Whole Genome Sequencing Testing for Solid Tumours in young people

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Is my patient eligible?

To review patient eligibility please Check the National Genomic Test Directory

All  current versions of the resources associated with the request process are curated on NHS England Genomic website under the Genomics Resources tab

For ease of navigation direct links are in blocks on below.

 

Pathway guide for WGS requests in Paediatric Oncology (non- neuro)

 

 

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Pathway guide for WGS requests in Paediatric Neurology Oncology

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Acute Leukaemia in children, teenagers or young adults (>25 years)

Requesting a test for WGS in Solid tumours in Young People

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Additional Forms

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All published forms can be found directly on the NHS Genomic Medicine Service Resources website.

For expediency we have directly linked to additional forms that may be required for specific circumstances in the conversation process:

NHS Genomic Medicine Service young persons' assent form

NHS Genomic Medicine Service genomic consultee declaration (adult requests only)

Below is the form for opt in and out to the National Genomic Research Library as part of the conversation process:

NHS Genomic Medicine Service participation in research form

 

WGS Clinical Guides

Biochemistry Clinical Guidelines

A short pathway guides for  the request process for Whole Genome Sequencing can be accessed in the drop down at the top of this page.

The HEE resource for guidance on elements of the consent conversation can be found here: 

Guide to requesting WGS in cancer

Genomics Education Programme Resources

There are many excellent education packages to support your genomic learning journey at Genomics Educational Resources

For more targeted Genomics Education resources to support Whole Genome Sequencing test pathway 

Whole Genome Sequence request need advice?

Contact us - fingers on a telephone number pad

If you require further information regarding genomic testing please contact the laboratory

Tel:0117 4146168 or SWGLHexports@nbt.nhs.uk

If you require support for navigating the pathway including completion of paperwork please contact the Genomic Healthcare Practitioners

email rduh.swgenomicpractitioner@nhs.net

 

Last updated 17th October 2023

Whole Genome Sequencing Testing For Solid Tumours

Regular Off Off

Is my patient eligible?

To review patient eligibility please Check the National Genomic Test Directory

All  current versions of the resources associated with the request process are curated on NHS England Genomic website under the Genomics Resources tab

For ease of navigation direct links are in blocks on below.

 

One page pathway guide for Sarcoma

Requesting a test for WGS in Sarcoma

Sample image

Additional Forms

Document image

All published forms can be found directly on the NHS Genomic Medicine Service Resources website.

For expediency we have directly linked to additional forms that may be required for specific circumstances in the conversation process:

NHS Genomic Medicine Service young persons' assent form

NHS Genomic Medicine Service genomic consultee declaration (adult requests only)

Below is the form for opt in and out to the National Genomic Research Library as part of the conversation process:

NHS Genomic Medicine Service participation in research form

 

WGS Clinical Guides

Biochemistry Clinical Guidelines

A short pathway guides for  the request process for Whole Genome Sequencing can be accessed in the drop down at the top of this page.

The HEE resource for guidance on elements of the consent conversation can be found here: 

Guide to requesting WGS in cancer

Genomics Education Programme Resources

There are many excellent education packages to support your genomic learning journey at Genomics Educational Resources

For more targeted Genomics Education resources to support Whole Genome Sequencing test pathway 

Whole Genome Sequence request need advice?

Contact us - fingers on a telephone number pad

If you require further information regarding genomic testing please contact the laboratory

Tel:0117 4146168 or SWGLHexports@nbt.nhs.uk

If you require support for navigating the pathway including completion of paperwork please contact the Genomic Healthcare Practitioners

email rduh.swgenomicpractitioner@nhs.net

 

Last updated 10/12/2024

Foundation Phase written guide

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This written guide was prepared to supplement the Foundation Phase Online Course videos, which can be found here. The guide suggests trying out changes in the way that you manage your ME/CFS, but we also know that these changes can be difficult to make. If you are finding it difficult to put any of these strategies into place, please discuss this with your individual clinician. This will usually be the clinician who assessed you.

This written information is available in a pair of pdf booklets with diagrams so if you would prefer to have the information in that format: please email BristolME@nbt.nhs.uk and ask the Bristol M.E. Service administrators to email you both of the Foundation Phase workbooks.

What is ME/CFS?

The main symptom of ME/CFS is a mental and physical fatigue which feels different from normal tiredness.Along with this are a range of other symptoms which can include:
- headaches
- widespread muscular and/or joint pain 
- sleep disturbance and unrefreshing sleep
- difficulties with concentration and memory (“brain fog”)
- feeling fatigued and ill after activities
- sore throats and tender glands
- dizziness and balance problems
- odd sensations like pins & needles and numbness
- sensitivity to light and noise
- digestive disturbance
Different people experience some symptoms more than others. For example, pain can be a big problem for some, and not for others. The condition affects people in different ways: some people are mildly affected, moderately affected, 
or severely affected. Some people have setbacks or relapses, other people are more stable.

 

What causes ME/CFS?

We often meet people who have developed ME/CFS following an infection, such as glandular fever. Other people have identified a significant amount of stress, or many stressful situations occurring together, or a long period of stress, which is thought to increase the odds of developing ME/CFS. A combination of an infection and stress is commonly reported. Occasionally, it seems to come “out of the blue”. Researchers are beginning to put together a picture about how the condition develops and the changes which take place in the body as a result of illness, but the exact mechanisms underlying ME/CFS are still unknown. Our current understanding is that the immune system and the nervous system are likely to be involved in ME/CFS. It is possible that the potential to develop ME/CFS may be partly connected with our genetic makeup. When an individual develops ME/CFS their external appearance does not usually change. This sometimes leads people who do not know anything about ME/CFS to conclude that it is a psychological problem. ME/CFS is not a psychological condition, but what we think and how we respond physically in this situation can influence the course of the illness in a helpful or an unhelpful way. With ME/CFS the body’s systems are said to have become poorly regulated and hypersensitive. The body is in a constant state of “high alert” almost as if a switch has been thrown and the whole system is in a state of emergency. This is thought to be why the stressors such as noise, light or physical activity can have a big impact on the symptoms of ME/CFS. 

Approach used by the Bristol M.E. Service

Our Service aims to help patients and their doctors to identify the condition, and then offers support to manage it as effectively as possible. This guide is put together to accompany our “Foundation Phase” ME/CFS self-management course. It also supports the individual work done between one of our clinicians and a person with ME/CFS who is trying to improve their management of the condition. The manual covers a wide range of issues which are important to our patients. You will need to work with your clinician to work out the best self management strategies for you and your particular situation.

The Consequences of ME/CFS

These are some of the consequences of having ME/CFS which our patients report:
- it’s hard to plan
- paid work, voluntary work and housework are affected
- it can be hard to get refreshing sleep
- it affects relationships with family and friends
- physical activity is reduced
- it’s hard to concentrate for work and study
- pleasurable activities are often stopped
Planning can be difficult because “ups and downs” in the condition are common. 

The Activity Cycle – “Boom and Bust”

People with ME/CFS often describe having varying amounts of fatigue from one day to another or even within the same day. This can make it difficult to decide whether or not to attempt an activity. Most people tend to do more when they feel a bit better and not as much when they feel unwell. You may find that you “overdo it” one day and then have several days recovering. This can lead to big swings in activity over time: this is known as the “boom and bust” approach or “activity cycling”. A graph of activity plotted over the days would show the “ups” of increased activity, and the “downs” of the recovery phase, looking a bit like a rollercoaster.

The signals that the body produces can sometimes be an unreliable guide as to what we should or should not be doing “in the moment”. This is very different from more recent or “acute” illnesses such as having a stomach bug. With an acute infection, the body reacts by making us feel unwell so that we rest more. When we feel better this is a sign that the illness has passed and we can get going again. ME/CFS is different to an acute illness: listening to the body on a moment-by moment basis to decide what we should or shouldn’t do is often unreliable because of the delayed increase in symptoms after activity known as Post Exertional Malaise. On days when you feel slightly better it is not necessarily a sign that the illness is passing. A different set of tactics is needed to manage ME/CFS effectively.

How can this ‘boom and bust’ approach to activity be changed?

- Recognise that this is how you tend to approach activity.
- Keep records such as an activity diary, this helps you to work out your baseline, and any planned increases later on. You might find it helpful to keep an activity diary.
- Analyse how much of an activity you can do on a good day and a bad day. Find a manageable level you could sustain: a similar amount each day. In practice, this will usually mean that you set a baseline of activity which starts out being lower than you would normally do on a good day. See section below on setting baselines.
- Balance periods of activity with regular short rests. See section below on pacing.
- Set realistic goals to help bring about change. You can discuss goalsetting with your clinician in your individual appointment.

What is Pacing and how can it help?

Pacing is all about balancing daily activity and rest to get control over a “boom and bust” pattern. The word ‘activity’ is used in a broad sense, to include mental and emotional activity, as well as the more obvious physical sort. Pacing is also known as “activity management” or "energy management". To understand pacing, it can be helpful to think of your available energy as being like a mobile phone battery:
- If you completely drain the battery, you have to wait to recharge it before you can use the phone again.
OR
- If you use some of the battery and make regular top-ups, then your phone will always be ready for use.

Before you start pacing you need to keep a record of your activity levels. You then need to decide on a baseline level of activity which you could do day after day, all things being equal. You would then try and keep your activity close to your baseline level. This will mean “holding back” on a better day. By holding back on a good day, you should have fewer bad days, and life becomes more predictable. There may still be some ups and downs with symptoms, for a range of reasons, such as poor sleep or infections. Pacing gives you awareness of your own abilities and limitations, which enables you to plan the way that you use your energy, prioritising what you can do with it. The graph of activity for someone who is pacing themselves would show a similar amount of activity on more days that the Boom and Bust pattern. Pacing can also provide a stable foundation of activity to build up from.

Many people have setbacks, when their symptoms get worse for a period of time. We advise people to ‘pace down’ during these times, and work to a lower baseline. People can then gradually ‘pace up’ again as they recover from the setback. This is like moving up through the gears of a car, rather than jumping straight into fourth gear on the first good day after a setback. We have a separate information sheet about managing setbacks. Over a period of time, when you can consistently manage your baseline level you may find you feel you can manage a bit more and can consider trying a small increase. This is sometimes called ‘pacing up’. Your clinician can support you with ‘pacing up’ activities if you’d like to try this approach.

What pacing is NOT about

It can be as important to understand early on what pacing is not about. It does not give you a free hand to push through activities, with enforced rest and recuperation (also known as “crashing”) afterwards. Pacing takes an altogether smoother approach:
- If you are prone to trying to cram in as much activity as you can in the morning, then have to rest during the afternoon or the next day to recover, pacing helps you to break this habit. 
- Similarly pacing discourages you from gathering energy through the day and then attempting a burst of activity later in the afternoon or evening.
Having said that, one of the advantages of knowing your baseline levels for different activities is that you know beforehand when you are likely to “overdo it”. This helps if you are likely to be overdoing it because you need to, or because you want to. You then know that you are likely to need to rest more afterwards and can make arrangements. This knowledge increases the amount of control you have over situations.

“Stop rules”: four different ways of knowing when to stop an activity

There seem to be four main ways that people use to know when to stop activities. It is worth knowing about these “stop rules”, so that you can learn which one you use most of the time. You may then choose to use other “stop rules” to get more control.

Stop Rule 1. “Fighting it”.This is somebody who tries to carry on with activities until their symptoms become so intrusive they have to stop. They “hit the wall”. They may say: “I won’t let it beat me: I carry on until I have to stop”. In this situation, they rely upon severe, intrusive symptoms to tell them when to stop activities. This person is more likely to fall into the Activity Cycle trap. However, they may get more done in the short term.

Stop Rule 2. “Listening to my body”. Some people notice a gradual increase in symptoms, which they start to identify as warning signs to stop. They will stop their activities sooner than somebody who is “fighting it”. They may say: “I listen to my body: it tells me when to stop”. This person is less likely to fall into the Activity Cycle trap, if they are able to notice the warning signs in time. One of the downsides of this strategy is having to pay regular attention to these symptoms to watch out for the warning signs. For many people, the warning signs come too late, for example the next day: this is known as Post Exertional Malaise.

Stop Rule 3. “Time-contingent pacing”. Using this stop rule, people learn from experience how long they can successfully manage an activity for. They may use a diary to work out what they can manage sustainably, day after day. They may say: “I keep an eye on the clock, because I know my limits. That way, I have some energy left for later”.

Stop Rule 4. “Activity-contingent pacing”. Using this stop rule, people learn from experience how much of an activity they can manage successfully. They may say: “I can iron two 
shirts, then I have a rest, even if I feel I could do a third one straight away”.

