There is a chance that if you are taking, or have been recently taking, Pre-exposure Prophylaxis (PrEP) that a negative test result will be a “false negative”. This means that the test would not identify the early stage of a HIV infection. It is therefore important that people who take PrEP do not rely on this screening test in the ED, and should continue to have regular HIV and sexual health testing.

How else can I access HIV and other sexual health testing?

Yuno Sexual Health clinic can provide information about and tests for HIV and other sexually transmitted infections. 

You can request a home testing kit for HIV through the Yuno sexual health website:

Yuno Sexual Health | Local Sexual Health Clinic and Free STI Tests

It is also possible to talk to your GP about having these tests if you have a particular concern.

"Opting out" means you choose not to have these specific blood borne virus screening tests, you can still have other blood tests. 

If you opt out of the screening test, this decision will be recorded in your medical notes. The computer system will 'block' the tests from being done for 12 months. Therefore, it is important to tell staff each time you are having a blood test in the Emergency Department if you still want to opt out. 

What if my doctor thinks I need one of these tests? 

If your doctor or clinician feels it is important that you have a test for one (or more) of these conditions, they can still arrange that specific test for you. This specific test will not be affected if you decide to opt out of the screening test. 

What if I decide I want to have these tests later?

If you decide that you would like to talk about having tests for HIV, hepatitis B, and hepatitis C, after you visit the ED, you can speak to your GP or access testing through Yuno Sexual Health clinic. You can request a test for one or all three, and you can request a home testing kit for HIV through the Yuno Sexual Health. 

Yuno Sexual Health | Local Sexual Health Clinic and Free STI Tests

HIV stands for Human Immunodeficiency Virus. ‘Immunodeficiency’ refers to the weakening of the immune system by the virus. HIV can be cauing damage silently for many years; you may have no signs or symptoms.  

For the vast majority of people with HIV, treatment is normally a fixed dose combination tablet, taking it once a day. The treatment is so effective that it stops the virus from reproducing in your body. It reduces the amount of virus in the blood to undetectable levels, meaning you cannot pass on HIV and can expect to live a normal lifespan.  

Further support and information: 

Home | Terrence Higgins Trust (tht.org.uk)

HIV and AIDS - NHS (www.nhs.uk)

Hepatitis C affects your liver and can lead to serious liver problems if not treated. You can have hepatitis C for many years and not notice any symptoms, but this does not mean it isn’t affecting your liver.  Hepatitis C is curable. Treatment is a course of tablets, taken for 8-12 weeks. You are unlikely to experience side-effects from the treatment. 

Further information and support: 

The Hepatitis C Trust | Hep C charity (hepctrust.org.uk)

Hepatitis C - NHS (www.nhs.uk)

Hepatitis B affects your liver. Most adults that contract hepatitis B recover fully, but if contracted as a child it is unlikely that the body will clear the virus on its own. Treatment is very effective and is usually in the form of tablets. Some people do not need treatment for the virus as it may not be causing damage to the liver. They will need regular check-ups though. An important other step is to vaccinate those that live with you and these vaccines can be provided free of charge by your GP.  

Further information and support at: 

Hepatitis B - British Liver Trust

Hepatitis B - NHS (www.nhs.uk)
 

BWPC are implementing new standards, processes and SAP Ariba modules to improve how we interact with our suppliers. The benefits of this include eliminating manual ways of work and duplication of effort for both parties. It will also ensure that our supplier details are current and accurate. It also allows you to self-manage your contact information and efficiently communicate this to BWPC.

Yes, the registration is a separate process that we expect all existing suppliers to complete. This allows suppliers to confirm BWPC’s standard procedures, self-manage their contact information and manage their catalogues when enabled. 

All purchase orders will be transacted through the SAP Business Network, if you wish to be integrated to receive orders via ERP then you would require an Enterprise account with SAP and then integration with BWPC. This can all be completed at a later date. Suppose you receive purchase orders from BWPC via PEPPOL / ERP systems. We are looking into a temporary alternative for go-live that won't change how you receive orders. 

Questionnaires are due to be sent out closer to the go-live date.

You can still participate with an SAP Business Network with a standard account which is free of charge. 

No, any POs sent via NHSSC will remain the same, only the products we may order directly with you will be affected by this change. 

