Your GP will discuss with you and, if appropriate, your carer why a referral is being recommended.

You are usually referred because your GP wants a specialist’s help in deciding how best to treat your condition or they do not have the equipment at the surgery for the required tests and investigations.

If your GP needs to refer you to a consultant-led service for a physical or mental health condition, in most cases you have the right to choose which hospital you go to.

If you do not express a preference, your GP will tend to refer you to a local hospital near where you live that is part of the local healthcare system.

For more information on referrals information please see here.

We offer a range of clinics and services here at Dysart Surgery for all your vaccination needs and advice.

Childhood Immunisations

One of the most important things that a parent can do for their child is to make sure that they have all their routine childhood vaccinations. It’s the most effective way of keeping them protected against infectious diseases.

Ideally, children should have their jabs at the right age to protect them as early as possible and minimise the risk of infection.

Find out which jabs your child needs, when they need them, and what the benefits of each jab are.

Please call the surgery to make an appointment.

For more information please visit the websites below:

Useful links

• NHS Choice – Vaccinations for you and your family
• Childhood Immunisation Schedule
• National Immunisation Schedule

---

Flu Immunisation

Seasonal flu is a highly infectious illness caused by a flu virus.

The virus infects your lungs and upper airways, causing a sudden high temperature and general aches and pains.

You could also lose your appetite, feel nauseous and have a dry cough. Symptoms can last for up to a week.

We offer ‘at risk’ groups the flu vaccine at a certain time each year to protect you against the flu virus.

You may be invited for a flu jab if you are:

• over 65 years of age
• pregnant

or have:

• a serious heart or chest complaint, including asthma
• serious kidney disease
• diabetes
• lowered immunity due to disease or treatment such as steroid medication or cancer treatment
• if you have ever had a stroke
• If you have any queries please contact the surgery.

For more information please visit the websites below:

Useful links

• NHS Choices – Flu and the Flu Vaccine

---

Pneumococcal Vaccine

The pneumococcal vaccine (or ‘pneumo jab’ or pneumonia vaccine as it’s also known) protects against pneumococcal infections.

Pneumococcal infections are caused by the bacterium Streptococcus pneumoniae and can lead to pneumonia, septicaemia (a kind of blood poisoning) and meningitis.

Read more about why the pneumococcal vaccination is needed.

Who should have the pneumococcal vaccine?

A pneumococcal infection can affect anyone. However, some people need the pneumococcal vaccination because they are at higher risk of complications.

These include:

• all children under the age of two
• adults aged 65 or over
• children and adults with certain long-term health conditions, such as a serious heart or kidney condition

Read more about who should have the pneumo jab.

How often is the pneumococcal vaccine given?

Babies receive the pneumococcal vaccine as three separate injections, at 2 months, 4 months and 12-13 months.

People over-65 only need a single pneumococcal vaccination which will protect for life. It is not given annually like the flu jab.

People with a long term health condition may need just a single one-off pneumococcal vaccination or five-yearly vaccination depending on their underlying health problem.

---

What is non-NHS work and why is there a fee?

The National Health Service provides most health care to most people free of charge, but there are exceptions: prescription charges have existed since 1951 and there are a number of other services for which fees are charged.

Sometimes the charge is because the service is not covered by the NHS, for example, producing medical reports for insurance companies, to whom it may concern letters. The Government’s contract with GPs covers medical services to NHS patients but not non-NHS work. It is important to understand that many GPs are not employed by the NHS; they are self-employed and they have to cover their costs – staff, buildings, heating, lightning, etc. – in the same way as any small business.

In recent years, however, more and more organisations have been involving doctors in a whole range of non-medical work. Sometimes the only reason that GPs are asked is because they are in a position of trust in the community, or because an insurance company or employer wants to ensure that information provided to them is true and accurate.

Examples of non-NHS services for which GPs can charge their own NHS patients are:

• accident/sickness certificates for insurance purposes
• school fee and holiday insurance certificates
• reports for health clubs to certify that patients are fit to exercise
• private prescriptions for travel purposes

Examples of non-NHS services for which GPs can charge other institutions are:

• life assurance and income protection reports for insurance companies
• reports for the Department for Work and Pensions (DWP) in connection with
• disability living allowance and attendance allowance
• medical reports for local authorities in connection with adoption and fostering

Do GPs have to do non-NHS work for their patients?

