Colposcopy

Colposcopy is a simple procedure used to look at the cervix, the lower part of the womb at the top of the vagina. It can confirm whether cells in your cervix are abnormal and determine whether you need treatment to remove them. These abnormal cells can go away on their own, but sometimes there's a risk they could eventually turn into cervical cancer if left untreated. 

Find out more about colposcopy, what to expect at your appointment, and the results:

Colposcopy - NHS

©North Bristol NHS Trust. This edition published January 2025. Review due January 2028. NBT003776

EPAC

The Early Pregnancy Assessment Clinic (EPAC) is an emergency service available to all women referred by their GP or healthcare professional. EPAC at Southmead Hospital accepts women who are experiencing pain and/or bleeding between 6 and 18 weeks of pregnancy, and see over 5000 emergency patients each year. 

You must be referred to the clinic; it is not a drop-in service.

After referral you are usually contacted within 24 hours and have a first consultation on the phone with one of our experienced early pregnancy team. A time to attend will be given to you if you need to come to clinic for an ultrasound or blood test. 

To contact the EPAC phone 0117 414 6778. Leave your name and phone number, and we will call you back as soon as possible. 

If you require emergency medical assistance please contact NHS 111. In an emergency such as very heavy bleeding or severe pain, phone 999 or go to the Emergency Department. 

Management of miscarriage

EPAC at Southmead Hospital offers a choice of treatment following diagnosis of a miscarriage: conservative management, medical management and surgical management under both local anaesthetic and general anaesthetic.

Ectopic pregnancy 

Treatment varies between conservative, medical and surgical management.

Current Anti D guidelines

Anti D 500 IU is recommended for all rhesus negative women with vaginal bleeding after 12 weeks of pregnancy. If bleeding continues intermittently, Anti D 500 IU is repeated after 6 weeks. If bleeding is heavy or there is significant pain, Anti D 500 IU is repeated after 2 weeks.

© North Bristol NHS Trust. This edition published January 2025. Review due January 2028. NBT003772 

Outpatient clinics are held at Southmead Hospital Bristol and Cossham Hospitals.

GP referrals – outpatient appointments (NHS e-Referrals or letter) to be sent to:

Centralised Booking Centre
Trinity House
Trinity Business Park
First Floor T3
Filton Road
Horfield
Bristol     
BS7 0DD

Telephone: 0300 5550103
Fax:  0117 4149400

Outlook is based at Southmead Hospital, in Bristol. We welcome referrals from NHS healthcare providers.

If you are a healthcare professional and want to make a referral to our service or discuss the support we offer, please visit our referrals page or please email us at PsychologyOutlookAppearanceTeam@nbt.nhs.uk or call 0117 4144888 

Address:  Outlook & Clinical Health Psychology, Office 3, Level 3,Gate 38, Brunel building, Southmead Hospital, BS10 5NB
   

You can refer for DXA:

• If you are a postmenopausal woman over 50 with a low trauma fracture (defined as a limb fracture after a fall from standing height or less while stationary or walking, or a vertebral fracture of the spine)
• Or, if you are a woman or man over 50 with a FRAX score in the intermediate or high risk zone

To make a referral, download and complete a form, alternatively you can order DXA on ICE. [attachments]

In other circumstances, you may want to contact us first to establish eligibility. If your patient is ineligible for a scan under the NHS, we also offer this service self-funded at a cost of around £72.

All GP referrals from the Bristol and South Gloucestershire areas are initially triaged by the Musculo-skeletal Assessment and Treatment Service.

Orthopaedic Spinal Surgery

The Trust’s orthopaedic spinal surgery service has changed its GP referral criteria and is currently not accepting new adult routine (non-urgent) referrals.

Nationally, there has been a steady increase in the numbers of referrals in this field, with few hospitals across the country offering this complex spinal service, combined with a shortage of experienced spinal surgeons.

As a result, at North Bristol NHS Trust this situation has led to more than 100 patients, from across the region, waiting more than 12 months for surgery which we consider to be unacceptable.
With every new additional referral, there is a risk that existing patients could get moved further down the waiting list as clinical re-prioritisation takes place.

Our first duty has to be for our patients we have already accepted onto our waiting list. The altering of our referral criteria will mean we can work through the backlog, as well as carrying out new urgent and emergency cases, with the aim of restoring the service fully within 18 months.

We believe this decision is in the best interest of our existing patients. This decision has been taken with the full support of our commissioners, who will now identify and manage alternative arrangement for the non-urgent patient referrals.