Yes, this is correct, only purchase orders are affected by this change.

You can register for an account through this link https://service.ariba.com 

Yes, you will receive an email notification to the email associated with your SAP account.  This email will notify you that a trade relationship request is ready to be accepted. This will be sent out once we have input your details into the SAP Business Network which may take 24-48 hours.

Yes. However, if you upgrade your SAP Business Network account to an enterprise account then integrating via your ERP would be possible. Suppose you are receiving purchase orders from BWPC via PEPPOL / ERP systems. In that case, we are looking into a temporary alternative for go-live so the way you receive orders doesn't change. 

 This may be due to the volume of transactions BWPC carries out with your company, as a standard account does not offer some features such as integration and a dedicated SAP helpdesk. If you wish to continue with a standard account then this can still be completed, but please note that we won’t be able to integrate with any of your ERP systems and orders may have to be extracted manually by yourselves on your account. 

No, one SAP Business Network account can service multiple customers.

Completing our process via the SAP Ariba is mandatory. Not completing it on time could result in non-compliance and impact our existing trade relationship. For new suppliers it will also prevent BWPC from taking the necessary steps to initiate your account in our system to allow transactions to occur.

If you have more than one business that is actively trading with us, you will receive a system generated invitation to register per organization or legal entity. You will need to re-register and re-qualify each one separately.

1. You do not need to create a new Ariba Network account to respond to questionnaires or participate in events with BWPC. You can use your existing account to: 

• Respond to registration, qualification questionnaires for BWPC and other customers.
• Respond to future sourcing events.
• Potentially manage contracts. However, some suppliers may want to create an additional Ariba Network account, to manage these three processes and modules separately from the transactional account or from the account used to manage other customers.

There is no cost associated with creating a standard Ariba Network account. Suppliers can use a standard account to: 

• Respond to questionnaires.
• Participate in sourcing events.
• Manage contracts.
• Receive POs.

At any time, suppliers can upgrade from their standard account to an Enterprise account. Costs may be incurred when upgrading to an enterprise account to transact with buyers.

If you or someone else in your organisation received the SAP Ariba system generated invitation to register their email, and it should have been sent to another person in your organisation, do not simply forward it on. Contact the Supplier Enablement Lead within BWPC to have the email with the link resent to the relevant contact.

If you are experiencing this problem, it could be one of the scenarios below: 

You have already logged into your existing account and then also clicked on the link in the email for the first time. Please note, the system will view this as an attempt to log in twice at the same time. You must either click on the link and log in from there or log into your existing account and navigate to the Ariba Sourcing screen. You can not to do both. 

If you have another SAP Ariba site open in another browser tab, please close that other tab and try to login again. 

If you received a certificate error in your browser when trying to access the Ariba Network login page at supplier.ariba.com, please clear your browser cache, cookies and search history. Close the browser and then try open the page again.

If you are an existing supplier of BWPC, some of your information may be migrated, so you need only confirm it for accuracy rather than starting new. However, you may need to re-provide some information or provide additional information. This will ensure that BWPC has the most accurate, up to date information they need to do business with your company moving forward.

It is important to perform deep breathing exercises after your operation to reduce the risk of developing a chest infection. Do this by taking 3 deep breaths, feeling your lower ribs move. Repeat this every hour throughout the day. If you need to cough after your operation, place a rolled-up towel across your abdomen and apply pressure. If you have had vaginal surgery, put your hand over the pad to support the perineum (the area between your vagina and back passage(anus/ rectum)) when coughing.

Regular movement of your legs is essential while you are less active than usual. Move your feet up and down at the ankles for 30 seconds every half an hour when you are in bed or sitting. You will also be given support stockings to wear whilst your mobility is reduced following your operation.

Bend your knees up one at a time. Keep knees together and roll onto your side. Push up into sitting with your arms, at the same time lower your legs over the side of the bed. If you have had abdominal surgery you can support your incision with a rolled-up towel. 

You can expect pain after your surgery. You will be provided with painkillers on discharge. Some painkillers, such as codeine, can cause constipation. Therefore, make sure to consume a high fibre diet and drink plenty of water to avoid constipation. Taking painkillers to reduce your pain will ensure that you get out of bed sooner and will therefore speed up your recovery and reduce the risk of blood clots.