Think about the four ways of knowing how to stop. Which one do you use more often? What are the “pros and cons” of the different stop rules? Remember, ME/CFS symptoms usually 
feel worse a day or two after activity, so they are often not a reliable guide as to when to stop. Setting a baseline uses either the third or fourth stop rule. An 
amount of time or activity is worked out that can be used as a guide to know when to stop. 

Baselines - knowing when to stop, to avoid the activity cycle

- Find a low level of activity that you could manage on a daily basis: this is your “baseline”.
- Aim to keep your activity at your planned baseline level: don’t be tempted to do more on a good day.
- Aim to do the activity on most days to avoid falling into the Activity Cycle trap. Establish a routine.
- Use a recording system to allow you to keep track of your baseline, until it becomes “second nature” to be aware of it.

One way of setting a Baseline: the "50% rule”

- Start by trying an activity at a level that you think you will cope with easily. Don’t feel that you need to push yourself to achieve your “personal best”.
- Record your achievements.
- After three days, work out the average that you have managed. Then decide whether you will realistically manage to keep up this average; if not you may need to lower your sights, perhaps reducing your baseline to 50% of the average. 
- Remember: you are aiming for a sustainable level which could then perhaps be built on to gain medium and long term improvements, not a quick change!

It is possible to work out your baseline for walking, or other activities which are important for you such as reading, computer use, and social activities. Once you have worked out your baseline, aim to stick to it until you are confident that your baseline is normally manageable.

Activity analysis

Activity levels can be analysed by being aware of the amount and intensity of energy required. It can be helpful to think of activities arranged along a line with sleep and rest at one end and high energy activities at the other. Balance is required - how would you feel if a day consisted of entirely low and restful activities? Or if they were all high? If you do have a day like this what happens? Many people report that this is what the boom and bust cycle feels like - a day or days or a part of a day doing high level activities then a long time recovering and only being able to do low or restful activities.It can be helpful to know what activities you find restful, low demand, medium and high demand, and try and get some balance between the different levels. You can use this awareness to plan your day or your week so that the activity types are spread out. 

A patient’s story

One of our patients has kindly agreed to be videoed talking about her story. Her name is Meline. In the video, she talks about the symptoms that she had and the difficulties they were 
causing in her day-to-day life. She also describes the strategies that helped her to gain more control over her ME/CFS and make progress with her goals. 
We thought that it may help you to listen to Meline’s story, particularly if you have recently been diagnosed and are in the early stages of learning about ME/CFS.
The video is available from the North Bristol NHS Trust website. To access the video, follow this link: www.nbt.nhs.uk/melinesstory

Rest: ways of using rest, and how to get good quality rest

Rest can be used to both conserve the energy you have and to recover from expending energy. Quality, recuperative rest is not the same as sleeping or low-demand activity, such as reading or watching TV. Being able to rest effectively can shorten your rest periods and can enable you to do more of the things you want to do. Long periods of rest can lead to a loss of fitness, so shorter, more effective rests can also stop you becoming weaker. Quality rest can involve learning relaxation methods such as progressive muscle relaxation, ‘grounding’, or relaxed breathing to relax body and mind. 
Effective relaxation can then become part of your life, and how you manage your energy. Here are some ways you can go about using rest. We would suggest you try these as an experiment - work out what works for you.
 
1. Plan your rests for the day: this helps you regulate your energy expenditure over the day and makes sure you do stop and rest. One advantage of having regular planned rest is that the body learns when it is rest time and goes into a deeper relaxation more efficiently.
2. If you have a high energy demanding activity in your day, plan to rest before you do the activity and afterwards too.
3. Once you have learnt a relaxation method, then try making an activity easier by using the method, for example using a breathing exercise while waiting in a shopping queue or sitting on the bus.
4. Try taking a quick “breather” every hour - 2 minutes or even less of a breathing exercise may help to reduce the energy drain. One way of thinking of this is to call it a “non smoking fag break!”
5. If you are watching TV, then try and do a relaxation method before you turn on the TV , or in breaks between programmes.

Planning rest

When scheduling your day/week think about the following:
- When are your high level activities today / this week?
- Can you use rest before and after these high level activities?
- Can you use low level activities in addition to rest?
- Can you use relaxation techniques in addition to rest?
- When else can you use rest to help you with your activities?

ME/CFS and Sleep

Most people with ME/CFS experience sleep difficulties. Some people will have difficulty falling asleep, or have broken sleep. Some people will have the opposite problem, and will sleep more than usual. This can reduce the quality of sleep, and leaves fewer hours awake to function. A sleep problem will usually add to the various other difficulties which already occur as a result of ME/CFS. Exhaustion and poor concentration are examples of this.

Can anything be done about sleep?

ME/CFS may cause problems with sleep, especially unrefreshing and disturbed sleep, but this is rarely the only reason why sleep is disturbed. The good news is that these other influences can be changed to improve sleep.

What is a normal good night’s sleep?

This varies from one person to the next, and changes as people get older. New born babies sleep for 18 out of 24 hours, young children up to 12 hours, young adults on average sleep for about 7 to 8 hours, whilst older people take even less, about 6 hours on average. So, how does your sleep compare with what you would expect to be getting? If you are concerned about this 
the next question is:-

What is the nature of the problem?

Is there a problem getting off to sleep? Do you keep waking up throughout the night? Do you wake early and cannot get back to sleep again? Is it that despite having slept you don’t feel you have slept well? Do you feel the need to sleep longer in the morning, go to bed early, or sleep in the daytime? Over-sleeping can increase levels of fatigue, worsen concentration, and reduce motivation and enjoyment of life. It is important to work out what kind of disruption is taking place. This helps in deciding what changes might help.

What conditions are you trying to sleep in?

Give some thought to how comfortable your bed is. Next, is the room helping? Temperature is important. It’s hard to sleep when it’s too warm as well as when it’s too cold. Are there any noises disturbing you which you could do something about? Some people are better able to sleep when there is a little noise going on in the background, and can’t sleep when it’s too quiet. 
What is the ventilation like? Some prefer a window open but others find it too cold or a distraction. Try to get the conditions right to suit your needs.

Food and drink

Going to bed after a big meal is usually a bad idea. Big meals do make people feel tired but digesting a large amount of food will keep many people awake. If on the other hand it has been a long time since your last meal, then hunger can keep you awake. If so, a light snack before bedtime may help.A hot drink often helps as a way of settling down to go to sleep. 
However, drinks with caffeine or other stimulants in them are not a good idea. These include coffee, tea and chocolate. Caffeine is a stimulant and is known to disturb sleep. This effect will last for several hours after drinking it. The more caffeine you have in the day the more likely it is to affect your sleep. If you do have drinks with caffeine in, and you do have sleep difficulties, then it is worth cutting the caffeine level down. It can help simply to avoid caffeine in the six hours before bedtime. Some people need to avoid caffeine in the afternoon and evening altogether. 
Alcohol is, in a sense a relaxant, (the opposite effect to caffeine). On the face of it a late drink might help you get off to sleep, hence the idea of a “nightcap”. However, there is some evidence to suggest that sleep which is affected by alcohol is less restful, and also alcohol can make many people with ME/CFS feel worse. 

Smoking and sleep

Nicotine is a stimulant, like caffeine, and there is strong evidence that smokers usually don’t sleep as well as nonsmokers. Happily, for those who give up smoking the evidence shows that they get off to sleep more easily within days of stopping. For those who don’t want to stop but are having problems getting off to sleep it is worth trying not to smoke in the three hours before bedtime. This will probably make sleeping worse to begin with as your body gets used to not having the nicotine, but you will quickly adjust, probably within three days.

Medications and sleep

Different medications do have important effects on sleep. If pain is disrupting your sleep, it might be worth discussing the pros and cons of different pain medication with your GP or a pharmacist. Simple painkillers can help, but some people benefit from medications like Amitriptyline, taken in very low doses, about two hours before bedtime. Your GP can find advice about sleep and symptom management in a guide available from the British Association of Clinicians in ME/CFS called the “BACME Guide to Symptom Management”. You can find this at the bottom of the home page of the BACME website: www.bacme.info

Physical activity and sleep

There are strong links between physical activity and good sleep. ME/CFS leads people to be less active during the day. This will make sleeping more difficult. On the other hand if you have been able to gradually increase the amount of activity you do in the day you may be already reaping one of the benefits: better sleep. Brisk exercise taken late in the evening tends to liven people up when it would be better to wind down. Some people manage gentle exercise such as stretching in the evening 
without disrupting their sleep.

Emotions and sleep

Some people will say that they do their worrying at night when everyone else is asleep. Although you might say that there’s nothing you can do when you’re in bed to sort your anxieties out, it’s sometimes hard not to worry anyway. If you want time to think things through on your own, it can be better to do this earlier in the day. Plan a time earlier in the day to think about your concerns, perhaps writing them down, as many people have found this process useful. Try to associate going to bed with going to sleep.
Some people will wake in the night and find they are unable to go back to sleep. If this is happening, and if you think that you are not restful and are likely to not drift off to sleep again afterwards then it can be better to get up and do something quiet, and preferably boring until you start to feel sleepy.

The golden rule for good sleep: establish a regular pattern

It’s possible to ignore most of the rules about sleeping and still manage all right. There are many who have a cup of tea and cigarette before going to bed, or who take the dog for a walk. They probably manage this because it is part of a regular habit of getting ready to go to bed. However being inconsistent with the time that you sleep is asking for trouble. You need a pattern. 
Taking care of this is by far the most important thing you can do. Getting up late one morning, and then early the next is disruptive to sleep. Your body needs a pattern. It needs to know when to expect to sleep and to wake. We can’t change the time of sleep a lot and assume our bodies will adjust. This is basically what has gone wrong when someone flies to another part of the world and experiences “jet-lag”. Another example is what is known as “Sunday Night Insomnia”, when someone who has gone to bed late on Saturday night and got up late on Sunday morning then finds that they can’t get off to sleep at the usual time on Sunday evening. If you want to improve your sleep at night and you sleep in the day, make a plan to gradually reduce any daytime naps, because otherwise this will become part of your 24 hour pattern. Daytime sleep can reduce the quality of night-time sleep. This is because it changes the pattern of deep (restorative) sleep which we get in the night. The only exception to this is a daily “power nap” of 20-30 minutes which can help some people to reduce daytime sleepiness. 

If you sleep for much more than eight hours, it might be worth trying to reduce your sleep, so that your sleep quality can increase. You will need to do this gradually, to allow your body to adjust. Most people find it is easier to set an alarm clock for a fixed time in the morning, and then slowly move the alarm clock earlier. There is nothing wrong with a 10 or 15-minute 
change every week or two, if you are making progress in the long-term. The reason for making the change in the morning is that our “body clock” is set when we first see daylight in the morning. Once the “body clock” is set, we will tend to feel naturally ready for sleep approximately 16 hours later. Opening the curtains a little can help with this process, but the sooner in the day that you can tolerate outdoor daylight the better. 
During the initial phases of any sleep reduction program people often feel more tired, but this usually improves within two to three weeks. The rewards for this in the long-term are better sleep quality, and more hours in the day in which to balance activity and rest.

Sleep summary

- Good sleep is about quality not quantity. 
- Gradually reduce daytime sleep. Substitute with more rest periods.
- Aim for a regular bedtime, and more importantly, stick to a regular time to get up. 
- A good balance between activity and rest during the day will help. 
- During the evening, particularly just before bedtime, it helps to have a regular set of activities that help you to wind down. Take less exercise at this time of day, avoid stimulants such as coffee, and avoid other things that wind you up. 
- If you wake in the night and can’t get back to sleep straight away (20 minutes) you might do better to get up. Try to relax and take rest instead. Only go back to bed when you have a good chance of falling asleep again.

ME/CFS and Stress

Stress is a normal reaction to the challenges we face in life. A certain amount of stress is necessary to keep us all going; without it, we would feel bored and listless. However, continued stress over a long period of time can be exhausting, and if your energy levels are low due to ME/CFS, the additional drain on energy because of stress is a particular problem. People differ both in the way that they react to stress and the extent to which they are aware of their own stress levels. Stress may have different effects at different levels: it may affect us biologically, physically, emotionally and in the way that we behave. It can also have cognitive effects: poor concentration, memory problems, and difficulties making decisions. All of the reactions above are normal. When we face a physically threatening situation these responses help the body prepare itself for action. This is known as the “Fight or Flight” response because the body prepares itself to fight, or run away from dangerous situations. This is a helpful, instinctive response. When the dangerous situation is over, the body can begin to recover. In modern society, a lot of the things that create stress are not dangerous situations where we can physically fight or run away from something. For example, financial worries or family problems can make us feel under stress. In these situations stress levels may rise and remain quite high, and after a while we may begin to feel the effects of this. Over a long period of time stress can make us feel exhausted and unwell. Some of the symptoms of chronic stress are the same as those of ME/CFS. How can we know which is which?

Managing ME/CFS and stress

Long term illness can cause its’ own worries. Worrying can trigger the stress response, and muscles then become tense. Changes in muscle tension can be quite subtle, and it is difficult to be aware of it happening. This increased tension can worsen fatigue, and aggravate any pain, leading to more stress and worry: a “vicious circle”.

We also tend to put ourselves under stress by doing some of the following things:
- Taking on more than we can do
- Not saying “No” to people
- Not being satisfied with what we have achieved
- Not having enough relaxing things to do
Being aware of some of these things can be useful. There are positive management strategies for stress, and for the symptoms of stress.

Reducing stress through relaxation

Most people already have things they tend to do when they feel quite stressed - there are lots of possible ways of tackling it. For example, some people listen to music, talk with a friend, or go for a walk. Regular exercise can also help to reduce tension in the muscles, and give a feeling of wellbeing. Sometimes your usual methods of handling stress may become less effective when stress rises beyond a certain point. It is useful during these times to have some specific methods of dealing with it.
It can be useful to become aware of the signs of increased tension and stress so we can spot them at an early stage, and manage the stress differently. Listening to a relaxation is one way of beginning to become more aware. Learning to relax means that you can reduce muscle tension and break out of the vicious cycle of fatigue, stress and tension, which can be worsened when living with ME/CFS. Relaxation is different from watching TV or reading a book; these activities may be tiring in their own right. When practising relaxation you need to find somewhere quiet and warm, where you can find a comfortable position and you will not be interrupted. 
At the beginning relaxation may be frustrating if you find it difficult to concentrate or feel it is not working. It is a skill, and is likely to take a bit of practice. Remember that there are different forms of relaxation, to meet individual preferences. It is worth seeing the initial stages as an investment of time, which can pay dividends in the medium and long term. Daily practise will give the best results.

You can download relaxation recordings from our website: www.nbt.nhs.uk/relaxation. Start by listening to the guidance, then if you are happy with the instructions, try the method yourself. You may need to practice each method several times to learn how to relax. If you are not making progress with these recordings, please discuss this with your ME/CFS clinician.
Finally, be aware of any effects of stress upon your sleep, or upon your ability to use rest. If you notice that you are awake at night feeling stressed about not sleeping, you can try using your relaxation skills to help. Clock watching at night is a common mistake: it can increase stress levels and make it harder to sleep. Can you use relaxation methods to help you to sleep, or to help you to rest more effectively? You may also benefit form learning meditation, which is different from relaxation. You can discuss this option with your clinician if you are interested in finding out more.

SWGLH Sample Requirements and Transport

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Sample Requirements and Packaging

Sample Requirements

  1. Please ensure that the patient identity has been verified before taking the sample.
  2. For the majority of molecular genetics analysis tests, blood samples in EDTA tubes (2 x 4ml for adults, 2-5ml for children and 1-2ml for neonates) is required.
  3. For cytogenetic analysis, for example karyotyping or Fluorescent in situ hybridisation, a blood sample in Lithium Heparin (2-5ml for adults/children and 1-2ml for neonates) is required.
  4. Chorionic villus samples or products of conception should be sent in transport media if you require this please contact the laboratory. Please see guidance for Solid Tissue Biopsy.
  5. Testing for facioscapulohumeral muscular dystrophy requires a larger volume of blood - minimum of 8ml in EDTA tube is requested
  6. For samples requiring RNA analysis there is a 72 hour cut-off for receipt of samples as reliable quantitation is not possible from follow-up samples older than 72 hours. Samples received that are older than 72 hours will not be processed and a repeat sample will be requested.
  7. For inherited cancer testing blood samples should be kept at room temperature or at 4oC and not be frozen before dispatch. They should be sent to the SWGLH to arrive within 1-3 days of sample collection.
  8. For other types of sample please contact the laboratory.

If any of the above requirements are not adhered to, this may result in rejection of the sample.

Packaging

Unless advised otherwise samples should be sent at room temperature. If there is a delay in sending most samples can be refrigerated at +4 degree Celsius for a few days without affecting quality.Amniotic fluid and chorionic villus samples should be transported to the laboratory urgently and should not be refrigerated.

Failure to adhere to this guidance or delays in transit could result in failure of the test.

The sample container should be leak-proof and must be placed in a transparent sample bag with the paperwork attached but not in the same compartment as the container. The outer sample packaging must comply with PI 650 for category B substances. The package should be clearly labelled 'diagnostic specimen UN3373'.

High Risk Specimens

If the sample is known to be high risk this should be clearly stated on the request form and sample container. Please contact the laboratory with any queries regarding the appropriateness of sending any potentially high risk samples.

Last updated 09/04/2024

Request Form Library

Please note that failure to use SWGLH referral forms for requesting tests will lead to a delay of genetic results and therefore could adversely affect patient management.

1. The editable request form is for use for the majority of Rare Disease clinical indications. It may also be used for phlebotomy and requests for DPYD. 

2. For non-haematological cancers the request forms are:

  • Solid tumour
  • Sarcoma

 

 

  • Circulating DNA
  • Neuropathology

3. Haematological cancers 

  • Bristol Haemato-Oncology Diagnostic Request Form

4. Request forms for Whole Genome Sequencing

5. Facioscapulohumeral muscular dystrophy (FSHD) Clinical Proforma

 

 

6. Combined HNF1B Patient and Clinical Information Sheet

 

 

7.  Familial Chylomicronaemia (FCS) Genetic Testing Request Form

Guidance documents

Quick links to guidance documents can be found below. Please also visit the sections on the left hand menu for further information.

Haematology

Guidance for the Management of possible Germline Variants Identified During Routine Genomic Testing in Haematology

Sample Labelling and acceptance

The minimum labelling requirements for the sample container are

  • Full Name (forename and surname)
  • One other unique identifier (Date of Birth/Unit No./NHS No.)

The request form must also include the same identifiers.

In addition the request form should include the following information:

  • Patient Forename
  • Patient Surname
  • NHS Number
  • 1st Line of Patient Address
  • Patient Postcode
  • Patient Date of Birth
  • Referrer Name (surname and first initial)
  • Referrer Facility
  • Hospital Number (if applicable)
  • National genomics test directory clinical indication code e.g. R53 Fragile X
  • Full clinical details of the patient being tested
  • Secure email address for return of reports

Please note any samples that do not meet the above requirements may be rejected.

For Non NHS England referrals please also provide billing information including any purchase order references.

Consent

It is the responsibility of the clinician to obtain consent for genetic testing and storage. The laboratory assume this has been done upon receipt of the request form and do not check consent has been obtained. Please refer to the guidelines from the Joint Committee on Medical Genetics.

Receipt of the sample and request form establishes an agreement to perform genetic testing.

The following must be clearly stated on the referral form:-

  • Test required
  • Clinical features
  • Relevant family history
  • Mother’s details for prenatal testing requests

Sample Transport

For the majority of routine priority specimens Royal Mail can be used. For urgent specimens where there is no inter site transport it is recommended that an approved courier service be used. For Rare Disease tests please send the sample to your nearest Genetics Laboratory (in the South West this will be Bristol genetics Laboratory or Exeter Genomics Laboratory (addresses below).

For samples requiring RNA analysis there is a 72 hour cut-off for receipt of samples as reliable quantitation is not possible from follow-up samples older than 72 hours. Samples received that are older than 72 hours will not be processed and a repeat sample will be requested.

For the Trusts in the north of our region (Gloucestershire Royal Hospital to Weston General Hospital) there is inter site transport – please contact your Pathology Logistics Lead for information.

For Trusts in the south of the region Bristol Genetics Laboratory use the Cervical Screening (HPV) Transport service provided by City Sprint.

If you have any enquiries please contact: SWGLHenquiries@nbt.nhs.uk

Please address samples to:


Bristol Genetics Laboratory
Pathology Sciences Building
Southmead Hospital
Westbury-On-Trym
Bristol
BS10 5NB

For Rapid Whole Genome Sequencing:

Exeter Genomics Laboratory
Level 3 RILD building
Royal Devon & Exeter NHS Foundation Trust
Barrack Road
Exeter
EX2 5DW

Bristol Genetics Laboratory Testing Terms and Conditions

Bristol Genetics Laboratory (BGL) Standard Terms For The Supply Of Genetic Laboratory Testing Services

Please note these terms and conditions solely apply to requests made outside of any dedicated contract or SLA that may have been agreed.

Agreement for the supply of genetic laboratory testing services by Bristol Genetic Laboratory (“BGL”) as part of North Bristol NHS Trust (“Provider") at Southmead Hospital, Southmead Road, Bristol BS10 5NB to you, the purchaser of such services ("Purchaser")

 

(A) You have submitted a request to the Provider, via a form contained at SWGLH Sample Requirements and Transport | North Bristol NHS Trust (nbt.nhs.uk) (“Request Form”), for the provision of specific genetic laboratory tests (“Services”).

(B) Each Request Form (howsoever sent to the Provider) shall be deemed to be an offer by the Purchaser to purchase the Services pursuant to the terms of this Agreement.  The Provider may, at its complete discretion, refuse to accept any Request Form.

(C) Each accepted Request Form shall constitute a separate Agreement, which shall expire on completion of the provision of the relevant Services by the Provider.

(D) The Purchaser shall be responsible for ensuring the accuracy of the content of any Request Form (including the Services requested and any test directory clinical indication code/name).

(E) Notwithstanding its acceptance of any Request Form, the Provider may cancel this Agreement at any time before the Services are delivered by giving written notice to the Purchaser.  The Provider shall not be liable for any loss or damage whatever arising from such cancellation.

(F) In submitting a Request Form, you are confirming your acceptance of the terms and conditions contained within this Agreement.

(G) This Agreement shall apply to the Services provided to you by the Provider to the exclusion of all other terms and conditions, including any terms and conditions which you may purport to apply to any order (including the Request Form), confirmation of any order (including any Purchase Order) or similar document or in any correspondence.

(H) No variation to the terms of this Agreement shall be binding unless agreed in writing by an authorised representative of the Provider.

(I) This Agreement (including the documents referred to in this Agreement) supersedes all prior representations and agreements between the Parties (whether written or oral) relating to the Services and sets forth the entire agreement and understanding between the Parties.  Each Party warrants to the other that it has not relied on any representation or agreement (whether written or oral) not expressly set out or referred to in the Agreement. 

IT IS AGREED as follows:

1 Defined Terms and Interpretation

1.1 In this Agreement, save where the context requires otherwise, the following words, terms and expressions shall have the following meanings:

2000 Act

means the Freedom of Information Act 2000;

2004 Regulations

means the Environmental Information Regulations 2004;

Assigned Role” 

means the profession, employment, office, works, duty, position and/or licence held by a member of the Provider Staff from time to time assigned by the Provider for the purpose of performing its obligations under this Agreement;

"Confidential Information"

any information or data in whatever form disclosed, which by its nature is confidential or which the disclosing Party acting reasonably states in writing to the receiving Party is to be regarded as confidential, or which the disclosing Party acting reasonably has marked ‘confidential’ (including, financial information, or marketing or development or workforce plans and information, and information relating to services or products) but excluding Personal Data (to which the provisions of Clause 18.5 and 18.6 shall be applied), or information which is disclosed in accordance with 2000 Act or 2004 Regulations or information which is published as a result of government policy in relation to transparency;

"Contract Price"

means the sums detailed in the price list for the Services (as updated from time to time), which is available from the Provider on request;

Data Controller

has the meaning given in Data Protection Legislation;

Data Processor

has the meaning given in Data Protection Legislation;

Data Protection Legislation

means:

(a) UK GDPR and the Data Protection Act 2018 to the extent that each relates to processing of personal data and privacy; and

(b) all applicable Law about the processing of personal data and privacy;

"Dispute Resolution Procedure"

means the procedure set out in Clause 17;

“Equality Legislation”

means any and all legislation, applicable guidance and statutory codes of practice relating to equality, diversity, non-discrimination and human rights as may be in force in England and Wales from time to time including, but not limited to, the Equality Act 2010, the Part-time Workers (Prevention of Less Favourable Treatment) Regulations 2000 and the Fixed-term Employees (Prevention of Less Favourable Treatment) Regulations 2002 (SI 2002/2034) and the Human Rights Act 1998;

"Force Majeure Event

means an event or circumstance which is beyond the reasonable control of the Provider, including war, civil war, armed conflict or terrorism, strikes or lock outs, riot, fire, flood or earthquake and which directly causes the Provider to be unable to comply with all or a material part of its obligations under this Agreement in relation to the Services;

GDPR

means the General Data Protection Regulation (Regulation (EU) 2016/679);

"Good Clinical Practice"

means using standards, practices, methods and procedures conforming to the Law and reflecting up-to-date published evidence and using that degree of skill and care, diligence, prudence and foresight which would reasonably and ordinarily be expected from a skilled, efficient and experienced clinical services provider and a person providing services the same as or similar to the Services at the time the Services are provided;

 

"Good Industry Practice" 

means the exercise of that degree of skill, diligence and foresight which would reasonably and ordinarily be expected from a skilled and experienced service provider engaged in the provision of services similar to the Services under the same or similar circumstances as those applicable to the Agreement and which are in accordance with any codes of practice published by relevant trade associations;

Good Practice

means Good Clinical Practice and/or Good Industry Practice, as appropriate;

Guidance

means any applicable health or social care guidance, guidelines, direction or determination, framework, standard or requirement to which the Purchaser and/or the Provider have a duty to have regard (and whether specifically mentioned in this Agreement or not), to the extent that the same are published and publicly available or the existence or contents of them have been notified to the Provider by the Purchaser and/or any relevant Regulatory or Supervisory Body;

Indemnity Arrangements

means:

(a) a policy of insurance (with an insurer of good repute);

(b) an arrangement made for the purposes of indemnifying a person or organisation; or

(c) a combination of (a) and (b);

"Indirect Losses"

means loss of profits (other than profits directly attributable to the provision of the Services), loss of use, loss of production, loss of business, loss of business opportunity, loss of reputation or goodwill or any other consequential or indirect loss of any nature, whether arising in tort or on any other basis;

"IPR"

means inventions, copyright, patents, database right, trademarks, designs and confidential know-how and any similar rights anywhere in the world whether registered or not, including applications and the right to apply for any such rights;

"Law"

means:

(a)          any statute or proclamation or any delegated or subordinate legislation;

(b)         any enforceable community right within the meaning of section 2(1) European Communities Act 1972;

(c)          Guidance;

(d)         any judgment of a relevant court of law which is a binding precedent in England; 

 (f)         any relevant code of practice,

in each case applicable and in force in England;

Losses

means all damage, losses, indebtedness, claims, actions, cash, expenses (including the cost of legal or professional services, legal costs being an agent/client, client paying basis), proceedings, demands and charges whether arising under statute, contract or at common law but excluding Indirect Losses;

"Month"

means a calendar month;

"Party"

means either the Provider or the Purchaser individually and "Parties" refers to both the Provider and the Purchaser together. A Party shall include all permitted assigns of the Party in question;

“Patient Safety Incident”

means any unintended or unexpected incident which could have or did lead to harm to one or more patients or service users;

“Personal Data”

has the meaning given in Data Protection Legislation;

“Process”

has the meaning given in the Data Protection Legislation and “Processed” and “Processing” shall be construed accordingly;

"Prohibited Act"

means that Party:

(a) offering, giving, or agreeing to give the other (or any of their officers, employees or agents) any gift or consideration of any kind as an inducement or reward for doing or not doing or for having done or not having done any act in relation to the obtaining of performance of this Agreement or any other agreement with the other Party, or for showing or not showing favour or disfavour to any person in relation to those agreements; and 

(b) in connection with this Agreement or any other agreement with the other Party, paying or agreeing to pay any commission, other than a payment, particulars of which (including the terms and conditions of the agreement for its payment) have been disclosed in writing to the other; or 

(c) committing an offence under the Bribery Act 2010;

Provider Staff

means all persons (whether clinical or non-clinical) employed or engaged by the Provider (including volunteers, agency, locums, casual or seconded personnel) in the delivery of the Services and/or the performance of its obligations under this Agreement; 

Purchaser Staff

means all persons (whether clinical or non-clinical) employed or engaged by the Purchaser including volunteers, agency, locums, casual or seconded personnel in the performance of its obligations under this Agreement; 

“Quarter”

means a period of three (3) Months commencing on 1 April, 1 July, 1 October and 1 January, and “Quarterly” shall be interpreted accordingly;

Regulatory or Supervisory Body

means any statutory or other body having authority to issue guidance, standards, or recommendations with which the relevant Party must comply or to which it must or should have regard, including:

(a) Care Quality Commission;

(b) NHS England & NHS Improvement;

(c) Department of Health;

(d) NICE; 

(e) Information Commissioner; and

(f) Healthwatch England,

including any successor body or bodies of the above;

Serious Incident

has the meaning given to it in the NHS Serious Incident Framework (available at: http://www.England.nhs.uk/ourwork/patientsafety/);

"Service Location"

means the location, premises and/or facilities identified in the Specification;

"Specification"

means the service specification set out in the Appendix;

“Staff”

means Purchaser Staff and/or Provider Staff as the context requires;

UK GDPR

the GDPR as incorporated into UK legislation by way of the European Union (Withdrawal Agreement) Act 2020 and as amended by the Data Protection, Privacy and Electronic Communications (Amendments etc) (EU Exit) Regulations 2019; 

VAT

means Value Added Tax or any successor tax from time to time;

"Working Day"

means a day (other than a Saturday or Sunday) on which banks are open for business in the City of London;

"Working Hours"

means 9am to 5pm on a Working Day.

1.2 In this Agreement, all references to any statute or statutory provision shall be deemed to include references to any statute or statutory provision which amends, extends, consolidates, or replaces the same and shall include any orders, regulations, codes of practice, instruments or other subordinate legislation made thereunder and any conditions attaching thereto. 

1.3 Unless the context otherwise requires, any reference to European Union law that is directly applicable or directly effective in the UK at any time is a reference to it as it applies in England and Wales from time to time including as retained, amended, extended, or re-enacted on or after 1 January 2021.

1.4 In this Agreement, any headings to Clauses and Paragraphs are for convenience only and shall not affect the meaning of this Agreement. Unless the contrary is stated, references to Clauses, Paragraphs and Appendices shall mean the clauses, paragraphs and appendices of or to this Agreement.

1.5 In the event of a conflict between the parts of this Agreement, the main body shall take priority over the Appendix.

1.6 Where a term of this Agreement provides for a list of items following the word "including" or "includes", then such list is not to be interpreted as being an exhaustive list.

1.7 In this Agreement, words importing any particular gender include all other genders, and the term "person" includes any individual, partnership, firm, body corporate, government, governmental body, trust, agency, unincorporated body of persons or association and a reference to a person includes a reference to that person's successors and permitted assigns.

1.8 In this Agreement, words importing the singular only shall include the plural and vice versa.

1.9 In this Agreement, reference to any body, organisation or office shall include reference to any other body, organisation, or office to which all or part of their respective functions are transferred from time to time (namely a successor body, organisation, or office). 

1.10 Except where an express provision of this Agreement states the contrary, each and every obligation of a Party under this Agreement is to be performed at that Party's cost.

1.11 In this Agreement, any obligation on any Party not to do or omit to do anything shall include an obligation not to allow that thing to be done or omitted to be done.

2 Services

2.1 In performing their respective obligations under this Agreement, each Party shall act in a timely manner and use all reasonable care, skill, and diligence in accordance with Good Practice.

2.2 The Parties shall ascertain, observe, perform, and comply with all relevant Laws, and shall do and execute or cause to be done and executed all acts required to be done under or by virtue of any Laws.

2.3 Subject to Clauses 2.7 and 12, the Provider will be responsible for providing the Services in accordance with the Specification. 

2.4 The Purchaser shall be responsible for meeting its obligations as detailed in the Specification.

2.5 The Parties will co-operate with each other in good faith, will comply with the reasonable requests of the other and will take all reasonable action as is necessary for the efficient transmission of information and instructions and to enable the Parties to perform their respective obligations in this Agreement.

2.6 If either Party becomes aware of any actual or potential problems that affect or might affect the performance of obligations under this Agreement, it shall notify the other Party as soon as reasonably practicable.

2.7 To the extent any act or omission of the Purchaser or Purchaser Staff prevents or delays the Provider from providing all or any part of the Services (and subject to the Provider taking reasonable steps to minimise and mitigate the impact of such prevention or delay), the Provider shall be relieved from meeting its obligations under this Agreement and the Purchaser shall not be entitled to bring a claim for breach of obligations under the Agreement insofar as such claim relates to such prevention or delay.

3 Equipment, Materials and Consumables

3.1 The Provider shall provide all equipment, materials, consumables, and other items required for the provision of the Services.

3.2 The Provider shall keep and maintain all equipment provided and/or used by the Provider in the provision of the Services in good repair and condition as necessary for the proper and satisfactory provision of the Services.

4 Use of the Service Location 

4.1 The Services shall be provided by the Provider from the Service Location.

5 Staff

5.1 The Provider shall assign to the Services at all times sufficient adequately qualified and trained individuals to provide the Services, who shall have the skills, competence, and expertise necessary and appropriate for the proper performance of the Services.

5.2 Prior to their engagement in the provision of the Services, the Provider must ensure that all of the Provider Staff:

5.2.1 have had their identity checked against original documentation to ensure that the information they have given to the Provider about their identity is genuine;

5.2.2 have the right to work in the United Kingdom;

5.2.3 have been subject to reasonable checks to ensure their suitability for the Assigned Role;

5.2.4 are capable and fit to undertake the Assigned Role, taking into account the requirements and risk associated with such role and the individuals with whom they may have contact;

5.2.5 are qualified and competent for the Assigned Role and (if applicable) are registered with any relevant professional body or bodies; and

5.2.6 meet the required standards of training, competency and conduct to safely undertake the Assigned Role.

5.3 In connection with the provision of the Services, the Provider must ensure that all of the Provider Staff:

5.3.1 where registered with any relevant professional body, (if applicable) have completed their revalidations by the appropriate professional regulatory body;

5.3.2 are appropriately supervised (including where appropriate through preceptorship, clinical supervision, and rotations arrangements), managerially and professionally;

5.3.3 are covered by the arrangements made by the Provider pursuant to Clause 11; and

5.3.4 are aware of and respect equality and human rights of colleagues, service users, carers, and the public. 

6 Monitoring

6.1 The Provider must comply with all reasonable written requests made by any relevant Regulatory or Supervisory Body (or its authorised representatives), the National Audit Office, the Audit Commission or its appointed auditors for entry to the Provider’s premises and/or any premises from which the Services are provided by it (including the Service Location) for the purposes of auditing, viewing, observing or inspecting those premises and/or the provision of the Services, and for information relating to the provision of the Services.

6.2 Subject to compliance with Law and Good Practice, the Parties must implement and/or respond to all relevant recommendations: 

6.2.1 made in any report by a relevant Regulatory or Supervisory Body;

6.2.2 of the National Audit Office or its appointed auditors following any audit; and

6.2.3 of any clinical audit (to the extent applicable to the Services). 

7 Records

7.1 The Parties agree to retain records relating to or generated through the provision of the Services in accordance with the requirements of Law.

8 Price and Payment

8.1 As consideration for the provision of the Services, the Purchaser shall pay the Provider the Contract Price.

8.2 Unless otherwise provided in this Agreement or agreed in writing by the Purchaser, the Contract Price shall include every cost and expense of the Provider directly or indirectly incurred in connection with the performance of its obligations under this Agreement, including the provision of the Services. 

8.3 The Contract Price shall be invoiced by the Provider Quarterly in arrears.  Each invoice shall be rendered on the Provider’s own invoice form and the following supporting information will be available:

8.3.1 the Services for which payment is claimed;

8.3.2 patient details and corresponding tests carried out (sent as a separate document via encrypted email to the email address detailed in the Request Form); and

8.4 any VAT payable in accordance with Clause 8.9,

together with such other information as may be required by Law, any Regulatory or Supervisory Body, or which may be reasonably required by the Purchaser.

8.5 Each invoice shall be issued by post to the Purchaser at the address detailed in the Request Form.

8.6 The Purchaser shall pay the Provider all invoiced amounts (excluding any bona fide disputed sums) no later than thirty (30) days after receipt of a valid invoice. An e-invoice may be validly disputed if the e-invoicing system operated by the Purchaser does not comply with European Standards on electronic invoicing.

8.7 Any disputed amounts shall be resolved through the Dispute Resolution Procedure. In the event that payment of disputed sums is agreed to be made pending resolution, such payment shall be without prejudice to the rights of the Purchaser to recover such sum in the event that the dispute is resolved or determined in favour of the Purchaser. Where it is agreed or determined that an amount withheld was payable or an amount paid was not payable then such amount shall be paid by the Purchaser or repaid by the Provider (as applicable) within ten (10) Working Days of the dispute being resolved or determined.

8.8 If payment of any invoiced amount (excluding any bona fide disputed sum) is not made by the Purchaser by the due date, then the Provider may apply interest at the rate determined under the Late Payment of Commercial Debts (Interest Rate) Act 1998 accruing on a daily basis until payment is made.

8.9 All amounts stated to be payable under this Agreement are exclusive of any VAT properly chargeable on any amount. Each Party shall pay to the other Party any VAT properly chargeable on any supply made to it under this Agreement provided that it shall first have received from the relevant Party a valid tax invoice in respect of that supply.

8.10 All sums shall be paid without deduction or set off.

9 Assignment and Sub-Contracting

9.1 Subject to Clause 9.2 and the Specification, the Purchaser shall not assign, sub-contract, novate or in any way dispose of the benefit and/or the burden of this Agreement without the prior written consent of the Provider (such consent not to be unreasonably withheld or delayed).

9.2 Nothing in Clause 9.1 shall prevent either Party that is a statutory body from assigning, novating, or otherwise disposing of its rights and obligations under this Agreement to its statutory successors or assigns including any successor of all or part of its functions, property, rights, and liabilities.

10 Liability 

10.1 Without affecting its liability for breach of any of its obligations under this Agreement, the Purchaser will be liable to the Provider for and must indemnify and keep the Provider indemnified against any Losses whatsoever in respect of:

10.1.1 any loss of or damage to property (whether real or personal);

10.1.2 any injury to any person, including injury resulting in death; and/or

10.1.3 a breach of Data Protection Legislation

that results from or arises out of the Purchaser’s negligence or breach of contract in connection with the performance of this Agreement (including the acts and omissions of the Purchaser Staff) except to the extent such loss, damage or injury has been caused by any act or omission by or on the part of, or in accordance with the instructions of, the Provider or the Provider Staff.

10.2 Without affecting its liability for breach of any of its obligations under this Agreement, the Provider will be liable to the Purchaser for and must indemnify and keep the Purchaser indemnified against any Losses whatsoever in respect of:

10.2.1 any loss of or damage to property (whether real or personal);

10.2.2 any injury to any person, including injury resulting in death; and/or

10.2.3 a breach of Data Protection Legislation

that result from or arise out of the Provider’s negligence or breach of contract in connection with the performance of this Agreement or the provision of the Services (including its use of equipment or other materials or products and the acts and omissions of the Provider Staff), except to the extent such loss, damage or injury has been caused by any act or omission by or on the part of, or in accordance with the instructions of, the Purchaser or the Purchaser Staff.

10.3 Nothing in this Agreement shall exclude or limit the liability of either Party to the other Party for: 

10.3.1 any liability in respect of claims relating to death or personal injury caused by the negligent acts or omissions of such Party;

10.3.2 any liability arising out of fraud or fraudulent misrepresentation by such Party or any of its Staff; and

10.3.3 any other liability which cannot be excluded by Law.

10.4 Subject to Clause 10.3, neither Party shall under any circumstances whatsoever be liable to the other Party, whether in contract, tort (including negligence), breach of statutory duty, or otherwise, for any Indirect Losses arising under or in connection with this Agreement.

10.5 Subject to Clause 10.3, the Provider’s total liability to the Purchaser under or in connection with this Agreement, whether in contract, tort (including negligence), breach of statutory duty or otherwise will not exceed a sum equal to the total Contract Price payable for the Services.

10.6 Each Party will at all times take all reasonable steps to minimise and mitigate any losses or other matters for which one Party is entitled to be indemnified by or to bring a claim against the other under this Agreement. 

11 Indemnity Arrangements 

11.1 The Provider must put in place and maintain in force at its own cost (and not that of any employee) appropriate Indemnity Arrangements in respect of:

11.1.1 employers’ liability;

11.1.2 clinical negligence, where the provision or non-provision of any part of the Services (or any other services under this Agreement) may result in a clinical negligence claim; and

11.1.3 public liability.

11.2 Indemnity Arrangements made in accordance with Clause 11.1 shall be sufficient to meet the requirements of Law and the potential liabilities of the Provider under this Agreement.

11.3 Subject to Clause 10, if the proceeds of any Indemnity Arrangements are insufficient to cover the settlement of any claim relating to this Agreement, the Provider must make good any deficiency.

11.4 The Provider must not take any action or fail to take any reasonable action nor (in so far as it is reasonable and within its power) allow others to take action or fail to take any reasonable action, as a result of which any Indemnity Arrangements put in place in accordance with Clause 11.1 may be rendered wholly or partly void, voidable, unenforceable, or be suspended or impaired, or which may otherwise render any sum paid out under those Indemnity Arrangements wholly or partly repayable.

11.5 Where provision of all or part of the Services includes the care and treatment of patients or service users of the Purchaser, the Provider shall, on and following expiry or termination of this Agreement, procure that any ongoing liability it has or may have in negligence to the Purchaser arising out of such care and treatment under this Agreement will continue to be the subject of appropriate Indemnity Arrangements for twenty one (21) years following termination or expiry of this Agreement or (if earlier) until that liability may reasonably be considered to have ceased.

12 Force Majeure

12.1 The Purchaser shall not be entitled to bring a claim for a breach of obligations under this Agreement nor shall the Provider incur any liability for any losses or damages incurred by the Purchaser to the extent that a Force Majeure Event occurs and the Provider is prevented from carrying out its obligations by that Force Majeure Event.

12.2 On the occurrence of a Force Majeure Event, the Provider shall notify the Purchaser as soon as practicable. Such notification shall include details of the Force Majeure Event, including how it will affect its performance under this Agreement, evidence of the effect on the obligations of the Provider and any action proposed to mitigate its effect.

12.3 The Provider shall use all reasonable endeavours to mitigate the effects of the Force Majeure Event and, subject to Clause 12.4, facilitate the continued performance of the Agreement.

12.4 If the Provider is prevented from performing its obligations under this Agreement as a consequence of a Force Majeure Event for a period of more than thirty (30) days, it shall have the right to terminate the Agreement by giving seven (7) days written notice of termination to the Purchaser. No compensation shall be payable by the Provider as a direct consequence of this Agreement being terminated in accordance with this Clause.

13 Termination

Without prejudice to any other right or remedy it may possess, the Provider shall be entitled in the following circumstances to terminate this Agreement by written notice in accordance with Clause 14.1:

13.1 the Purchaser commits a material breach of this Agreement which:

13.1.1 where capable of remedy, is not remedied within five (5) Working Days of the Provider serving notice of such breach on the Purchaser (or such longer period as is agreed between the Parties); or

13.1.2 is not capable of remedy;

13.2 the Purchaser commits a serious and fundamental breach of this Agreement; 

13.3 the Purchaser commits a breach of Clause 15.1 and Clause 15.4.1 applies,

all of the above constituting an event of default, by the Provider, for the purposes of this Agreement. 

14 Effects and Arrangements on Termination or Expiry

14.1 In the event that the Provider has the right to terminate this Agreement pursuant to Clause 13 and wishes to exercise that right then, without prejudice to any other rights or remedies in this Agreement, the Provider will notify the Purchaser in writing of its intention to terminate this Agreement, specifying the date upon which this Agreement will terminate ("Termination Date").

14.2 Upon expiry of the Agreement through effluxion of time or on earlier termination of the Agreement in accordance with any of its terms, the Purchaser shall immediately pay to the Provider all sums due under this Agreement. 

14.3 Any rights, duties, or obligations of either of the Parties which are expressed to survive, or which otherwise by necessary implication survive the expiry or termination for any reason of this Agreement, together with all indemnities, will continue after expiry or termination, subject to any limitations of time expressed in this Agreement. 

14.4 Any expiry or termination of the Agreement will not prejudice the rights, obligations and duties of the Parties arising prior to such expiry or termination taking effect and shall be without prejudice to any right or remedy which has already accrued or subsequently accrues.

15 Prevention of Corruption

15.1 Each Party: 

15.1.1 agrees that it shall not (and shall procure that its Staff and any sub-contractors shall not), in connection with this Agreement, commit a Prohibited Act; and

15.1.2 warrants, represents, and undertakes that it is not aware of any Prohibited Act in connection with the execution of this Agreement, excluding any arrangement of which full details have been disclosed in writing to the other Party before execution of this Agreement.

15.2 Each Party shall: 

15.2.1 if requested, provide the other Party (“Other Party”) with any reasonable assistance, at the Other Party’s reasonable cost, to enable the Other Party to perform any activity required by any relevant government or agency in any relevant jurisdiction for the purpose of compliance with the Bribery Act 2010; and 

15.2.2 have an anti-bribery policy (which shall be disclosed to the Other Party) to prevent it (or any of its Staff or sub-contractors) from committing a Prohibited Act and shall enforce it where appropriate.

15.3 If any breach of Clause 15.1 is suspected or known, the breaching Party must notify the other Party immediately. Where such notification is given, the breaching Party must respond promptly to the other Party’s enquiries, co-operate with any investigation, and allow the other Party to audit books, records, and any other relevant documentation. 

15.4 Without prejudice to Clause 15.3, if either Party or any of its Staff or sub-contractors commits a breach of Clause 15.1 (with or without the knowledge of the other Party), the other Party shall be entitled to:

15.4.1 terminate this Agreement and recover from the breaching Party the amount of any loss resulting from such termination;

15.4.2 recover from the breaching Party the amount or value of any gift, consideration or commission concerned; and

15.4.3 recover from the breaching Party any other loss or expense sustained in consequence of any breach of Clause 15.1

16 Complaints and Incident Reporting

16.1 A record of all complaints received by the Provider of whatever nature regarding the provision of the Services shall be kept by the Provider.

16.2 All complaints received by either Party in relation to this Agreement shall be notified to the other Party as soon as reasonably practicable and in any event within five (5) Working Days of receipt.

16.3 The Parties shall co-operate fully with each other in investigating and resolving any such complaints made. In respect of any complaints arising out of this Agreement which fall within the terms of the Purchaser's complaints procedure, the Provider shall also comply with the Purchaser’s complaints procedure (as notified to the Provider in writing from time to time) to the extent it applies to the relevant complaint.

16.4 The Parties shall comply with the arrangements for notification of Patient Safety Incidents and Serious Incidents to any Regulatory or Supervisory Body, in accordance with Law.

16.5 Each Party shall send the other Party a copy of any notification it gives to a Regulatory or Supervisory Body where that notification directly or indirectly relates to the Services.

17 Dispute Resolution Procedure

17.1 In the event of a dispute arising between the Parties out of this Agreement (which those involved in the day to day management of this Agreement have been unable to resolve), either Party may serve written notice of the dispute on the other Party, setting out full details of such dispute.

17.2 The Parties respective Finance Directors (or their nominated deputies) shall meet in good faith as soon as possible and in any event within ten (10) Working Days’ notice of the dispute being served pursuant to Clause 17.1, at a meeting convened for the purpose of resolving the dispute.

17.3 If the dispute remains after the meeting detailed in Clause 17.2 has taken place,then:

17.3.1 where the Parties are within the same Integrated Care System (“ICS”), they shall participate within an ICS mediation process, whereby further routes to resolve the issue informally (and in the spirit of systems working) shall be undertaken. This process will be chaired by the nominated senior manager from within the relevant ICS and attended by both suitably senior members of both Parties. This process shall have ten (10) Working Days allocated, by which time if there is not resolution, either Party may refer the matter in accordance with Clause 17.3.2 as a matter of last resort;

17.3.2 where the Parties are not within the same ICS, they may, by agreement, attempt to settle such dispute by mediation in accordance with the Model Mediation Procedure of the Centre for Effective Dispute Resolution (“CEDR”) or any other model mediation procedure as agreed by the Parties. To initiate a mediation, either Party may give notice in writing (a "Mediation Notice") to the other requesting mediation of the dispute and shall send a copy thereof to CEDR or an equivalent mediation organisation as agreed by the Parties asking them to nominate a mediator. The mediation shall commence within twenty (20) Working Days of the Mediation Notice being served.  Neither Party will terminate such mediation until each of them has made its opening presentation and the mediator has met each of them separately for at least one (1) hour. Thereafter, paragraph 14 of the Model Mediation Procedure will apply (or the equivalent paragraph of any other model mediation procedure agreed by the Parties).  The Parties will co-operate with any person appointed as mediator, providing them with such information and other assistance as they shall require and will pay their costs as the mediator shall determine or in the absence of such determination such costs will be shared equally.

