NHS referral service

If you have been referred for more treatments or tests, you can check on the referral using the NHS website or App. You will need a letter of referral from your GP if you would like to see a private specialist or consultant.

Following Up Referrals, Appointments, Results and Hospital Correspondence

We understand that waiting for a hospital appointment, test result or referral can be frustrating, particularly when you are unsure what is happening.

We will always make sure that we have completed any action required from the practice. However, once a referral, appointment, investigation or treatment has been passed to a hospital or other healthcare service, there are often things that only that service can tell you or arrange.

If a referral is already in progress then, where possible, we ask that you contact the relevant hospital or healthcare service directly.

This can often be the quickest way to get an update and means you can speak directly to the team responsible for your care.

If a referral has been made then you will see this in your NHS app as a referral letter, or  request to radiology investigation. If more than 2 weeks has passed since a discussion with a clinician and agreement to refer and you cannot see the referral then please contact us by email to secretaries.combedown1@nhs.net. For fast track referrals , these should be visible in your NHS app after 48 hours-  please contact us earlier for these if you cannot see the referral in your app.

If you cannot connect with your medical records in the NHS app, you will need to speak to one of our reception/care navigation team (telephone or attend reception desk).

NHS referral service

If you have been referred for NHS treatment, tests or an appointment, you may be able to check the progress of your referral using your NHS account or the NHS App.

You will need your NHS account login details to access this service.

Check a referral on the NHS website

You can also find more information about referrals and hospital appointments on the NHS website:

Find out more about referrals and appointments

Private referrals

If you need a referral  to a private specialist or consultant, you may need a referral letter from your GP. Please speak to your insurers first, and/or the admin/secretarial team  if you are unsure what is required.

Request for or enquiries about private referrals where you have already seen or spoken to a clinician can be sent to secretaries.combedown1@nhs.net. If you have not seen or spoken to a clinician yet, then please fill in a triage form giving as much details as possible. Sometimes our clinicians can make a private referral without an appointment, sometimes they will need to see  or speak to you first.

RUH/other Hospital appointments and referrals

If you are waiting for an outpatient appointment or have questions about a referral that has already been sent, please contact the relevant hospital department directly.

The hospital team can usually provide the most up-to-date information about:

·         when you are likely to be seen;

·         the status of your referral;

·         appointment availability;

·         changing or rearranging an appointment; and

·         questions or concerns about your hospital care.

If you are waiting for an appointment at the Royal United Hospitals Bath (RUH), information about current waiting times and how to contact individual departments is available on the RUH website.

If you are waiting for an appointment for physio with HCRG, you can find their contact details here.

Test and investigation results

If a hospital or specialist has arranged a test or investigation, they are normally responsible for reviewing the result and explaining it to you, including any further treatment or follow-up that may be needed.

If you are waiting for a result from a test arranged by a hospital or specialist, please contact the department or clinician who requested the test in the first instance.

If your GP has arranged the test, the GP practice will be responsible for reviewing the result and contacting you if further action is needed.

Please allow time for correspondence to arrive

After a hospital appointment, investigation or procedure, it can sometimes take several weeks for results, clinic letters or other correspondence to reach the GP practice.

If you have recently attended an appointment or had a test, please allow a reasonable amount of time for the hospital to review the information and contact you before asking us to chase it.

If you are concerned about a delay, contacting the hospital department directly is usually the best first step.

We will still help when you need us

We appreciate that not everyone is able to contact hospital services themselves.

Please let us know if you need additional support because, for example, you:

·         have significant difficulties with your mental health;

·         have memory or cognitive difficulties;

·         have communication difficulties;

·         are frail or otherwise vulnerable; or

·         have already tried to contact the hospital or healthcare service but have been unable to get a response.

In these circumstances, we will consider how we can support you.

If you are unhappy with a hospital service or delay

If you have tried to resolve an issue with the relevant hospital department and remain unhappy about the service, communication or delay, you can contact the hospital's Patient Advice and Liaison Service (PALS) for help and advice.

What we will do

Before asking you to contact another healthcare service, we will make sure that there is no outstanding action required from the GP practice — for example, we will check that a referral has been sent where appropriate.

Our aim is to make sure you are given the right information and support while ensuring that you can speak directly to the healthcare team responsible for your care.

If you genuinely need our help to contact the secondary care team, we will do our best to support you.

We cannot routinely contact secondary care services on behalf our patients to chase referrals,  as this takes our admin team away from the work they need to do in the practice processing referrals, emails and contacts received from outside agencies and supporting GPs in their work.