You may have a pack (small gauze similar to a tampon) in your vagina following vaginal surgery to reduce the risk of bleeding. This will be removed by a nurse while you are in hospital.

You may have some vaginal bleeding for 2-3 weeks after your surgery. This is normal. However, if the bleeding becomes heavy or smells offensive, you need to contact your GP or the hospital as this may signify an infection. Use sanitary towels instead of tampons to reduce the risk of infection.

Bladder

You may have a urinary catheter (tube into bladder to help it drain) in place after your operation for up to 24 hours until you are easily able to walk to the toilet to empty your bladder. Once your catheter is removed you can go to the bathroom to empty your bladder.

Ensure you sit on the toilet properly and relax your breathing. If you are struggling to empty your bladder it is important to speak to your nurse. They will measure how much urine you pass (pee) and scan your bladder to determine how much is left.

If you have had a pelvic floor repair especially of the anterior wall of your vagina, you may notice that your urine flow is slower and may take longer. This should settle with time. If you have problems passing urine, you may need to have a catheter for a few days.

It is important to ensure you drink enough after your operation, approximately 1.5 to 2 litres per day, little and often is best. Try to avoid caffeinated drinks, fizzy drinks, and alcohol as these may irritate your bladder and cause urgency. Drinking less frequently can make your urine more concentrated which can irritate your bladder. Also try to avoid going to the toilet ‘just in case’ even if you have fear of leaking as this can lead to poor bladder habits.

Bowels

It is important to avoid constipation after your operation as this puts extra strain on your pelvic floor muscles and potentially your operation site. To prevent constipation, make sure you drink plenty of fluid, increase the fibre content in your diet and if necessary, use laxatives. Your doctor can prescribe these for you to take whilst in hospital and at home.

Sit on the toilet with a stool under your feet, as shown in the picture below. Do not strain and keep your tummy muscles relaxed.

It is helpful to take a slow breath in through your nose so that your stomach moves outwards, and your chest remains still and then exhale through pursed lips. You may also find it useful to support your perineum (the area between your back passage (anus/rectum) and your vagina), when opening your bowels. Please see the picture below.

Your pelvic floor muscles are a sling of muscle from the pubic bone at the front of your pelvis to the coccyx and sacrum at the back of your pelvis. They help to support the bowel, bladder and uterus, maintain bladder and bowel control, support the pelvis and aid sexual function.

It is important to strengthen these muscles leading up to and after your operation. Once your catheter has been removed and you can pass urine, you can gently start these exercises.

To contract your pelvic floor, tighten your back passage – as if you are stopping yourself passing wind (farting). At the same time, tighten your vagina. Women used to be told to practice their pelvic floor muscle training by stopping the flow of urine. This is no longer recommended as it can affect your bladder function in the long term.

Try to feel the muscles lifting upwards and forwards towards the pubic bone. Feel the muscles working together. Then relax, let go and feel the muscles return to their starting position. Try not to squeeze your buttocks or leg muscles. Avoid holding your breath and just continue to breathe normally.

To begin with, especially if you haven’t practised these exercises before, you might lack confidence. Keep practicing the above and when you’ve mastered simply contracting and relaxing, move onto the next exercises.

There are two different recommended pelvic floor exercises:

Exercise 1 – Slow pull-ups

Tighten the pelvic floor muscles slowly. Continue to tighten for the length of the hold, relax, and feel the muscle let go. How many seconds can you hold the contraction for?

Aim for 5 seconds to begin with, when you let go – can you feel the muscles relax?

If not, you have held the contraction for too long, try again with a shorter hold – even just one second. Some women may only be able to only hold for 1-2 seconds. Others as many as 8-10 seconds. Don’t panic if you are not able to feel very much to start off with. It may take a bit of practice so keep going. The key is to discover your hold time, and gradually build this up to a maximum of 10 seconds. And don’t forget, keep breathing normally throughout.

Rest for roughly 5 seconds in between each contraction, to ensure that the muscles have fully relaxed. Repeat this 5 times. As it gets easier, gradually increase the length of hold, and number of repetitions (aim for 10 long squeezes for 10 seconds each).

