There are a number of drugs used for the treatment of neurological conditions that are subject to the Traffic Light System and/or Shared Care Protocols (SCPs).

The latest versions of the SCPs can be found on the www.bnssgformulary.nhs.uk or you should check with the Pharmacy. 

TIA Clinics

7 day service. For patients with TIAs or minor stroke.

First Seizure Clinic Referral

Please download the referral form

and attach to the referral made for the ‘First Seizure clinic – Neurology – Southmead’ service via NHS eReferrals.

Contact the Neonatal Intensive Care Unit
Telephone: 0117 4146800

Outpatient clinics are held at Level 1, Brunel building, Southmead Hospital and at Cossham Hospital.

Comprehensive Geriatric Assessment (CGA) clinics. For older people who are developing difficulties with everyday activities, memory problems and taking a lot of medication. The service reviews the medical aspects of these problems to improve quality of life. The service is accessed via NHS eReferrals and has links with the Admissions Avoidance clinic run in the older persons medical unit.

Falls Service (delivered by Dr Seema Srivastava, Lead Consultant for Falls at Southmead Hospital Bristol and all Medicine for Older People consultants at Cossham Hospital). For patients who have fallen or at risk of falling who wish to stay steady and minimise further falls. The service consists of a consultant led specialist falls clinic with links to the community services.
Referrals can be made through the Emergency Department, GPs, Community Nurses and Intermediate Care.

Parkinson Disease (Dr Ronald Barber and Dr Jarrod Richards). Consists of an outpatient clinic based at Cossham Hospital.

Osteoporosis & metabolic bone disease (Dr Karen Harding, Dr Walsh and Dr Srivastava). Assesses patients with severe/complex osteoporosis, offers advice on alternative treatment for patients intolerant to oral biphosphonates and accepts referrals for patients with other metabolic bone problems such as Paget's disease and osteomalacia. Clinics are held at both Southmead Hospital Bristol and Cossham Hospital.

Cardiovascular Chest Medicine in Older People (Dr John Pounsford). Provides specialist assessment of older people with breathing difficulties thought to be due to their lungs. Clinics are held at Southmead Hospital Bristol.

Please fax referrals to 0117 4149448 or 0117 4149400.

Referral Criteria for Hospital Medical Assessment of patients with falls

• Patients with suspected Syncope
• Patients with unexplained dizziness
• Patients with recurrent falls where a cause has not been found despite performing a multi-factorial falls risk assessment or patient is falling despite interventions put in place to manage risks

Exclusions:

• Patients who need Physiotherapy and Occupational Therapy only
• Patients who have already had a Hospital Medical Assessment of Falls in the last 24 months.

Prior to Referral: GP and community nurse must have carried out a multi-factorial falls assessment including blood tests and accurate medication review as per CCG Integrated Falls Pathway. Please include details of these assessments with referral.

Access:

• NHS eReferrals (General Older Person's Medicine and Falls Specialist Medical Assessment at Southmead or Cossham Hospital)
• Written GP referral letter can be faxed to 0117 4149457
• For South Gloucestershire CCG, GPs should use the new GPs Falls Risk Assessment and Referral template
• For community Matrons, Community Nurses for Older People, Community Therapists, REACT team, download: 
  Falls Service Referral Form for Medical Specialist Falls Review.pdf36.1 KB
• Please fax falls clinic referrals from community teams to: 0117 4149457.

Guidance:

In 2008 the first national strategy for end of life care was published. The Department of Health’s End of Life Care Strategy (2008) provided guidance and recommendations to organisations that plan and commission care for those people who are approaching the end of their life with the aim of raising standards. Since this publication other strategies have built on this guidance have help inform end of life care in North Bristol NHS Trust (NBT).

It is the role of the Specialist Palliative Care Team and NBT’s End of Life Care Strategy Group to interpret and implement this guidance in a meaningful way.

One Chance to Get it Right.
Improving people’s experience of care in the last few days and hours of life.
www.gov.uk/government/uploads/system/uploads/attachment_data/file/323188/One_chance_to_get_it_right.pdf

Ambitions for Palliative and End of Life Care
endoflifecareambitions.org.uk

General Practitioners (GP's) and Community Nurses are the main providers of palliative and end of life care in the community. Most GP practices use the Gold Standards Framework (GSF) - a simple tried and tested framework to help primary health care teams deliver the best possible care for people nearing the end of their lives. Initially developed for cancer patients, it is now used for any patient with a life limiting illness and in other settings such as care homes. For patients with complex palliative and end of life care needs the primary health care team may work alongside specialist community palliative care teams.

For more information Gold Standard Framework - Patients & Carers (goldstandardsframework.org.uk)

Marie Curie
Marie Curie Cancer Care is a charitable organization in the United Kingdom, which provides nursing care, free of charge to patients and their families. The charity is best known for its network of Marie Curie Nurses who work in the community to provide end-of-life care for patients with cancer and other life-limiting illnesses in their own homes. For more information, visit www.mariecurie.org.uk

St Peter’s Hospice
St Peter’s Hospice is Bristol’s only adult hospice caring for local people with incurable illnesses. The hospice is committed to improve the quality of life for patients while extending care and support to their families and loved ones.
The hospice works in collaboration with other community and hospital based healthcare professionals to develop, influence and provide flexible specialist services that meet the needs of people with life-limiting illness.
Services offered by St Peters Hospice include:

• 24 Hour Advice Line
• Community Nurse Specialists
• In Patient Unit Care
• Day Hospice
• Hospice at Home
• Medical Support
• Psycho Social and Spiritual Team (Social Work, Spiritual Care, Music Therapy and Bereavement Support)
• Complimentary Therapies
• Fatigue and Breathlessness Programme
• Physiotherapy and Occupational Therapy
• Education Centre

St Peters Hospice
Charlton Road
Brentry
BS10 6NL

Telephone: Switchboard 0117 915 9400
24 Hour Advice Line 0117 9159430

For more information on current available services visit www.stpetershospice.org.uk

For patients who live in Gloucestershire and Somerset the local hospices are:

Longfield
Burleigh Lane
Minchinhampton
Gloucestershire
GL5 2PQ
Telephone: 01453 886 868
Email: info@longfield.org.uk

For more information visit www.longfield.org.uk

Weston Hospice Care
Jackson-Barstow House
28 Thornbury Road
Uphill
Weston-super-Mare
Somerset
BS23 4YQ
Telephone: 01934 423900

For more information visit www.westonhospicecare.org.uk

 Dorothy House Hospice Care                                                                                                             Winsley                                                                                                                                             Bradford on Avon                                                                                                                                           BA15 2LE                                                                                                                                                     Telephone 01225 722988                                                                                                                                

For more information visit www.info@dorothyhouse-hospice.org.uk

The End of Life Care at North Bristol NHS Trust aims to deliver care in line with nationally recognised priorities for care of the dying person:

1. The possibility that the person is dying is recognised and communicated clearly, decisions are made and actions taken in accordance with the person’s needs and wishes, and these are regularly reviewed and decisions revised accordingly.
2. Sensitive communication takes place between staff and the dying person, and those identified as important to them.
3. The dying person, and those identified as important to them, are involved in decisions about treatment and care to the extent that the dying person wants.
4. The needs of families and others identified as important to the dying person are actively explored, respected and met as far as possible.
5. An individual plan of care, which includes food and drink, symptom control and psychological, social and spiritual support, is agreed, coordinated and delivered with compassion.

In order to support staff in delivering high quality care that is tailored to the individual, we use a framework of care called the Purple Butterfly approach. This approach is used to acknowledge when the focus of a persons care is comfort and symptom control and to identify their priorities and needs.

At NBT we are committed to providing high quality, personalised care at end of life. Alongside use of the Purple Butterfly approach we deliver regular palliative and end of life care teaching to all grades of staff and undertake audits to measure quality and effectiveness.

If you are a relative, carer, or friend caring for someone at the end of life, visit Caring for patients at the end of life | North Bristol NHS Trust (nbt.nhs.uk) for more information. 

Most palliative and end of life care at NBT is provided by the ward doctors and nurses led by the consultant in charge of the patient’s care. For patients and families with more complex palliative and end of life care needs, the ward team can refer to the Hospital Specialist Palliative Care Team who will work with them.

Specialist palliative care is available to any patient within North Bristol NHS Trust who has an advanced, progressive, life-threatening illness with a high level of need.

The Hospital Palliative Care Team is an advisory service providing specialist assessment and advice on the management of a range of issues that patient’s and their relatives and carers may face. This may include:

• Physical symptoms such as pain or sickness
• Coming to terms with difficult news
• Talking through treatment choices
• Help with talking to other family members
• Practical advice on benefits
• Spiritual support
• Facilitating patient choice in planning future care (advance care planning)
• Facilitating rapid discharge from hospital at end of life
• Referring to community health care professionals and palliative care services
  to ensure continuity of care
• End of life care

Visits by the Specialist Palliative Care Team are made from Monday to Friday, 9am to 5pm.

The team consists of consultants, clinical nurse specialists, specialist registrars, occupational therapists, chaplains and social workers. A number of nurses in the team are qualified nurse prescribers. This means that following an assessment they may prescribe medications to help relieve any symptoms that the patient may be experiencing. The nurse prescriber will discuss this with the patient and/or carer in further detail.

The team also delivers an extensive education programme to many groups of staff in the hospital aiming to develop knowledge and skills in palliative and end of life care.

Contact

Medical Photography 
Gate 38 Level 3
Brunel building
Southmead Hospital
Westbury-on-Trym
Bristol
BS10 5NB

Email: Photography@nbt.nhs.uk
Telephone: 0117 4146500

We continue to triage all the TWW referrals, but as of January 1st 2018 the LCNS will also be reviewing all abnormal CXR with a high suspicion of lung cancer and requesting a full staging CT scan.

We will also inform the patient and GP practice and request an urgent TWW referral.

When you send your patients for CXR, please advise them that depending on the results they may be contacted directly from the hospital.

To enable us to request further investigations please ensure the TWW form is completed in as much detail as possible, such as smoking status, performance status, anticoagulation medication and relevant past medical history.

Telephone: 0117 4141900

Email: sarah.smith@nbt.nhs.uk

Email: deborah.walton@nbt.nhs.uk

For Information about Lung Cancer care pathways, visit http://pathways.nice.org.uk/pathways/lung-cancer