17.4 Nothing in the Dispute Resolution Procedure shall in any way affect either Party's right to terminate this Agreement in accordance with any of its terms or take immediate legal action, acknowledging that where this is an agreement between NHS bodies it shall fall under section 9 of the National Health Service Act 2006.

18 Confidentiality and Data Protection

Confidentiality

18.1 Subject to Clauses 18.2 to 18.4, where one Party (the “Recipient”) receives Confidential Information from the other Party (the "Discloser") or its representatives, the Recipient undertakes to keep such Confidential Information secret and strictly confidential and not to disclose such Confidential Information to any third party without the Discloser’s prior written consent.

18.2 Nothing in Clause 18.1 shall prevent the Recipient from:

18.2.1 using any general knowledge, experience or skills which were in its possession prior to the commencement of the Agreement;

18.2.2 disclosing Confidential Information where it is required to do so by: (i) judicial, administrative, governmental or regulatory process in connection with any action, suit, proceedings or claim; (ii) any Regulatory or Supervisory Body; (iii) for the purpose of the examination and certification of the Recipient’s accounts; or (iv) otherwise by applicable Law; and/or

18.2.3 without prejudice to the generality of Clause 18.2.2, disclosing Confidential Information in compliance with the 2000 Act and/or the 2004 Regulations; 

18.3 Clause 18.1 shall not apply to:

18.3.1 any Confidential Information which is in or enters the public domain other than by breach of this Agreement or other act or omission of the Recipient;

18.3.2 any Confidential Information disclosed to any person engaged in the performance of this Agreement to the extent that such disclosure is reasonably necessary for the proper performance of this Agreement and the disclosee is contractually bound on terms the same, or substantially the same, as those relating to Confidential Information in this Agreement;

18.3.3 any Confidential Information which is already lawfully in the possession of the Recipient prior to its disclosure by the Discloser; and/or

18.3.4 any Confidential Information which is obtained by a third party who is lawfully authorised to disclose such information.

18.4 The Parties agree that the provisions of this Agreement shall not be treated as commercially sensitive for the purposes of the 2000 Act or 2004 Regulations.

Data Protection

18.5 Each Party shall (and shall procure that its Staff and sub-contractors shall):

18.5.1 comply with its obligations (and comply with any requirements imposed on it) under the Data Protection Legislation which arise in connection with this Agreement (including the provision of the Services); 

18.5.2 disclose Confidential Information where it is required to do so by: (i) judicial, administrative, governmental or regulatory process in connection with any action, suit, proceedings or claim; (ii) any Regulatory or Supervisory Body; (iii) for the purpose of the examination and certification of the Recipient’s accounts; or (iv) otherwise by applicable Law; and/or

18.5.3 without prejudice to the generality of Clause 18.2.2, disclose Confidential Information in compliance with the 2000 Act and/or the 2004 Regulations.

18.6 For the purposes of this Agreement, it has been identified that the Provider will Process Personal Data in respect of which the Purchaser is the Data Controller. Details of such Processing and the terms on which it has been permitted by the Data Controller are as set out below: 

A The following specifies the terms on which the Data Controller permits the Data Processor to Process the specified categories of Personal Data for the purposes of this Agreement.

 

Item

Category of Personal Data & Data Subject

(“Relevant Personal Data”)

Data Controller

(“Controlling Party”)

Data Processor

(“Processing Party”)

1.Name of patients, Date of Birth of patients, Sex of patients, Clinical Phenotype Information of patients The PurchaserThe Provider
2.Patient resultsThe Purchaser and ProviderThe Provider

B The Controlling Party permits the Processing Party to Process the Relevant Personal Data. Such permission is strictly limited to the purposes and for the duration specified below. 

 

Item

Relevant Personal Data

Permitted Purpose 

Duration

1.

Name of patients, Date of Birth of patients, Sex of patients, Clinical Phenotype Information of patientsTest results interpretation and reportingProcessing would end after last sample is reported. Data is held on departmental servers and in the departmental LIMS for 30 years as per guidelines- The Retention and Storage of Pathological Records and Specimens.   Guidance from the Royal College of Pathologists and the Institute of Biomedical Science, 5th Edition (Updated 2015) and BSGM 3rd edition guidelines July 2019: BSGM Consent and Confidentiality in Genomic Practice

2.

Patient resultsto support diagnosis and treatmentProcessing would end after last sample is reported. Data is held on departmental servers and in the departmental LIMS for 30 years as per guidelines- The Retention and Storage of Pathological Records and Specimens.   Guidance from the Royal College of Pathologists and the Institute of Biomedical Science, 5th Edition (Updated 2015) and BSGM 3rd edition guidelines July 2019: BSGM Consent and Confidentiality in Genomic Practice

 

C The Controlling Party will ensure that it has a lawful basis on which to share the Relevant Personal Data with the Processing Party and shall satisfy itself that the Permitted Purpose is consistent with that lawful basis. Details of this lawful basis are as set out below and will be reflected by the Controlling Party in its Privacy Notices: 

 

Item

Relevant Data

Lawful Basis

1.

Name of patients, Date of Birth of patients, Sex of patients, Clinical Phenotype Information of patients

6(1e) - the processing is necessary for the official functions vested in the controller, and the task or function has a clear basis in law

 

9(2h) Preventative or occupational medicine for assessing the working capacity of an employee, medical diagnosis, provision of health or social care, treatment/ management of health or social care systems and services based on EU or member state law or a contract with a Health Professional

 

2.

Patient results

6(1e) - the processing is necessary for the official functions vested in the controller, and the task or function has a clear basis in law

 

9(2h) Preventative or occupational medicine for assessing the working capacity of an employee, medical diagnosis, provision of health or social care, treatment/ management of health or social care systems and services based on EU or member state law or a contract with a Health Professional

 

19 Freedom of Information Act and Environmental Information Regulations

19.1 Subject to Clause 19.2, where a Party (“Recipient Party”) receives a request for information pursuant to the 2000 Act or the 2004 Regulations and such request relates to this Agreement it shall:

19.1.1 notify the other Party as soon as practicable; 

19.1.2 before responding, give the other Party an opportunity to comment on the request and the information to be disclosed; and

19.1.3 without prejudice to the Recipient Party’s rights and obligations to make the final decision, consider comments provided by the other Party pursuant to Clause 19.1.2,

and the other Party agrees to provide the Recipient Party with reasonable assistance in complying with such request.

19.2 Where Clause 19.1 applies, if the Recipient Party is not subject to the 2000 Act or the 2004 Regulations but the other Party is, the Recipient Party shall:

19.2.1 as soon as is practically possible, and in any event within no more than two (2) Working Days, deliver to the other Party the original request for information; and

19.2.2 assist the other Party in responding to the request for information in accordance with Clause 19.1.

20 Intellectual Property Rights

20.1 Neither Party will acquire the IPR of the other Party pursuant to this Agreement.

21 Equality and Human Rights

21.1 Each Party shall ensure that:

21.1.1 it does not, whether as an employer or as a provider of services, engage in any act or omission that would contravene the Equality Legislation; and

21.1.2 it complies with all its obligations as an employer or as a provider of services as set out in the Equality Legislation and takes reasonable endeavours to ensure its Staff do not unlawfully discriminate within the meaning of the Equality Legislation.

21.2 The Provider shall:

21.2.1 in the management of its affairs and the development of its equality and diversity policies, cooperate with the Purchaser to support and facilitate compliance, by the Purchaser, with its own duties of equality whether under Equality Legislation or otherwise;

21.2.2 take such reasonable and proportionate steps as the Purchaser considers appropriate to promote equality and diversity, including race equality, equality of opportunity for disabled people, gender equality, and equality relating to religion and belief, sexual orientation, and age; and

21.2.3 impose on all its sub-contractors and suppliers, obligations substantially similar to those imposed on the Provider by this Clause 21. 

22 Third Party Rights

A person who is not a party to this Agreement shall have no rights pursuant to the Contracts (Rights of Third Parties) Act 1999 or otherwise to enforce any of the terms of this Agreement.

23 Waiver

No failure or delay by either Party to exercise any right, power or remedy will operate as a waiver of it nor will any partial exercise preclude any further exercise of the same or of some other right or remedy.

24 Severance

If any provision of this Agreement, not being of a fundamental nature, shall be held to be illegal or unenforceable, the enforceability of the remainder of this Agreement shall not thereby be affected.

25 Relationship of the Parties

At all times in connection with this Agreement, the Provider shall be an independent contractor and nothing in this Agreement shall create a relationship of agency or partnership or a joint venture as between the Parties, and accordingly the Provider shall not be authorised to bind the Purchaser. For the avoidance of doubt, unless expressly stated to the contrary, nothing in this Agreement will be construed as, or have effect as, construing any relationship of employer and employee between the Provider and the Purchaser.

26 Notices

26.1 Any notice to be given under this Agreement shall either be delivered personally or sent by first class post (or airmail).  The name and address for service on the Provider shall be Lorraine Warne, South West GLH Business Operations Manager, Bristol Genetics Laboratory, North Bristol NHS Trust, Pathology Sciences Building, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB.  The name and address for service on the Purchaser shall be as detailed in the Request Form.

26.2 A notice shall be deemed to have been served if:

26.2.1 delivered personally, at the time of delivery; 

26.2.2 sent by first class post, at the expiration of forty-eight (48) hours after the envelope containing the same was delivered into the custody of the postal authorities; and

26.2.3 sent by airmail, at the expiration of five (5) days after the envelope containing the same was delivered into the custody of the postal authorities.

26.3 A copy of all notices personally delivered or posted by the Purchaser shall be sent by email to lorraine.warne@nbt.nhs.uk.

26.4 In proving such service, it shall be sufficient to prove that personal delivery was made, or that the envelope containing such notice was properly addressed and delivered into the custody of the postal authority as prepaid first class letter (or airmail) (as the case may be).

26.5 This Clause does not apply to the service of any proceedings or any documents in any legal action or, where applicable, any arbitration or other method of dispute resolution.

27 Governing Law and Jurisdiction

27.1 This Agreement and any non-contractual obligations arising out of or in connection with it shall be governed by and construed in all respects in accordance with the laws of England.

27.2 Subject to Clause 17, the courts of England shall have exclusive jurisdiction to hear and settle any action, suit, proceeding or dispute which may arise out of or in connection with this Agreement (including non-contractual disputes or claims) and the Parties irrevocably submit to the jurisdiction of those courts.

APPENDIX: SPECIFICATION

1 Description of the Services

Provider Obligations

  • The Provider will provide a genetics laboratory service (processing, examination and reporting of samples) to the Purchaser, in respect of the tests detailed in the Request Form.
  • The preferred means of reporting test results is by email. The reports will be sent by secure email in adherence to the Provider’s IM&T policies. The Purchaser’s email address for reports is as detailed in the Request Form. Where secure email is not possible, the Provider will provide hard copy reports to the Purchaser by second class post to the postal address detailed in the Request Form. Where appropriate, reports will include full interpretation of genetic results, advice on diagnosis, follow-up test and genetic risks.
  • The Provider’s Consultant Clinical Scientists shall provide advice and clinical management of patients to the Purchaser during Working Hours.
  • Upon request, the Provider will supply a copy of the Quality Manual (or similar documentation) that describes the organisation and quality system of the laboratory.
  • The Provider will provide testing according to accredited UKAS ISO15189:2022 standards for medical laboratories and relevant best practice guidelines. Where any quality issues may affect the provision of the Services to the Purchaser, the Purchaser will be informed as soon as possible.
  • Certain business interruption events may require the processing and testing of samples by a mutual aid partner laboratory. Should it be necessary to invoke the Provider’s Business Continuity Plan, including such “mutual aid” arrangements, the Provider will notify the Purchaser as soon as possible. 

Purchaser Obligations

  • The Purchaser will obtain informed consent from patients in respect of collection, storage, and disposal of Pathology specimens in compliance with national standards and guidance.
  • The Purchaser shall follow the sample and transport guidance for each patient test request (as detailed in the Request Form and website SWGLH Sample and Test Information | North Bristol NHS Trust).
  • The Provider shall have completed the Request Form with the following information:

- Patient/participant name/ID

- DOB (if available)

- Other numerical ID for example sample number, Hospital number or NHS number

- Examinations required

- Referring organisation

- Referring clinician

  • The Purchaser acknowledges that failure to comply with any of the above obligations may result in a delay to the provision of the Services or, in some specific circumstances, a rejection of the Request Form by the Provider.