Referral to Occupational Therapy

Referral to occupational therapy for inpatients on the wards at Southmead Hospital Bristol are made via an electronic referral by the nursing staff or other medical staff working on the ward.

Not all patients require the involvement of an occupational therapist.

Outpatient Service Referral:

GP referrals are accepted for the following outpatient services:

• Orthopaedic upper limb rehab
• Scar management, run by the burns and plastics team

Nutrition & Dietetics - For Clinicians

Inpatient Services

• Our acute services team is made up of dietitians who work within North Bristol NHS Trust providing a dietetic service to all the wards. The service is available between 8.30am and 4:30pm Monday to Friday.
• Referrals for an inpatient review should be made on Careflow.

Discharge Services

• Patients who continue to need support to increase nutritional intake following discharge from hospital will be referred to the community Nutrition and Dietetic team by the ward dietitian if appropriate.
• Patients who are being fed through a feeding tube will be referred to the Home Management Service (HMS). HMS will make arrangements to deliver feed products at home and to monitor progress.

Outpatient Services

• Please see Remedy for guidance 

Provide diagnosis, treatment and rehab of illness in older people.

The Complex Assessment and Liaison (CALS) service
The CALS service operates in the emergency zone, Level 0, Brunel building. It consists of consultant geriatricians (Dr Neubauer, Dr McCracken and Dr Richards), Advanced Nurse Practitioners, OTs, Physiotherapists, social workers and case managers. The team has developed strong links with the community to promote seamless care for the patient between primary and secondary services.

These patients will have a comprehensive geriatric assessment (CGA) which will address not only their initial medical presentation, but their co-morbidities, rehabilitation, psychological and social needs.

The team aims to improve the identification of patients with frailty syndromes such as, delirium, dementia, falls and incontinence and enable these problems to be addressed, improve sign posting to appropriate services, improve patient quality of life and ensure more patient centred and timely discharge planning.

The CALS team also cover some ward beds on Level 1, Brunel building for specific patients identified by the team as being able to be rapidly discharged with intensive input. They also provide advice to GPs via a “Geriatrician of the day” hotline.

Patients admitted with fractures
Medicine Older People is very active in the care of older patients admitted with fractures, particularly hip fractures.

Dr Harding's clinical work is now focussed on the trauma wards on Level 2, Brunel building and Level 5, Brunel building and all hip fracture patients are now admitted under shared care with the Orthopaedic Surgeons.

Dr Harding, Dr Walsh and Dr Srivastava now provide a daily consultant ward round (Monday to Friday) to assess and manage the medical needs of these patients, lead their multidisciplinary rehabilitation and contribute to planning discharges.

Undergraduate Teaching
The Medicine for Older People department teaches forth year University of Bristol students for over forty-four weeks a year. Twice yearly exams take place in the Learning and Research, Southmead Hospital Bristol. The Department is also involved with teaching and assessing second, third and fifth year students.

Rapid Access Clinic

Cossham Hospital. Consultant responsible Dr Nigel Jones

This clinic is designed to provide a rapid medical assessment and management plan for a deteriorating patient who may otherwise end up in hospital. The service can help avoid unnecessary admission and support the intermediate care teams.

What does it involve?
A comprehensive geriatric assessment is performed by a consultant. Diagnostics including bloods, CAT scans and ultrasounds are preformed on the same day and a medical summary is dictated and faxed to the GP by the evening.  Medications are changed and dispensed as needed.

Which patients are eligible?

• Patients must be over 60 years old.
• Not obviously requiring acute emergency admission
• Social circumstances clear, no intractable social crises
• Deteriorating and threatening admission

Referrals should be made by telephone: 0117 340 8400 or by contacting the Consultant of the day on 07738 859048 or email referral to nbn-tr.olderpersonsrapidaccess@nhs.net

A series of questions will be asked (see direct access referral form). You will then be informed when a patient can attend. Up to three patients per day can be seen.

Patient travel
Please see if a relative or friend can take the patient to the hospital and collect them once they have finished. If this is not feasible then the PCT’s have an arrangement with WINGS. Please phone the Wings Ambulance service on 0117 9720999. You need to inform them that this is a Direct Access Patient. Please inform the Wings ambulance service of the urgency of the assessment. It is important that the patient gets to the Hospital as early as possible to enable all the investigations to be done in a timely way and to enable us to access the results on the same day.

Should results not be available by the time the clinic closes or the patient is deemed more ill than first thought, they will be transferred to Southmead Hospital Acute Assessment Unit under the care of the physician of the day.

Download Direct Access Clinic referral form PDF: