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Clinical Biochemistry in Primary Care

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 Clinical Guidelines

For guidance on hyperlipidaemia treatment guidelines and monitoring patients on lipid lowering therapy please see advice on Remedy

 

 

 

 

 

 

 

 

 

 

BNSSG Adult Vitamin D Prescribing Guidance

 

Blood Tests

 

Urine and Other Tests

 

 

Ambient Voice Technology

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We are trialing Ambient Voice Technology in some Outpatient appointments 

From March 2026, we are running a 12-month trial of Ambient Voice Technology (AVT) in some of our Outpatient appointments. 

Ambient Voice Technology (AVT) is like having a smart helper that, with your permission, listens to you and your clinician’s conversation during your consultation, automatically turning the conversation into notes.   

This trial is starting with a small number of clinicians in Gynaecology, Urology, Neurology, Gastroenterology and Hepatology Outpatient clinics. 

If your clinic has the option to use AVT, you will be informed at the start of your appointment. We will only use AVT with your consent. If you choose not to consent to the use of AVT, your appointment will continue as normal. 

What is AVT?

AVT is a smart tool that helps your healthcare team take notes during your appointment. 

  • It only listens to what you and your clinician talk about if you give consent, and it never records. 
  • It captures your conversation in real time and turns it into notes and letters for your health record.  
  • Your clinician checks everything to make sure it’s correct. 

You might have seen something like this if you’ve ever talked to your phone, used voice commands in a car, or asked a smart speaker to do something. 

What will happen if you say yes to AVT? 

  • A microphone, mobile device, or laptop will listen to what you and your clinician say during your appointment.  
  • Your appointment will feel the same, but your clinician won’t need to type as much – they can focus more on you.  
  • The AVT captures your words into text straight away and creates a summary and clinic letter.   
  • After your appointment, your clinician checks the notes and letters to make sure they are correct before adding them to your health record. 

Why are we trialing AVT? 

We want to see if AVT helps our patients and clinical teams. 

  • It lets clinicians spend more time talking to you instead of typing notes. 
  • It writes while you talk in real time, so your health records are more accurate and ready faster. 
  • This could mean letters or referrals get sent to your GP or other healthcare services more quickly after your appointment. 

Your privacy is really important. At the start of your appointment, your clinician will tell you if AVT is an option. You can choose to have your appointment with or without AVT. 

Your information is always encrypted and securely handled meeting GDPR and NHS standards. Only authorised staff at the hospital access it.

Do you store recordings of my appointment?

No, we don’t keep recordings. 

  • AVT writes down the words while you talk - it does not save the sound. 
  • Only discussions that are relevant to your care and documentation will be added to your health record.  
  • Private or sensitive conversations that aren’t about your care are not added. 
  • We always follow consent protocols in line with NHS guidance. 

Can I choose not to have AVT during my appointment?

Yes, you can choose not to use AVT in your appointment. Your appointment will continue as normal. You are welcome to discuss your choice or concerns with your clinician who will respect your choice and ensure it is documented.

Who can I contact if I have questions about AVT before my appointment?

Contact your clinical team or clinic using the information at the top of your appointment letter. You are welcome to ask questions during your appointment. 

More information

For details on how we collect, use and store personal information, including data collected via digital tools in outpatient settings, please visit our Privacy Policy and Data Protection webpage.

Low insoluble fibre diet

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Introduction

You have been asked to follow a low insoluble fibre diet. This can help improve symptoms, give your bowel time to rest after surgery, or help prevent a blockage in your bowel. 

You may only need this diet for a short time. If your doctor says you need to follow it for longer than a month, we might suggest taking a daily multivitamin to make sure you get all the nutrients you need. 

If you have any questions or worries about this diet, ask your doctor or healthcare professional.

Types of fibre

There are different types of fibre in the foods we eat. The two main types are called "soluble fibre" and "insoluble fibre."

Soluble fibre

Soluble fibre mixes with water in your gut and turns into a gel-like substance that your gut bacteria can break down. It can help with both diarrhoea and constipation. Soluble fibre is usually safe for you to eat.

Here are some examples of foods with soluble fibre:

  • Milled or ground oats, like Quaker Oat So Simple or Ready Brek.
  • Fruit without the peel, seeds, or skin.
  • Vegetables without the peel, seeds, or skin.

Insoluble fibre

Insoluble fiber is the "roughage" in our food. It does not get broken down by our body and helps make our stools bigger and easier to pass.

Here are some examples of foods with insoluble fiber:

  • Wholegrain foods like brown or seeded bread, cereal, rice, pasta, and couscous.
  • Skins of vegetables, fruits, beans, and pulses
  • Pith, seeds, and stringy parts of fruits and vegetables.
  • Nuts and seeds.
  • Salad and leafy greens.

Removing insoluble fibre

Many foods, like some fruits, vegetables, beans, and lentils, have both soluble and insoluble fibre. To make these foods easier for you to eat, you need to remove the insoluble fibre.

Here’s how you can do that:

  • Peel the skins and cook vegetables until they’re soft.
  • Peel the skins and stew fruits until they’re soft.
  • Peel and remove seeds, then blend vegetables into a smooth soup or sauce, or fruits into a smoothie.
  • If you can’t peel or remove seeds, blend the fruit or vegetable and then use a sieve to strain out the “bits”.

Recommended foods and foods to watch

Food typeRecommended foods (low insoluble fibre)Foods to watch (higher insoluble fibre or foods that increase risk of blockage)
Meat, fish and meat alternatives

Most meats, fish or meat alternatives are fine to eat. Including:

  • Fresh or frozen lean meats/poultry and fish.
  • Meat or fish in batter or breadcrumbs.
  • Tofu/Quorn.

Processed meats or fish dishes that have fruit or vegetables are not suitable. Including:

  • Avoid meat that is fatty or has tough parts like gristle, and fish with tough skin or bones.
  • Sausages with big chunks of fruit or vegetables inside.
Dairy and dairy alternative foods

Most dairy or dairy alternative products are fine to eat. Including:

  • Smooth yoghurt.
  • Milk.
  • Eggs.
  • Cream, crème fraiche, sour cream.
  • Hard and soft cheeses.
  • Ice cream, custard, milk puddings.

Dairy or dairy alternative products containing fruit or vegetables are not suitable. Including:

  • Yoghurt with big chunks of fruit, nuts, granola or muesli
  • Cheese with fruit or nuts.
Vegetables
  • Flesh of well-cooked veg that have had the peel and seeds removed like aubergine, avocado, beetroot, butternut squash, carrots, courgettes, cucumber, marrow, parsnips, pumpkin, swede, sweet potato, turnip.
  • Sieved tomato sauce e.g. tomato purée, passata sauce, ketchup.
  • Smooth vegetable juice, puree, soup.
  • Green leafy vegetables e.g. Brussel sprouts, cabbage, curly kale, lettuce, spinach, spring greens.
  • Vegetables with lots of roughage e.g. celery, coleslaw, cassava, leek, mushroom, okra, onion, olive, pak choi, peas, radish, spring onion, yam.
  • Corn e.g. sweetcorn, popcorn.
  • Tomatoes with skins and seeds.
Fruit

Some fruits are suitable but you need to peel, remove seeds and cook well. Including:

  • Tinned fruit (no skins) e.g. apricots, nectarines, pears, peaches.
  • Stewed/fresh fruit e.g. apples, apricots, banana, mango, melon, nectarine, pear, peaches, plantain, plums
  • Smooth fruit juice
  • Smoothies with no bits.

Fruits where you cannot peel, remove seeds, or piths are not suitable.

Including:

  • All dried fruits e.g. figs and raisins.
  • Berries, citrus fruits, grapes, kiwi, passion fruit, pomegranate, strawberries, and rhubarb
  • Fruit juices/smoothies with bits.
Cereals

‘White’ varieties are suitable.

Make sure there are no nuts, seeds or dried fruit.

Including:

  • Low fibre breakfast cereals e.g. Rice Krispies, Cornflakes, Coco pops, Frosties, porridge, Ready Brek.
  • White bread products e.g. sourdough, bread, rolls, bagels.
  • Plain pasties e.g. croissant.
  • Plain naan bread, chapatti.
  • White rice, pasta, plain couscous, egg/rice noodles.
  • Tapioca, semolina.
  • Plain biscuits/ crackers.

Wholemeal, wholegrain and brown varieties are not suitable. Including:

  • High fibre/wholegrain breakfast cereals e.g. All Bran, Branflakes, Weetabix, Granola, Muesli.
  • Brown/wholemeal and rye bread.
  • Bulgar wheat, buckwheat, pearl pearl barley, quinoa.
  • Rough oatcakes,wholemeal/grain
  • crackers.
  • Wholegrain rice, wild rice, wholewheat pasta, wholemeal couscous.
  • Biscuits/crackers/pastries containing dried fruit, nuts, seeds, or coconut.
Miscellaneous
  • Potato crisps.
  • Condiments and smooth dips e.g. BBQ/brown sauce, ketchup, mayonnaise, salad cream.
  • Salt/ ground pepper, herbs, spices.
  • Smooth paste e.g. harissa, chipotle, Thai green curry.
  • Savoury snacks containing nuts e.g. Bombay mix, cereal bars.

Meal ideas

Breakfast:

  • Cereal with milk, such as cornflakes, rice crispies.
  • White toast, low fat spread and a topping such as smooth jam, smooth peanut butter.

Midday meal:

  • White bread sandwich with lean meat, fish, eggs, cheese or a meat alternative.
  • Jacket potato with cheese , fish, chili without beans and blended onions or onion powder. Remember to avoid the potato skin.
  • Smooth pesto pasta with chicken breast and cheese.
  • Smooth soup with white bread.
  • Peeled roasted root vegetables with white pasta, couscous, rice.

Evening meal:

  • Meat, fish, or a meat alternative with peeled mashed potatoes, and peeled, well-cooked carrots and broccoli florets.
  • Stew with peeled and well-cooked carrots, potatoes, and courgette.
  • Meat or meat alternative stir fry with white rice or noodles, and peeled carrot, courgette, and broccoli florets.
  • Spaghetti Bolognese made with lean mince, peeled carrots, onion/garlic puree or powder, and passata tomato sauce (using white spaghetti).
  • Fish pie with peeled carrots, broccoli florets, and a peeled mashed potato topping.
  • Meat, fish, or cheese risotto made with onion/garlic puree or powder.

Tips 

  • High insoluble fibre foods include:
    • Nuts
    • Pips
    • Piths
    • Seeds
    • Skins on fruits and vegetables
    • Wholemeal/grain
    • Leaves
  • If you cannot peel a fruit or vegetable, like raspberries, they’re not suitable - unless blended into a smooth consistency. Sieve any remaining bits out.
  • Prepare a sauce as usual (e.g. with onions, garlic, peppers), then blend and sieve to remove large bits. Cook meat or meat alternatives separately, then add the blended sauce.
  • Blend onions, garlic, and ginger, then freeze in portions using an ice cube tray to add to meals later.
  • Batch freeze peeled vegetables to save time later.
  • Onion, garlic, and ginger powder can be used instead of whole onions, garlic, or ginger.
  • Salad alternatives:
    • Cooled white pasta with smooth pesto or a smooth tomato sauce (such as passata).
    • White rice or couscous with peeled and roasted root vegetables.
    • Peeled white or sweet potato salad with a smooth dressing.
    • Add protein like cheese (such as feta, halloumi) or egg.

© North Bristol NHS Trust. This edition published January 2025. Review due January 2028. NBT003820

Powered AAC resources

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AAC software and apps

AAC Suppliers

See our recommendation on arranging supplier visits on How AAC WEST work with independent professionals, suppliers and charities

Mounting and switches 

Access

Accessibility settings 

Accessibility settings on mainstream devices can be changed and may support someone to use direct touch. 

Styluses 

Styluses are available from a number of suppliers including these: 

Switch access 

  • Single message switches such Talking Tiles (black ones are £9), Little Mack, Big Mack available from www.inclusive.com 
  • Other switches such as Buddy button, Specs switch, Palpad available www.inclusive.com  

Developing switching skills 

Eye gaze access 

Developing eye gaze skills 

Other useful links

Resources for symbol users (child or adult)

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Paper-based AAC resources

Symbolised communication boards and books:

When pointing is difficult (note the above resources may also be accessed with partner assisted scanning).

Communication passports/Health passports 

Powered AAC resources

Powered AAC resources 

Multilingual resources

AAC Assessment Tools

AAC Implementation Resources

Yes/No shaping 

Modelling 

Communication partner training/resources: 

Resources for alphabet users (child or adult)

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These resources are designed for people who will use the alphabet to spell messages to support their communication. 

Paper based resources

For the alphabet charts you need to convert to PDF before printing. This will make sure background colours print correctly. (How to: Once editing done 'Save as' and change the file type to PDF OR Print and select 'Print to PDF'. Open the PDF and then print).

Alphabet charts - direct touch

These documents are for you to download, edit, and print. Remember to save as PDF before printing. 

PreviewDocument 
AAC keyboard black background, white tiles, black bold text
AAC users grid of letters, white background and bold black text
AAC users grid of letters and words with yellow tiles and black bold text
AAC users grid of letters and word black background, white tiles, black bold text
AAC users grid of letters and words, white background, black bold text
AAC users grid of letters and words, yellow tiles and bold black letters
AAC users grid of letters and instructions

Alphabet charts - partner assisted scanning (PAS)

These documents are for you to download, edit, and print. Remember to save as PDF before printing. 

PreviewDocument
AAC users grid of letters white tiles, black bold text
Keyboard with black letters on white background with
Keyboard of black letters on yellow tiles with black background
Keyboard of white tiles with black letters on a black background

 

Keyboard of letters with black text and white background
Keyboard of black letters on yellow tiles with a black background

 

For other alphabet charts you can explore the Ace Centre Resources: 

Alphabet and phrase charts - eye pointing

Phrase charts and books - partner assisted scanning

These documents are for you to download, edit, and print. 

NameInformationPreviewResource
Simple scanning communication chartA simple communication chart for users to scan and respond yes or no to various options. 
Screenshot of a simple scanning communication chart
Pragmatic PAS chart (adapted)

This chart is adapted from the work of Linda J Burkhart and from the version available on Ace Centre. 

The communication chart is designed to be read aloud by the communication partner.  When the person who is using the chart to communicate hears the option they want to communicate, they indicate “yes” in some way.   

Try and read aloud the options in a neutral voice.  When an option is selected, you could repeat the word or phrase selected in a livelier voice.  You will see examples of this in the videos below.   

Begin by personalising the vocabulary on the chart.  You will find it easier if you keep to the structure provided, but anything can be changed. 

Consider laminating the chart, ideally using a matt laminate pouch. Or you could print the chart on tearproof/waterproof paper or use card.  

The chart references a spelling chart.  You can download a wide range of alphabet charts from  Ace Centre.

You can view videos of communication books based around similar principles as this chart being used on the Ace Centre’s YouTube page Ace Centre - YouTube.

Screenshot of ACE pragmatic PAS chart. A series of white boxes with text and arrows

 
PAS chart (5 blank categories)
Chart for AAC user with text offering 5 categories and yes or no

Powered AAC resources

Multilingual resources 

AAC assessment tools 

AAC implementation resources 

Resources for adults with aphasia

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These resources are for supporting people with aphasia to use AAC within a total communication approach with communication partner support. 

Paper-based AAC resources

Powered AAC resources (aphasia specific)

Multilingual resources

Articles, webinars and blogs for SLTs

AAC Assessment Tools

AAC implementation resources

Support with AAC devices

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Support with AAC devices

Here is some information about what to do for some common issues with AAC devices.  

Please only contact AAC WEST about devices that we are responsible for. 

Our contact details are at the bottom of this page.  

Mounting problem

Issue with a current mount? 

  • Contact AAC WEST Tech Team (see details at the bottom of the page).

Need a new mount? 

AAC device mounted to wheelchair

Hardware problem 

Issues with:

  • Screens
  • Camera
  • Charger
  • Turning device on

Contact AAC WEST Tech Team (see details at the bottom of the page).

AAC icons of plug, cracked tablet screen, switch, tablet charging port, and charger

Software problem

Issues with:

  • Device not speaking. 
  • Device freezing/crashing.
  • Device not working as normal. 

First try:

  • Power off and turn it on.
  • For iPads, try a hard shut down.
  • Complete all hardware and software updates. 

If not resolved first contact:

  • The local team, for example teacher, support worker, and local speech and language therapist.
  • The supplier see (details at the bottom of the page).

If not resolved:

Contact AAC WEST Tech Team (see details at the bottom of the page). 

AAC software logos

Editing

Need to make changes to the vocabulary such as:

  • Adding words.
  • Changing symbols.
  • Adding pages. 

First explore:

If not resolved first contact:

  • The local team, for example teacher, support worker, and local speech and language therapist.
  • The supplier (see details at the bottom of the page). 

If not resolved:

  • Contact AAC WEST Tech Team (see details at the bottom of the page). 
Icons for editing AAC software

Supporting AAC users

Support with: 

  • Help to learn how to use their AAC.
  • Modelling AAC.
  • Communication partner skills.

First explore:

If not resolved first contact:

  • The local team, for example teacher, support worker, and local speech and language therapist.
  • The supplier (see details at the bottom of the page).

If not resolved:

  • Contact AAC WEST Tech Team (see details at the bottom of the page). 
Person supporting another person using an AAC device

Supplier contact details 

Check your device for the company name. Suppliers can support with a range of issues. If you give them consent they can have remote access to your device to provide support. 

AAC WEST contact details 

Please contact us if the above do not resolve your device issue. 

Admin

For admin, appointments, and referral queries.

Tech Team

For hardware issues like faulty batteries, broken screens, missing equipment, and frozen iPads.

Support

Support for software issues like missing grid sets/cells, Dropbox/account issues, and connectivity.

© North Bristol NHS Trust. This edition published October 2025. Review due October 2028. NBT003817.

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