Exercise 2 – Fast pull-ups

Tighten the pelvic floor muscles quickly. Let go straight away. Wait for a second. Repeat this 10 times and as you get more confident aim for approximately 1 contraction per second.

Pelvic floor exercise routine

Do exercise 1 and 2 at each session. As soon as you can, increase to 10 slow and 10 fast pull-ups. Aim to repeat each session at least 3 times a day. When you start, do the exercises lying or sitting. As your muscles get stronger progress to standing. 

Do not expect immediate improvement – but do not give up. As the muscles get stronger you will be able to increase your hold time and number of repetitions. Use this link to view our pelvic floor video to help guide you.

How to do pelvic floor exercises - msk (bnssg.nhs.uk)

Top tips

Try to get in the habit of tightening your pelvic floor muscles before you cough, sneeze or lift anything.

After your operation it is important to start strengthening your deep abdominal muscles called tranversus abdominis. They work together with your pelvic floor muscles to provide support for your spine and internal organs.

Deep core muscles

Lying on your back let your tummy relax, breath in gently. As you breathe out gently pull in the lower part of your tummy, hold for 5 seconds, and repeat 5 times. Do not move your back. You should be able to breathe and talk whilst exercising. This can also be done in sitting or standing.

Pelvic tilting

Lie on your back with your knees bent. Pull your tummy in and flatten your back on the bed. Hold, and then relax. Do not hold your breath. Repeat 5-10 times twice daily.

For exercise progressions please visit: POGP (thepogp.co.uk)

Do not drive until you are confident you can do an emergency stop. If you have undergone abdominal surgery, we advise you not to drive for at least 4-6 weeks but check with your insurance company regarding your policy.

You should avoid sexual intercourse for the first 6 weeks following vaginal or hysterectomy surgery, ensuring any bleeding has stopped. This will allow tissues to heal and reduce the risk of developing an infection. It is important that you wait until you feel ready and use sufficient lubrication. If you are concerned or intercourse remains uncomfortable after 3-4 months, it is a good idea to discuss this with your GP.

BNSSG Pelvic Health Physiotherapy Service : Pelvic Health Physiotherapy Service - msk (bnssg.nhs.uk)

POGP POGP (thepogp.co.uk)

RCOG Home | RCOG

NHS The NHS website - NHS (www.nhs.uk)

Squeezy NHS app for pelvic floor exercises: Home Page - Squeezy (squeezyapp.com)

BSUG (2020) Anterior vaginal wall repair without the use of mesh. 

IUGA (2020) Recovery Guide Following Vaginal Repair Surgery/Vaginal Hysterectomy

POGP (2019). Fit following Surgery advice and exercise following gynaecological surgery. 

RCOG (2015) Information for you after a Laparoscopic Hysterectomy.

RCOG (2015) Information for you after a Pelvic Floor Repair Operation.

RCOG (2015) Information for you after a Vaginal Hysterectomy.

RCOG (2015) Information for you after an Abdominal Hysterectomy.

We support people to maximise their independence and return to enjoyment of meaningful activities. We provide specialist assessment and therapy for people who have: 

• Cognitive impairment, such as difficulties with orientation, memory, reasoning and attention.
• Motor skill deficits, such as changes to strength, coordination or sensation.
• Postural and specialist seating requirements.
• Fatigue changes and who require support with their daily routine.
• Low levels of awareness of the environment around them (disorders of consciousness).

We provide specialist assessment and therapy for people who have:

• Difficulties with mobility, balance and dizziness.
• Strength, sensory and coordination issues.
• Changes to muscle and joint range of movement.
• Difficulty breathing and coughing effectively. 
• Tracheostomies (a breathing tube).
• Low levels of awareness of the environment around them (disorders of consciousness).

We provide specialist assessment and therapy for people who have:

• Changes in their communication, such as producing and understanding language, unclear speech, changes to how the voice sounds and social interaction skills.
• Communication difficulties requiring support to contribute to decisions around their care.
• Difficulties with swallowing when eating and drinking.
• Low levels of awareness of the environment around them (disorders of consciousness). 
• We also work closely with Physiotherapists, Doctors and Nursing staff to support patients who have tracheostomies to communicate and swallow safely

We assess and manage patients’ hyper-acute rehab needs following severe injury, which can often be complex and disabling. 