With certain limited exceptions, for example a GP confirming that one of their patients is not fit for jury service, GPs do not have to carry out non-NHS work on behalf of their patients. Whilst GPs will always attempt to assist their patients with the completion of forms, they are not required to do such non-NHS work.

Is it true that the BMA sets fees for non-NHS work?

The British Medical Association (BMA) suggest fees that GPs may charge their patients for non-NHS work (i.e. work not covered under their contract with the NHS) in order to help GPs set their own professional fees. However, the fees suggested by them are intended for guidance only; they are not recommendations and a doctor is not obliged to charge the rates they suggest.

Why does it sometimes take my GP a long time to complete my form?

Time spent completing forms and preparing reports takes the GP away from the medical care of his or her patients. Most GPs have a very heavy workload and paperwork takes up an increasing amount of their time. Our GPs do non-NHS work out of NHS time at evenings or weekends so that NHS patient care does not suffer.

I only need the doctor’s signature – what is the problem?

When a doctor signs a certificate or completes a report, it is a condition of remaining on the Medical Register that they only sign what they know to be true. In order to complete even the simplest of forms, therefore, the doctor might have to check the patient’s ENTIRE medical record. Carelessness or an inaccurate report can have serious consequences for the doctor with the General Medical Council (the doctors’ regulatory body) or even the Police.

If you are a new patient we may not have your medical records so the doctor must wait for these before completing the form.

What will I be charged?

It is recommended that GPs tell patients in advance if they will be charged, and what the fee will be. It is up to individual doctors to decide how much they will charge. The surgery has a list of fees based on these suggested fees which is available on request.

What can I do to help?

• Not all documents need a signature by a doctor,  you can ask another person in a position of trust to sign such documents free of charge. Read the information that comes with these types of forms carefully before requesting your GP to complete them.
• If you have several forms requiring completion, present them all at once and ask your GP if he or she is prepared to complete them at the same time to speed up the process.
• Do not expect your GP to process forms overnight: urgent requests may mean that a doctor has to make special arrangements to process the form quickly, and this may cost more.

Our Fees

To Whom It May Concern Letter – Simple – Complex	£25 £45
Medical Report – Limited – Standard Without Exam – Standard With Exam	£30 £100 £125
Holiday/ Health Insurance/ Lifestyle Reports -Simple -Complex – With exam	£45 £85 £125
All HGV, Taxi Medicals, Pre Employment Medicals and Bus Medicals	£125
Private Sick Note	£15
Private Prescription	£15
Crem 4 From	£82
Lasting POA form	£60

Working together to improve your health

Everyone is at risk of developing heart disease, stroke, diabetes, kidney disease and some forms of dementia. The good news is that these conditions can often be prevented – even if you have a history of them in your family. Have your free NHS Health Check and you will be better prepared for the future and be able to take steps to maintain or improve your health.

Visit NHS Choices – Health Checks for further information.

---

Why do I need an NHS Health Check?

We know that your risk of developing heart disease, stroke, type 2 diabetes, kidney disease and dementia increases with age. There are also certain things that will put you at even greater risk.

These are:

• being overweight
• being physically inactive
• not eating healthily
• smoking
• drinking too much alcohol
• high blood pressure
• high cholesterol

Both men and women can develop these conditions, and having once could increase your risk of developing another in the future.

• In the brain a blocked artery or a bleed can cause a stroke.
• In the heart a blocked artery can cause a heart attack or angina.
• The kidneys can be damaged by high blood pressure or diabetes, causing chronic kidney disease and increasing your risk of having a heart attack.
• Being overweight and physically inactive can lead to type 2 diabetes.
• If unrecognised or unmanaged, type 2 diabetes could increase your risk of further health problems, including heart disease, kidney disease and stroke.

---

What happens at the check?

• This check is to assess your risk of developing heart disease, type 2 diabetes, kidney disease, and stroke.
• The check will take about 20–30 minutes.
• You’ll be asked some simple questions. For example, about your family history and choices which may put your health at risk
• We’ll record your height, weight, age, sex, and ethnicity.
• We’ll take your blood pressure.
• We’ll do a simple blood test to check your cholesterol level.

---

What happens after the check?

• We will discuss how you can reduce your risk and stay healthy
• You’ll be taken through your results and told what they mean. Some people may be asked to return at a later date for their results.
• You’ll be given personalised advice on how to lower your risk and maintain a healthy lifestyle.
• Some people with raised blood pressure will have their kidneys checked through a blood test.
• Some people may need to have another blood test to check for type 2 diabetes. Your health professional will be able to tell you more.
• Treatment or medication may be prescribed to help you maintain your health.

---

Questions you may have

Certain small surgical operations can be performed at the surgery. With minor surgery the recovery time is usually short and you will be back to your usual activities fairly quickly (depending on your procedure).

Before attending for minor surgery you will need to see a doctor for the diagnosis and then you will be given an appointment to attend for your procedure.

We offer a range of clinics and services here at Station Road Surgery to help manage chronic diseases.

Chronic Heart Disease

The most common symptoms of coronary heart disease (CHD) are chest pains (angina) and a heart attack.

You can also experience other symptoms, such as palpitations and unusual breathlessness. In some cases, people may not show any symptoms before they are diagnosed.

---

Angina

If your coronary arteries become partially blocked, it can cause chest pain (angina). This can be a mild, uncomfortable feeling similar to indigestion.

However, a severe angina attack can cause a painful feeling of heaviness or tightness, usually within the centre of the chest, which may then spread to the arms, neck, jaw, back or stomach.

Angina attacks are often triggered by physical activity or stressful situations. Although symptoms of Angina usually pass within 10 minutes, you can alleviate the symptoms by resting or using a nitrate tablet or spray.

---

Heart attacks

If your arteries become completely blocked, it can cause a heart attack (myocardial infarction). Heart attacks can cause permanent damage to the heart muscle and, if not treated straight away, can be fatal.

If you think you are having a heart attack, dial 999 for immediate medical assistance.

Although symptoms can vary, the discomfort or pain of a heart attack is usually similar to that of angina but often more severe. During a heart attack you may also experience the following symptoms:

• Sweating
• Light-headedness
• Nausea
• Breathlessness

The symptoms of a heart attack can be similar to indigestion. For example, they may include a feeling of heaviness in your chest, a stomach ache or heartburn. However, these symptoms can also be accompanied by a pain that affects the arms (particularly the left arm), the neck and the jaw.

A heart attack can happen at any time, including while you are resting. If heart pains last longer than 15 minutes, it may be the start of a heart attack.

Unlike angina, the symptoms of a heart attack are not usually relieved using a nitrate tablet or spray.

In some cases, you may have a heart attack without any symptoms, called a silent myocardial infarction. This is more common in people with diabetes.

---

Heart failure

Heart failure can also occur in people with CHD when the heart becomes too weak to pump blood around the body, which can cause fluid to build up in the lungs that makes it increasingly difficult to breathe.

Heart failure can happen suddenly (acute heart failure) or gradually over time (chronic heart failure).

Useful links

• British Heart Foundation – Angina
• British Heart Foundation – Cardiovascular Disease
• British Heart Foundation – Heart Attack

---

Diabetes

Diabetes is a long-term condition caused by too much glucose, a type of sugar, in the blood. It is also known as diabetes mellitus.

There are two main types of diabetes, which are explained below:

• Type I Diabetes
• Type II Diabetes

Normally, the amount of sugar in the blood is controlled by a hormone called insulin, which is produced by the pancreas. The pancreas is a gland behind the stomach. When food is digested and enters your bloodstream, insulin moves any glucose out of the blood and into cells, where it is broken down to produce energy.

However, in people with diabetes, the body is unable to break down glucose into energy. This is because there is either not enough insulin to move the glucose, or because the insulin that is there does not work properly.

Our specialist diabetes team will provide you with support, regular reviews and the day-to-day care of your needs.