General Quality Standards

The Provider will have policies, procedures, and quality systems (as appropriate) to assure standards of technical, professional, and managerial competence, which include:

  • Compliance with standards laid down by UK Accreditation Service (UKAS) ISO 15189 for Medical Laboratories and the Healthcare Commission including validation and business continuity
  • Employment of appropriately qualified staff
  • Adequate levels of staffing and skill mix
  • Compliance with statutory and other national requirements
  • Compliance with professional standards
  • Compliance with appropriate health and safety requirements
  • Participation and review of external quality assurance and internal quality control performance
  • Accreditation of the department providing the Service with UKAS. In the event of any problem with accreditation, the Purchaser will be informed of the areas that have been identified as ‘non-compliant’ along with any expiry date (to the extent relevant to the Services)

Service Standards

Reports on specimen analysis will contain all necessary factual information and (where appropriate in the judgement of the Provider’s Consultants) interpretation and advice. Computer generated reports will be provided unless circumstances arise outside the Provider’s control. The Provider will maintain computer records of all reports.

Target reporting times are as specified on the SWGLH website Quality Page (see SWGLH Quality | North Bristol NHS Trust (nbt.nhs.uk)).  These may be reviewed and amended by the Provider from time to time.

Once received, all samples will by assessed by the Provider to assess their priority:

a) Samples judged medically urgent will be processed upon receipt and the results communicated as soon as possible. Samples marked “urgent” will be given priority over routine samples. It is expected that the laboratory will be notified by telephone of urgent samples and the sample will be clearly marked as “urgent”.

b) On request, clinically important urgent results will be telephoned to a designated member of the Purchaser’s clinical staff.

c) Non urgent results will be provided by post or secure email (as above).

d) Computer reports will bear the date of receipt and the date of reporting.

Access to advice for the Purchaser’s medical practitioners and nursing staff will be made available during Working Hours.

2 Service Location

Pathology Sciences Building

Southmead Hospital

Westbury-on-Trym

Bristol BS10 5NB

3 Records

The Provider shall maintain records in accordance with the guidance published by the Royal College of Pathologists – ‘Retention and Storage of Pathological Records and Archives,’ current version accessible at: 

https://www.rcpath.org/uploads/assets/049ea966-df5c-4a9f-9353ba24a69bb808/The-retention-and-storage-of-pathological-records-and-specimens-5th-edition.pdf

The Provider shall handle and retain clinical material in accordance with current guidelines in relation to patient consent from the Department of Health and the General Medical Council.

 

Last updated 25/02/2025

Rheumatology Transition and Young Adult

Regular Off Off

Transition and Young Adult Clinics are held at Brunel Building Southmead Hospital. These are with Dr Nicola Minaur (Consultant Rheumatologist) and Elaine McCormack (Specialist Rheumatology Nurse).

Rheumatology Transition clinics are held 4 times a year for young people who are transitioning (moving) from the Paediatric Rheumatology clinic at the Bristol Children's Hospital to the Adult Rheumatology Service. 

These are with Dr Nicola Minaur, Elaine McCormack, and a Peadiatric Specialist Nurse. Transition Clinics are also held at the University Hospital Bristol (UHB) so young people can choose where they would like to be seen. 

Further information about Transition from Children's to Adult Rheumatology services in Bristol can be found here: http://www.uhbristol.nhs.uk/transition/rheumatology

 Further information about living with a Rheumatology condition as a Young Adult can be found here:

NRAS (National Rheumatoid Arthritis Society) Support for Living with JIA: https://jia.org.uk/ 

Versus Arthritis Young People: https://www.versusarthritis.org/about-arthritis/young-people/

Arthurs Place: An Award winning magazine and social network for young adults living with Arthritis: https://arthursplace.co.uk/

The Barbara Ansell Network for Adolescent Rheumatology (10 - 24 years) (BANNAR):  https://www.versusarthritis.org/about-arthritis/young-people/barbara-ansell-national-network-for-adolescent-rheumatology-bannar/

Off The Record Bristol (OTR). Mental Health support for young adults (11 - 25 years) living in Bristol and South Gloucestershire:  https://www.otrbristol.org.uk/

Patient and Carer Partner Profiles

Regular Off Off
Patient and Carer Partner Anela, smiling at the camera.

Anela Wood

Patient and Carer Partner

My name is Anela and I have been involved with the hospital as a Patient Partner for over a year. I became involved through the Bristol Sight Loss Council and the work being done to help improve services for those with visual impairment. Through this work I linked into the Patient Partnership and was keen to be involved as I wanted to work more broadly with staff and patients. I thought it was a good way to feed into services from my personal experience.

I have come from a background of lots of different things including paid work and volunteering, fundraising and event planning for all ages from children to adults. Being blind myself I can bring my own personal experience to the work I do. I also studied English at university and find that this helps me with the role of Patient Partner. 

The work I am involved in centres around raising awareness for people with visual impairment in the hospital. This includes being involved in Digital Patient work, delivering sight loss awareness training to staff, and doing a patient story for Board. I also attend the Patient Partnership Group, Patient Experience Group and Carers Strategy Group.

I really enjoy the role, it’s really nice to work with an organisation who want to work collaboratively to make services better for those with visual impairment and sight loss. With lots in the pipeline I am excited to see how things will evolve. NBT are leading the way for other hospitals.

Eddie Strong smiling at the camera.

Eddie Strong

Patient and Carer Partner

My name is Eddie Strong, and I have been a member of the Patient Partnership Group for four years.  My first connection with the hospital was eight years ago when I became a member of the newly formed Movemaker Volunteer Team when the new hospital opened. 

I do not come from a medical background having worked as a Project Manager in the aviation and naval industries.  I do, however, have 20 years’ experience as a Chair Magistrate covering all aspects of law.  In this role I received extensive training with emphasis on understanding, fairness and encouraging logical thinking.  These attributes have proved invaluable in the positions I currently hold on numerous hospital committees such as Doctor Revalidation, Resuscitation, Research, Falls Academy and Nocturia. I am also on the Sustainable Development Steering Group.  I get a great deal of satisfaction by being a representative on these panels and feel, in a small way I am making a valuable contribution in these groups adding to the success of this amazing hospital. My aim, therefore, is to continue in these roles for the foreseeable future.

In my spare time I am a member of the Magistrates Association and enjoy being part of a vintage motorcycle club.

Amanda and her husband David smiling at the camera

Amanda Threlfall

Patient and Carer Partner

My name is Amanda Threlfall and I am a new member of the Patient Partnership Group.  I am a full-time caregiver (unpaid carer) for my husband.

Both myself and my husband have used the NHS many times, and always appreciate the care provided, and I was glad to be able to join the group as a voluntary member.  Sometimes as patients and carers we can see things from a different perspective, little things that can make a big difference and this group allows a constructive dialogue.  I think this is so important as we all know the NHS is under immense pressure, now more than ever, and if we as patients want the NHS to be there for us, to be in a better position and the staff that care for us at the time when we are most vulnerable we need to be there for them too. 

Both my husband and I spent pretty much all our working lives in the pharmaceutical industry and I have been so grateful to keep using my skills from my time at work to help others, and to have the opportunity to do so.  I’m just starting to find my feet and have joined a couple of groups.

There are many ways to be involved, and not all need to be lengthy or long-term commitments.  I would encourage anyone to give it a go, and I think we should all feel like our voice matters equally no matter of our backgrounds.  For me as a carer this gives me a sense of purpose, and that even though my life is limited as my husband is housebound that I can still help make a difference.  At times this feels selfish as I am not actively caring, but keeping that part of me nourished helps me have the strength to keep caring.  We all have a different story to tell and its can be incredibly powerful to hear other experiences and how we can all work together for a kinder and better world.

Gordon smiling at the camera

Gordon Halford

Patient and Carer Partner

My name is Gordon Halford. I am the Deputy Chair of the Patient Partnership.

Some time ago I had a heart attack and cardiac arrest. Following excellent treatment at Southmead Hospital I sought some way of contributing to the work of the NHS in my area. I discovered there was a group called at that time the Patient Panel now Patient partnership. I applied to join eleven years ago, was interviewed and joined the group. In the years since then I have enjoyed involvement in the activities of the group.

All of us have something to offer as support to the hospital and representing the interests of the patient.

As a Chartered Engineer I sat on panels assessing new equipment for installation in the new hospital at Southmead. In addition to the Patient Partnership Group meetings I sit or have sat on a number of committees including medical speciality groups, complaint response reviews, quality committee, patient experience group, appraisal of research projects, falls committee, clinical policy, audits and other interesting activities like hospital document reviews.

As other domestic commitments have increased I have been able to scale down my involvement in certain activities but still get satisfaction from contributing in several interesting groups.

Sarah smiling at the camera

Sarah Cox

Patient and Carer Partner

I am Sarah Cox, am a Mum to a 12 year old, a full time Carer for my Grandfather, and I have been a member of the Patient Partnership Group for nearly a year. I have Systemic Sclerosis and am a patient under many services at Southmead, including Rheumatology, Plastic Surgery, Respiratory and Cardiology. To date I have undergone 61 operations, the majority of which have been the amputations of my fingers and toes.

I am a proud patient of North Bristol NHS Trust and have a vested interest in improving the services and running of the hospital. I enjoy being part of the PPG because it allows me to voice and share my experiences with people who can help to open discussions that will implement change for better outcomes. I get a lot of satisfaction from feeling listened to and involved in the changes that are made and implemented. It’s wonderful to be in the hospital and see things taking place that I helped to shape and develop. Being part of the PPG triggered a deeper interest in patient care and I enrolled on a Health and Social Care degree. Much of my studies enrich my experience and knowledge of Healthcare and this underpins my part within the PPG.

Patient and Carer Partner Profiles

How to treat your injured knee

Regular Off Off

Following injury, your knee may be swollen, bruised, painful or stiff. In order to help the natural healing process, follow the advice below.

During the first 48-72 hours

In the first few days, apply a packet of frozen peas wrapped in a damp tea towel to the painful/swollen area. This can be left on for up to 20 minutes, every 2 hours, provided that it is comfortable. If uncomfortable, remove it as it may cause a burn.

Initially treatment is to calm inflammation and control the swelling and pain. This can be managed with:

  • Rest. Try and walk as normally as possible by putting your heel down first, but reduce the amount of walking you do. If your knee becomes more swollen you might need to do a little less.
  • Ice. In the first few days, applying frozen peas wrapped in a damp tea towel to your knee can help with the pain. Ideally for 15 mins every couple of hours. If it’s uncomfortable remove the ice pack as it may cause a burn.
  • Painkillers are important to help you keep moving around. Paracetamol and ibuprofen are effective pain killers when taken regularly and can be taken together. We do not routinely dispense these as they can be bought cheaply over the counter from a chemist or supermarket. Read the packet instructions for the doses.
  • Elevation of the leg with the knee supported will discourage swelling.

We no longer offer compression bandages for sprains as they appear not to have an effect on the speed of recovery. But some people find them comforting to wear and you can purchase them from a pharmacy if you want to try one.

It is important to rest and elevate the leg.

Avoid walking on the injured leg as far as possible. You may have been given crutches, If so, use them to cut down the weight through the injured leg.

You may have been given a brace or knee support. This should be comfortable and not too tight or too loose. You will have been advised on how to remove this for showering and if you need to keep it on a night.

After 3 days

It is essential to start exercising. This will promote healthy healing and prevent future stiffness and weakness. Exercises should be performed slowly, moving into discomfort, but not pain. They can be repeated 5 - 6 times spread through the day.

Exercise 1: Knee push downs

  • Support your injured leg, tense your thigh muscles, hold for 5 seconds then relax. 
  • Repeat 10-20 times.

Exercise 2: Knee straightening over rolled blanket

  • Sit on a bed or the floor with your knee resting over a rolled blanket or firm cushion. Pull your foot up at the ankle, then straighten the knee by tightening the muscles on the front of your thigh. Hold for 5 seconds, then lower and relax. 
  • Repeat 10-20 times.

Exercise 3: Knee bending with towel

  • Support injured leg and slide your heel towards your bottom. You can assist this with a towel looped round your foot. 
  • Repeat 10-20 times.

Exercise 4: Gentle knee bending

  • Let your knee bend as far as possible and gently move it backwards and forwards for 3 - 4 minutes. Try to bend the knee a little further at each session. This can be performed either over the edge of a table or a high chair.

If any of the exercises or walking cause your knee to swell further, stop the exercises and rest in elevation for a further 1 - 2 days.

Walking

Depending on the extent of your injury, you may have been given elbow crutches or sticks to enable you to walk with a good walking pattern. Try to walk normally, by putting your heel down first, unless you have been told not to put any weight through your knee.

It is important to remain mobile if possible; however, in the early stages after your injury, doing too much will cause increased pain and swelling. You need to monitor the pain and swelling and adjust the amount of activity accordingly.