Following a biopsychosocial model of healthcare, we consider the person’s medical and rehabilitation needs in the context of their life and circumstances. Our focus aims to be holistic, recognising the importance of the ‘whole person’. 

We work with the team of therapists to help identify and assess ongoing rehabilitation needs and we liaise with appropriate onward rehabilitation services to facilitate a supportive discharge from the acute hospital setting.

You can expect to receive your initial therapy assessment within the within the first few days of being admitted to the ward. 

Due to fluctuating demands on the therapy teams, we cannot guarantee the frequency of your sessions. How often you are seen may also change over the course of your admission, however we will strive to provide as much rehabilitation as is required. 

Due to the nature of the acute hospital setting, your therapy sessions are not timetabled. We can aim to accommodate preferences for approximate timings of sessions where possible

Not necessarily. How an injury affects someone can differ between people. You will be assessed and seen by the therapy disciplines identified based on your particular set of needs.

Not officially, but as your areas of focus for therapy become clearer, there may be one particular therapist who becomes your main point of contact.

Acute hospitals often rely on the movement of patients to different wards or areas to accommodate new patient admissions. There is therefore a possibility that you may not remain on your original ward for your whole stay. In this case, your team of therapists will provide a verbal and/or written handover of the input you have received to your new team of therapists, who will continue to work with you.

Southmead Hospital has access to an interpreting service. This can be helpful to support patients and families where English is not their first language. An interpreter can be helpful in helping you understand you or your relative’s current medical and rehab plan. Please speak with your Nurse or Therapist if you wish to use this service.

Pavord, I. D. et al. The use of induced sputum to investigate airway inflammation. Thorax 1997; 52:498-501. 

Pizzichini, E. et al. Safety of sputum induction. European Respiratory Journal 2002; 20:9-18.

Fast Track appointments team Southmead Hospital 
Monday - Friday 8:30am - 4:30pm 
0117 414 0538

NBT website 

Information about cancer types, advice and support.
Cancer Services | North Bristol NHS Trust (nbt.nhs.uk)

NBT NGS Macmillan Wellbeing Centre 

Southmead Hospital, Westbury-on-trym, Bristol, BS10 5NB 
Monday - Friday 8:30am - 4:15pm 
0117 414 7051 
wellbeingcentre@nbt.nhs.uk 
NGS Macmillan Wellbeing Centre | North Bristol NHS Trust (nbt.nhs.uk)

Macmillan Support Centre Weston

First floor, Weston General Hospital, Grange Road, Uphill, Weston-Super-Mare, BS32 4TQ 
Monday - Friday 9am - 4pm 
01934 881078 or text 881079

Everyone is welcome at the Macmillan Wellbeing Centre.

Macmillan Cancer Support

Every day 8am - 8pm 
0808 808 0000 
Macmillan Cancer Support | The UK's leading cancer care charity

Better Health 

Healthy changes start with little changes. Whether you want to lose weight, drink less alcohol, get active, or quit smoking you have access to lots of free tools and support. 
Better Health - NHS (www.nhs.uk)

Better Health: Every Mind Matters 

Simple ways to lift your mood. 
Every Mind Matters - NHS (www.nhs.uk)

Eating Well  

Information and guidance about eating a healthy, balanced diet. 
Eat well - NHS (www.nhs.uk)

• Write down your most important questions.
• List or bring all your medicines and pills – including vitamins and supplements.
• Write down details of your symptoms, including when they started and what makes them better or worse.
• Ask your CNS team for an interpreter or communication support if needed.
• Ask a friend or family member to come with you, if you like.

• Don't be afraid to ask if you don't understand. For example, 'Can you say that again? I still don't understand.'?
• If you don't understand any words, ask for them to be written down and explained.
• Write things down, or ask a family member or friend to take notes.

• Write down what you discussed and what happens next.
• Keep your notes.

• 'what's happening if I'm not sent my appointment details,' and 'can I have the results of any tests?'
• If you don't get the results when you expect – ask for them.
• Ask what the results mean.

• What are the tests for?
• How and when will I get the results?
• Who do I contact if I don’t get the results?

• What happens next?
• Do I need to come back and see you?
• Who do I contact if things get worse?
• Do you have any written information?
• Where can I go for more information?
• Is there a support group or any other source of help? 