Ear care

Ear Wax

  • Ear wax is normal it provides protection for your ears
  • Your ears are self-cleaning
  • The movement of your jaw while eating and talking moves the wax along the canal
  • Ear wax only becomes a problem if it causes deafness, pain or if a health professional
    needs a clear view of the ear drum

What makes ear wax worse?

  • The amount of wax produced varies from person to person
  • Some people produce excessive amounts of wax and this can block the ear canal
  • Wearing a hearing aid, ear plugs and or head phones can interfere with wax expulsion
  • Narrow and or hairy ear canals
  • If you are elderly – the wax produced may be harder and drier
  • Dry skin in people who suffer with eczema or psoriasis

What you shouldn’t do

  • Use cotton buds to clean the ear. This forces the wax deeper into the canal and can cause damage, trauma and possible infection
  • Do not use objects such as matches, hair grips, crochet hooks, knitting needles, keys etc. this can cause trauma and possible infection
  • If your ears are itchy do not scratch or rub them with your finger nails or any other objects
  • Do not use anything smaller than your elbow in your ear!!

What helps?

  • Try and keep your ears dry. When washing your hair, showering or swimming putting some Vaseline around the inner part of your ear can help
  • Don’t put your head under the water when bathing
  • If you regularly get blocked years, use olive oil drops weekly

When to see the GP or Advanced Nurse Practitioner

If you are experiencing the following symptoms:

  • Pain
  • Discharge or bleeding from the ear
  • Sudden deafness
  • Dizziness
  • Foreign bodies (you may be advised to attend A&E)

What you can do to manage the problem?

  • If you are not experiencing any of the symptoms on the previous page, the following is recommended:
  • Olive Oil Drops – The following needs to be done 2 -3 times daily for 14 days.
  1. Lie on your side with the affected ear uppermost
  2. Pull the outer ear gently backwards and upwards to straighten the ear canal
  3. Put 2 -3 drops of olive oil into the affected ear(s) and gently massage just in front of the ear
  4. Stay lying on your side for 10 minutes to allow the wax to soak up the oil.
  5. Afterwards, wipe away any excess oil but do not plug your ear with cotton wool as this simply absorbs the oil
  6. Your hearing problem may initially worsen after first starting to use the olive oil drops; this is why you are advise d to concentrate on treating one ear at a time if both ears are blocked with wax.
  7. In most cases, after 14 days, the wax will have softened sufficiently to encourage the wax to come out without further intervention.
  8. However, if you feel your hearing is still impaired, please make an appointment with the practice nurse for further advice and management.

Alternatively

There are now a number of over-the -counter kits available from pharmacies. These contain a wax softener as drops which you use for 3 -4 days and a small bulb syringe to enable you to remove the wax from your ear canals yourself. They can easily be purchased from your pharmacy or online by searching for ‘ear bulb syringe’ e.g. aculife bulb ear syringe, otex express combi pack or macks wax away earwax removal system for examples.

The specially designed ear syringes are designed to create enough pressure to clear wax out of the ear without causing damage to the ear drum. It is very important to use hand -temperature, tepid body temperature water for this process having used olive oil or the drops in the previous days. Prolonged use of the drops in the over-the-counter preparations other than olive oil can cause irritation and soreness and should not be used for more than a few days at a time.

Healthy eating, exercise and obesity

The nation is getting fatter and the health problems are getting bigger with it. Advice is available on: www.foodfitness.org.uk

Health Eating

When it comes to a healthy diet, balance is the key to getting it right. This means eating a wide variety of foods in the right proportions, and consuming the right amount of food and drink to achieve and maintain a healthy body weight. The ‘Eatwell Plate’ highlights the different types of food that make up our diet, and shows the proportions we should eat them in to have a well-balanced and healthy diet.

Exercise

Exercise is essential to maintain both mental and physical wellbeing. Being active in your daily life at every opportunity will play a key role in this.

NHS guidelines state that to stay healthy, adults aged 19-64 should try to be active
daily and should do: at least 150 minutes of moderate aerobic activity such as
cycling or brisk walking every week, and. strength exercises on two or more days a
week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders
and arms)

For more information the NHS Live Well page.

If you are struggling with your weight and eating habits please make an appointment
to see a Nurse or a Health Care Assistant at the Surgery & they will be able to help
you.

Park Run 

We are a Park Run practice!

What is Park Run?

Parkruns are free, weekly, community events held all around the world

5k events are held every Saturday morning in areas of open space

2k junior parkruns for 4-14 year olds and their families are held on Sunday mornings

 

Why join a Park Run?

Over 850 locations across UK

Organised by local volunteer teams

Walk, run, jog, volunteer or spectate – take part in any way that suits you

You can learn new skills and enhance your health and happiness in the great outdoors

Make new friends, feel part of your local community and improve your fitness

Open to all, including those who are inactive or have health conditions or disabilities

 

Park Runs in Bath

Bath Skyline parkrun

Every Saturday at 9:00am

The event takes place at ‘Free Fields’, North Road/Claverton Down Road (opposite Shaft Road), Bath

https://www.parkrun.org.uk/bathskyline/

 

Bath Odd Down junior parkrun

A 2k event for juniors only (4-14 year olds)

Every Sunday at 9:00am

The event takes place at Odd Down Sports Ground, Chelwood Drive, Bath, BA2 2PR

https://www.parkrun.org.uk/bathodddown-juniors/

Weight loss information

If your BMI is over 30 then you may benefit from some weight loss. Even losing just 10% of your body weight will bring about marked health gains.

There is plenty of advice out there, you can start at the NHS website. Better Health - NHS (www.nhs.uk)

What can we help you with at the surgery?

Weight loss is not easy. You may have head about weight loss injections and some of our patients are accessing these privately via online pharmacy services. These can be prescribed on the NHS to diabetics and are normally initiated by the RUH or diabetes specialist clinicians.

A new GP led service for prescribing of weight loss medications is being phased in. Not all GP practices will offer this service, but we plan to do so.

A small cohort of our registered patients with very high BMI and multiple co-morbidities may be eligible for GP prescribed injections and we will contact you if the information we hold brings your name up in a search as being potentially eligible. You can find more information about this at https://bsw.icb.nhs.uk/information-for-patients-on-availability-of-new-weight-loss-treatment/

Weight loss injections may also be available through an online weight loss service called Oviva and eligible patients can get an NHS referral to this service through their GP if they fulfil certain criteria.The criteria for acceptance for BSW patients has recently changes and is much stricter- patients now require a BMI of > 40 and 4 co-morbidities (from obstructive sleep apnoea, cardiovascular disease, hypertension, diabetes and dyslipidaemia) Please see their website for more information and choose BSW ICB How to get weight loss injections on the NHS | Oviva UK.

Occasionally we will prescribe ‘Orlistat’ which is basically a medication that gives you diarrhoea and bloating if you eat fat- so it acts as a deterrent to keep you on course.

But we would argue that a healthy diet, including a weight loss diet, needs to include some fat, so this isn’t that helpful. And, more importantly, it doesn’t help everyone.

The usual advice is to create a calorie deficit but this doesn’t work for everyone and it is more important to switch to healthier foods if you can and change your lifestyle. An improvement in the gut biome by eating more fibre rich foods may help with weight loss as this supports hormonal changes that can reduce food cravings.

If your BMI is over 30 and you would like to be referred to the local Health lifestyle service provided by Everyone Health (previously provided as the lifestyle service by HCRG) for advice and support in relation to increasing activity which may aid weight loss , then you can make an appt to see or speak to one of our HCAs who will be happy to make the referral for you. We do need an up-to-date weight and height for this. You can use the machine in our waiting rooms for this if you can’t come into an appointment. Alternatively you can self-refer to this service via the wellbeing hub Home - Everyone Health Bath & North East Somerset

The NHS also offers weight loss advice via the NHS website Better health website: Better Health - NHS (www.nhs.uk)

If you have diabetes or hypertension (are on BP medications) and BMI is over 30 then we can refer you to the NHS digital weight loss service. Please contact us asking for a referral. We will need an up to date height and weight.

If you have prediabetes, we can refer you to the prediabetes education programme which is designed to promote weight loss- this protects against progression to diabetes. Please contact us asking for a referral. We will need an up to date height and weight.

If you have type 2 diabetes we can refer you to the diabetes education programme which also promotes weight loss to improve blood sugar control. Please contact us asking for a referral. We will need an up to date height and weight.

A Tier 4 referral can be made by a GP for individuals with BMI over 40 who are at severe risk from their weight and who wish to be considered for bariatric surgery. This is a long process and at times these NHS services have been suspended due to lack of capacity. At the time of writing we are able to refer individuals with BMI over 40 for bariatric service who also have serious co-morbidities.

If you have concerns about a young person’s weight (under 17) then please make an appt for them to see a GP to make an assessment and advise on options for support.