Gradually wean off Elbow Crutches (if applicable) and increase your activity as pain and swelling subside.

Please remember to return the crutches/sticks to the Emergency Department or the recycling area in the entrance of the Brunel building.

Returning to sport

Before returning to any sporting activities involving running and twisting and turning at speed, your knee should be free of pain, fully mobile and strong. 

Depending on how badly your knee is sprained, it may take between 4 - 12 weeks, sometimes longer, to get back to normal. 

Activities such as swimming, cycling, weights and step work can be used to help build up the knee initially. When you feel ready, gradually build up your running distance. Where sports such as rugby and football are concerned, join in training sessions before returning to matches.

If you are concerned about your progress, contact your GP or the Emergency Department that you originally attended.

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT002262.

Contact Emergency Department (ED)

Gate 35, Level 0
Brunel building
Southmead Hospital
Southmead Road
Westbury-on-Trym
Bristol
BS10 5NB

Emergency Department Main Reception Gate 35: 0117 4145100 or 0117 4145101

We're introducing online letters for appointments

We know how important it is that you receive details about your visit to hospital quickly and easily.

That’s why we’re introducing online letters for appointments so you can get your appointment information by text or email direct to your smartphone, tablet or computer.

Outlook Patient Information

Regular Off Off

Who are we and how can we help?

We are a friendly service offering highly specialist psychological support to adults with appearance concerns relating to an unusual, changed or visible difference in appearance. This includes concerns that may be a result of:

  • Congenital conditions, for example birthmarks, hemangioma, hemifacial microsomia. 
  • Health conditions, for example dermatological, musculoskeletal or neurological conditions, including facial palsy.
  • Trauma after illness or accidents that have resulted in changes to someone’s appearance, for example scars, burns or stroke. 
  • Treatment, for example plastic or maxillofacial surgery, prosthetics, or stoma.

“These sessions weren’t just about emotional help but practical help and advice, which helped me enormously.”

“Having someone understand why I have the problems I do and who could see where I am coming from was so helpful.”

We provide psychological support for appearance-related concerns including:

  • Adjusting to a visible difference or changed appearance following illness, injury, or chronic/congenital condition. 
  • Support with decision-making and/or preparing for surgery, or other medical treatments.
  • Anxiety regarding treatment e.g. pre-surgical, having an anesthetic, or procedural anxiety.
  • Managing psychological trauma following an accident, injury, surgery, or other treatments.
  • Coming to terms with a diagnosis and/or coping with treatment.
  • Adjusting to loss and grief e.g. a change in your body.
  • Coping with emotional issues around your appearance e.g. anxiety, worries, feeling low.
  • Building confidence or self-esteem, e.g. returning to work, family, and social situations.
  • Difficulties in dealing with other people’s reactions.
  • Help getting back to previous activities or adjusting to new ones e.g. going home after being in hospital, getting back to work/study.
  • Signposting to other services that may be more appropriate for co-existing difficulties.

What happens when you get referred?

We only accept referrals from a healthcare professional (e.g. GP or hospital team). When you are referred to the service, we will send you a letter asking you to confirm that you would like to be seen. We will then put you on our waiting list and will contact you as soon as we can offer you an appointment. It is completely up to you whether you choose to come and see us.

“The sessions were flexible and adapted to my changing needs. We focussed on practical changes which I could implement in my day-to-day life”

“The sessions feel informal and the pace of it is within your control”

“The session gave me the tools to help myself to realise. ‘I can do this, nothing bad will happen if I try’”

What can you expect at your first appointment?

Before your initial appointment, you will be sent some questionnaires to complete online. This is to help us understand how things are for you now, and how they change during the course of any support we may provide.

If you feel unable to complete the questionnaires, or require any reasonable adjustments, please let us know by getting in touch. We can arrange to meet with you prior to your initial appointment to discuss any concerns and support you to complete them.

At the initial appointment, you will meet a member of the Clinical Psychology Team. We are experienced in helping people to feel more able and confident to cope with the emotional impact of health issues and appearance-related concerns.

During the first session, you will have the opportunity to explore your concerns. We will also explain in more detail how we might be able to support you with these. At the end of the first session, the psychologist will discuss a plan of care, which may include further sessions with Outlook or signposting to other services.

If you would like anyone to join your sessions, such as a family member or friend, you are welcome to invite them as long as they are over 16. Sometimes, we will ask your permission if another colleague can join the session. It is fine to say no.

“It has been great to feel like there is finally someone to listen and understand what I am going through. I was able to talk openly in a comfortable surrounding environment without judgement. Thank you so much - the sessions made a huge impact on life!”

“I felt relaxed enough to open up and say how I was really feeling, which meant the right help and advice was given.”

What will the sessions involve?

As well as having a safe and supportive space to discuss your difficulties, we will often explore:

  • Ways to handle difficult thoughts, feelings, or sensation (e.g. fatigue) so they have less impact on you.
  • Clarifying what matters to you (your personal values) and what change or progress might look like.
  • Work with you to facilitate change, enabling you to move towards your goals.

We may also agree on some activities for you to do between sessions. Learning new skills takes time and practice but these activities will help you to get the most from your sessions.

“The support has given me the confidence to have my photo taken, ask for something in a shop, go out for a meal…all baby steps to begin with but which have helped me put my life back together.”

“During the sessions we have been working on noticing, reflecting and having a more positive outlook. I feel through discussion this has really helped and having the week in between appointments to input ideas very useful.”

How many appointments will you have?

We usually provide short-term, focused psychological support. We will work with you to decide what goals you want to achieve. This will help us decide together if we are the right service to support you and if so, how many sessions would be useful. Follow-ups are usually 50 minutes long.

We are not able to offer long-term, regular sessions in this service.

However, if that seems a useful or appropriate option for you, we can try to help you find other services that offer longer-term counselling.

“It was great to feel more able to help myself…this meant that my progress has continued even once I’d stopped the sessions.”

What happens to the information we discuss?

We take confidentiality seriously. Most of what we talk about with you will remain private. However, it can be helpful for us to share important information with staff closely involved in your care, e.g. in summary letters after the first and last appointments. 

If there is anything you don’t want shared, please discuss this with the psychologist. However, if we are very concerned there is a risk of harm to you or others we may need to pass this information to relevant services, such as your GP. We keep a brief record of our session together in the medical notes and fuller notes are kept securely within the psychology team. If you have any particular concerns about confidentiality, please let us know.

Where are we based?

We run clinics in Gate 24, the Brunel Building, at Southmead Hospital, Bristol. On arrival, there is a main reception desk where you can find a map of the building, as well as staff and volunteers that can assist you to find your appointment venue. 

If you would prefer, we are able to offer appointments over video call. We can discuss this with you when arranging your initial appointment. 

If you want to give us feedback

We really value feedback from all clients who access the service and we will ask people at the end of their time with us to complete an anonymous feedback form. You can also provide direct feedback by writing to us or contacting the Advice and Complaints Team on 0117 414 4569.

“The sessions were flexible and adapted to my changing needs. We focused on practical changes which I could implement in my day to day life.”

“I appreciated the opportunity to talk things through and giving me hope.”

“I have achieved things I never thought I would manage again.”

“This experience has been hugely influential in my recovery and sense of wellbeing. My own journey is far from complete but I am so much better than I was.”

“Thanks to my sessions I now feel much more at ease with my feature, I don’t care what other people think of it!!”

© North Bristol NHS Trust.  This edition published May 2024. Review due May  2027. NBT003402.

Contact Outlook

Routine Sample Referral to Other Laboratories

Regular Off Off

Updated on 23/12/21

NBT Metabolic Biochemistry

https://www.nbt.nhs.uk/severn-pathology/pathology-services/clinical-biochemistry/biochemical-genetics

Clinical Biochemistry
Pathology Sciences Laboratory
Southmead Hospital
Westbury-on-Trym
Bristol
BS10 5NB

Urine organic acids, blood spot acylcarnitine profiles, blood spot galactosaemia screens and plasma amino acid analysis for follow-up of positive IMD screening results.

 

NBT Bristol Genetics Laboratory

https://www.nbt.nhs.uk/severn-pathology/pathology-services/bristol-genetics-laboratory-bgl

Bristol Genetics Laboratory
Pathology Sciences
Southmead Hospital
Bristol
BS10 5NB

CF mutation analysis

 

NBT Haematology

https://www.nbt.nhs.uk/severn-pathology/pathology-services/haematology

Haematology Department
Pathology Sciences
Southmead Hospital
Bristol
BS10 5NB

Confirmation of sickle and haemoglobinopathy results by iso-electric focussing.

 

Birmingham Children’s Hospital

Department of Clinical Chemistry
The Birmingham Children's Hospital NHS Trust
Steelhouse Lane
Birmingham
B4 6NH

Biopterin analysis as part of the differential diagnoses associated with elevated phenylalanine levels.

 

Red Cell Centre – Kings College Hospital

Molecular Pathology
c/o Central Specimen Reception
Blood Sciences Laboratory
Ground Floor Bessemer Wing
Kings College Hospital
Denmark Hill
London
SE5 9RS

Sickle cell disease testing by DNA, for babies that have had a blood transfusion before the blood spot sample was collected.

 

Virology – Royal Free Hospital

RRL – Specimen Reception (VIROLOGY Section)
1st Floor HSL Laboratories
Royal Free Hospital
Pond Street, Hampstead
London
NW3 2QG

CMV virology: See https://www.nbt.nhs.uk/severn-pathology/pathology-services/clinical-biochemistry/newborn-screening/blood-spot-retrieval for further information and downloadable consent form.

 

Newborn Screening Laboratory – Cardiff

Medical Biochemistry & Immunology
Heath Park
Cardiff
CF14 4XW

Bloodspot homocysteine analysis as part of the second-tier testing for Homocystinuria.

Contact Newborn Screening

Newborn Screening Laboratory (Bristol)
PO Box 407
Bristol
BS9 0EA

Email: newbornscreening@nbt.nhs.uk
Telephone: 0117 414 8412
 

Opening times: 9am - 5pm Monday - Friday excluding bank holidays.

Clinical advice & interpretation is available during working hours.

Access the NHS Blood Spot Screening Programme Centre

Routine Sample Referral to Other Laboratories

Stroke Research Useful Contacts

Regular Off Off

If you are seeking further guidance and/or support about Stroke, we recommend visiting the following health partners.

Across their pages, you will find a variety of resources and useful contacts to compliment the information you may already have received from North Bristol NHS Trust as part of your treatment or participation in one of our research studies.

Bristol Health Partners, Stroke Health Integration Team (HIT)

Bristol Health Partners, Stroke Health Integration Team (HIT) brings together clinicians, commissioners, academics, care and support providers and other experts, as well as people who have had strokes and their families and carers.

We are committed to preventing strokes and improving the lives of people affected by stroke through working together beyond the limits of individual organisations, in Bristol, North Somerset and South Gloucestershire (BNSSG).

If you would like be involved, even in a small way, please get in touch by emailing strokehit@bristolhealthpartners.org.uk 

The Stroke Association

The Stroke Association can provide free support to anyone who has been affected by a Stroke. This includes family, friends and carers. They can provide information, signposting and both practical and emotional support. If an adviser cannot help directly then they can usually find someone who can.

Stroke Helpline: 0303 3033 100 (lines are open Monday – Saturday)
Supporter Care: 0300 3300 740
Email: helpline@stroke.org.uk

Bristol after Stroke

Bristol after Stroke is a Bristol based charity, made up of professionals and volunteers who are able to provide information and support in the months and years following a Stroke. You can either refer yourself, or be referred by a carer, professional or agency that may be working with you.

The Bristol after Stroke team will ask a few questions about you and your stroke and what assistance you would like. They offer information and guidance, including referral on to other specialist help, advocacy to help you negotiate with other agencies, emotional and psychological support, counselling and peer support. They also offer rehabilitation support and care for the carers.

Address: The Gatehouse Centre, Hareclive Rd, Bristol BS13 9JN
Email: office@bristolafterstroke.org.uk
Telephone: 0117 964 7657

Other useful links

South Gloucester Council: A directory of useful services - search 'stroke' to access their directory.

Visit Home from Hospital service - (British Red Cross) website

Take Part in Research

Patient & Doctor viewing an x-ray

Become one of the thousands of people taking part in research every day within the NHS.

About Research & Development

NBT Researcher

Find out more about our research and how we're working to improve patient care.

Contact Research

Research & Development
North Bristol NHS Trust
Level 3, Learning & Research building
Southmead Hospital
Westbury-on-Trym
Bristol, BS10 5NB

Telephone: 0117 4149330
Email: research@nbt.nhs.uk

R&I Stroke.jpg