• PMP aims to develop a broad set of strategies for managing the impact of the pain on your physical, emotional, and social wellbeing. The course will explore your personal values to support you in making changes to improve your quality of life.  
• It is a group programme delivered by a team including a physiotherapist, occupational therapist, and psychologist. 
• You will meet once a week for 12 weeks, either in person or online. 

• SMP sessions build on your current knowledge of pain management focusing on activity management, managing difficult thoughts and emotions, relaxation, communication, and flare-up management.
• It is a group programme delivered a member of the pain management team, and a trained volunteer who has personal experience of persistent pain.
• You will meet once a week for eight weeks, either in person or online, with other people who are challenged by persistent pain. 

• Backpack supports people who are functioning well but struggling with variable levels of pain and flare-up episodes. This may be impacting on family life, work, social and leisure activities. By developing a set of strategies, we aim to improve activity and functioning whilst minimising the impact of worse days and flare-ups.  
• It is a group programme run by a by a physiotherapist and psychologist.  
• You will meet once a week for 6 weeks, either in person, or online.    
• You can be referred by your GP, physiotherapist, local MATS (musculoskeletal assessment and treatment service), spinal surgery services, and the pain service.  

• This is for people with persistent pain who also struggle with insomnia, to help you explore the science behind, and the various factors that affect sleep. We aim to tailor this information to the individual challenges you have, and to help you build strategies for improving the quality and duration of your sleep.
• It is a group programme facilitated by our assistant psychologist and a trained patient volunteer.
• It is a five-week course, online or in person. 

• This group offers support to adults (over 18) who support our patients. It aims to discuss challenges, support each other, and look after ourselves.  
• It is facilitated by staff.  
• This is a rolling group that takes place online once a month.

• This workshop is for people who are managing pain whilst in work but may also be helpful as a first step for those who are keen to move towards returning to employment.  
• You will be introduced to the legislation (laws) about employment and long-term health conditions such as persistent pain. You will then discuss ideas about how to use self-management skills in the workplace, and how best to communicate your needs effectively to employers and colleagues.  
• It is a one-off group meeting online.  

Mindfulness is a form of meditation that is recognised worldwide, particularly in relation to health and stress. It involves learning a number of techniques that are practiced throughout the day and have been shown in numerous studies to improve your ability to cope. 

The techniques are based on simple meditation techniques. These are linked with being more able to actively manage health conditions which cause pain and fatigue. 

• The programme aims to give you a deeper understanding of biological systems involved in the persistent pain experience, and to directly link this understanding to gaining tools for managing pain, primarily through helping you develop a more compassionate stance towards yourself and your pain. 
• The course will help you understand what ‘compassion’ is, how to build self-compassion, and why this is important and helpful in the management of persistent pain. 
• It is a group programme led by a psychologist from the pain service, and a psychologist from the ME/CFS service.
• It is held once a fortnight for eight weeks online. 

• This programme aims to help identify patterns in relation to activity and exercise and support you to work towards your activity goals in a flexible and sustainable way. 
• There are strategies to support self-compassion and self-care throughout the programme. 
• This is an eight-week online programme led by a physiotherapist.

• This course is based on the Neuro Development Sequence – the movement patterns we go through as babies when learning to walk. We revisit these movement skills as adults to help improve our function and confidence with movement now. The course also includes other fundamentals of movement. These include (where possible) regaining symmetry in movement patters, the role of breathing in movement, mobility and stability exercises, and looking at the neural pathways as a key component of successful movement.  
• It is run by the physiotherapist from the pain management and ME/CFS service.  
• It takes place online (on Zoom) for 6 weeks on a Thursday at 13:30-14:15. You may have the option to join some follow-up movement sessions held periodically though the year.

• This is for people with persistent pelvic pain. It covers some of the same topics as the generic PMP such as understanding pain mechanisms in the body, flare-up management, stress, relationships, and sleep. It also covers specific pelvic pain topics such as bladder and bowel function, pelvic floor exercise, hormones, and psychosexual health.
• It is a group course run by the gynaecology and pelvic health physiotherapy services. You will also have one individual appointment with the pelvic health physiotherapist.
• The sessions last two and a half hours and are once a week for 12 weeks.