathways based on evidence for best practice and built around patients needs.

General rheumatology referrals

Appointments can be done through NHS eReferrals or by faxing a referral to us.

All referrals are triaged by the consultants. We endeavour to see cases suspected to be early inflammatory arthritis within 3 weeks. If you feel that a sooner appointment is needed contact us directly.

For urgent referrals please contact the rheumatology registrar or the on call rheumatology consultant via switchboard 0117 9505050.

Our multidisciplinary team consists of 7 consultant rheumatologists, SpRs, a junior doctor, specialist nurses, physiotherapists, occupational therapists, orthotics and a clinical psychologist.

We provide services for a wide range of rheumatological conditions in adults including:

• Inflammatory arthritis
• Connective tissue disease and vasculitis
• Widespread pain if an inflammatory condition needs to be excluded
• Complex osteoporosis or metabolic bone disease

Conditions we treat:

• Rheumatoid arthritis
• Psoriatic arthritis
• Ankylosing spondylitis
• Reactive arthritis
• Adults with Junvenile Idiopathic Arthritis and transition services
• Other inflammatory arthritis
• Connective tissue diseases including SLE, scleroderma, Sjogrens, mixed connective tissue diseases.
• Myositis
• Behcet's syndrome
• Vasculitis
• Giant cell arteritis
• Polymyalgia rheumatica
• Osteoporosis and metabolic bone disease
• Crystal arthritis (e.g. gout and pseudogout)

For guidance on referral to LEEP please see the BNSSG Remedy webpage: Pulmonary Rehabilitation (Remedy BNSSG ICB).

Referring to the renal service 

Please visit Remedy for current information about referring to the renal service including:

• Advice & Guidance Service (Remedy BNSSG ICB)
• Acute Kidney Injury (Remedy BNSSG ICB)
• Chronic Kidney Disease (Remedy BNSSG ICB)
• Renal HOT Clinic (Remedy BNSSG ICB)

• Email address for GPs querying/chasing results: radiologygpqueries@nbt.nhs.uk
• Opening hours for GP referrals are 8.30am – 4.30pm Monday to Friday 
• Imaging paper requests fax: 0117 4149466
• For appointment queries please telephone: 03003000089 for the Imaging Appointment office (8am – 7.45pm)
• To contact a Secretary please ring 0117 4149014 (between 9am – 5pm) this will put you through to the Imaging secretaries office.

The Health Psychology Service is available for adults with a physical health condition where:

• They are having trouble adjusting to the condition
• The condition is interfering with their lives, or
• Psychological matters affect the condition or its management. 

We are a tertiary level service and generally speaking we will only accept referrals from consultants within North Bristol NHS Trust. However, there is a possibility that we can accept referrals from GPs if funding can be secured. 

The other exception is for psychology services for people affected by HIV, and these individuals may be referred by GPs, other health care professionals or relevant community agencies, or on rare occasions patients may self-refer.

GPs interested in making a referral should contact the Head of Service.

Patients are usually refereed to the Plastic Surgery Department via 1 of the routes outlined below:

• Referral from their General Practitioner if they meet the differing criteria.
• As an emergency admission from the Accident & Emergency Department.
• A referral to the Plastic Surgery Trauma Clinic.
• A consultant referral from another speciality, this can involve an outpatient referral or a hospital transfer.

List of services

North Bristol NHS Trust physiotherapy department offers a comprehensive service covering many different areas and departments.

Outpatient Services

There are specialist outpatient services running at North Bristol NHS Trust physiotherapy. Please feel free to contact the named clinician for advice or queries about referrals.

If you are a patient we are very sorry but we can't offer specific clinical advice without an assessment.

• The referral is prioritised as needing either an urgent or a routine appointment. 
• At the moment this is not a self referral clinic - we must have a referral to see the patient.

Physiotherapy Services Referral Form
When a referral is received by the physiotherapy department it is viewed by a senior physiotherapist and decided if the patient needs an urgent appointment or can wait for a routine appointment.

Download:[attachments]

Referral information
The purpose of the information we require is to triage patients to the most relevant specialist to provide the quickest access to the most appropriate treatment and to avoid long delays when referring between services.

Email: painclinicclinical@nbt.nhs.uk

Exclusion
Pain Management Services are not always successful in relieving the patient’s pain. This may be for a variety of reasons. Whilst it may be helpful to review a previous patient after a period of time to ensure that no new treatments have been developed, multiple repeated referrals are not necessarily in the patient’s best interest. In these difficult and complex pain problems, discussion between the GP and the Consultant in Pain is indicated.

Whilst a therapeutic intervention may help some individuals this will often only have a limited effect and should be part of a multidisciplinary management programme. A decision on an intervention will only be made after a full discussion with the patient if it is considered appropriate. We do not perform procedures at the request of a referring individual unless it is part of a combined management approach with an associated team.

We aim to improve the quality of lives of our patients by controlling, reducing and where possible, curing their pain.

Download: 

Map of Medicine - guidelines for:

• Pathway for management of chronic widespread pain - Diagnosis of fibromyalgia.pdf117.45 KB
• Back pain
• Sciatic
• Pelvic pain

The following criteria should be filled for new referrals:

• The patient has not attended a Pain Clinic for the same condition before (see below)
• Any underlying cause for the pain has been eliminated
• The patient does not want or is not fit for a definitive procedure
• The referral has been discussed with the patient and the patient has agreed that this is the most appropriate management pathway
• Drug therapy has been tried (see flow diagrams) but has been ineffective
• Advice has been given about exercise and a healthy lifestyle. Rest can cause increased disability and patients should be encouraged to maintain as much mobility as possible
• An explanation about the aims of the Pain Service has been given to the patient so they can make an informed decision about whether they want to engage with our approach to management
• The patient has not been referred to a different specialty for the same condition at the same time
• The patient is not being referred for a specific intervention

Urgent referrals
We often have requests to bring forward appointments. In the interests of equity this is not possible unless there is a cancellation when we will endeavour to fill the slot with another patient. We are doing our best to keep the waiting times as short as possible.

Tertiary referrals
Patients already seen in another Pain Clinic and those referred from out of area for management of specific problems will be considered as tertiary referrals.

Rejections
We will not accept a referral for any specific intervention e.g. injections or acupuncture.