All Diabetic patients are entitled to an annual review. The Practice will normally contact you if yours is due. The review takes place in two parts – a data collection appointment and where appropriate, a follow up care plan appointment. If you feel you have been missed, or require a more urgent review, then please contact the Practice to arrange an appointment.

At the initial data collection appointment, your blood pressure, weight, urine, feet and well-being will be checked. It is necessary for you to bring an early morning urine sample with you. Following your initial appointment, a care plan booklet will be sent to you and if necessary, an appointment with your GP or one of our specialist nurses will be arranged.

For more information please visit the websites below:

Useful links

• Diabetes UK

---

Hypertension

Hypertension relates to High Blood Pressure.

High blood pressure often causes no symptoms, or immediate problems, but it is a major risk factor for developing a serious cardiovascular disease (conditions that affect the functioning of the heart and the circulation of blood around the body), such as a stroke or heart disease.

Useful links

• NHS Choices – High Blood Pressure Explained
• Blood Pressure Association
• British Heart Foundation
• British Hypertension Society

---

Respiratory

Our respiratory clinics are primarily intended for patients with Asthma and COPD.

Asthma is caused by inflammation of the airways. These are the small tubes, called bronchi, which carry air in and out of the lungs. If you have asthma, the bronchi will be inflamed and more sensitive than normal. Our practice nurses have specialist asthma qualifications. During their clinics they monitor your overall condition, offer advice, answer any queries and ensure your treatment is effective.

Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease. People with COPD have trouble breathing in and out. This is referred to as airflow obstruction. Breathing difficulties are caused by long-term damage to the lungs, usually because of smoking.

---

Asthma and COPD Clinics

We hold clinics to diagnose and to help patients to manage their asthma or COPD.

We like to see all our patients who have been diagnosed with these conditions at least once a year, depending on the severity of your condition, we may invite you to come to the clinic more often in order to ensure we give you the care you require.

Useful links

• NHS Choices – Asthma
• The British Lung Foundation
• Asthma UK
• NHS Choices – COPD

We offer a range of  services here at Dysart Surgery to help with cancer screening.

Bowel Cancer

Bowel cancer is a term used to describe cancer in the colon, rectum or the small bowel.

The symptoms of bowel cancer can include:

• Bleeding from the back passage (rectum) or blood in your stools
• A change in normal bowel habits to diarrhoea or looser stools, lasting longer than 4 to 6 weeks
• A lump that your doctor can feel in your back passage or abdomen (more commonly on the right side)
• A feeling of needing to strain in your back passage (as if you needed to pass a bowel motion)
• Losing weight
• Pain in your abdomen or back passage
• A lower than normal level of red blood cells (anaemia)

Because bowel tumours can bleed, cancer of the bowel often causes a shortage of red blood cells. This is called anaemia and may cause tiredness and sometimes breathlessness.

Bowel cancer screening

How do I get a screening kit?

If you are aged 60-69 years, you will be sent your screening invitation automatically through the post. All you need to do is make sure that your GP has your correct address.

‘People aged 70 years and over or under the age of 60, who wish to be screened, should request a kit. Simply telephone the free helpline on 0800 707 60 60.’

Macmillan Cancer Support

Have questions about cancer? Visit www.macmillan.org.uk or call 0808 808 000 free (Monday to Friday 9am – 8pm).

---

Breast Screening

The National Breast Screening Programme was introduced in 1988 as an early detection service for breast cancer. It states that all women who are aged between 50 – 70 years of age will be routinely invited for free breast screening every three years. The programme is very successful and currently saves around 1,400 lives per year.

Breast screening aims to find breast cancer at an early stage, often before there are any symptoms. To do this, an x-ray is taken of each breast (mammogram). Early detection may often mean simpler and more successful treatment. When women are invited for their mammogram depends on which GP they are registered with, not when their birthday is.

The screening office runs a rolling programme which invites women by area. The requirement is that all women will receive their first invitation before their 53rd birthday, but ideally when they are 50.  If you are under 50 and concerned about any aspect of breast care, please contact the surgery to make an appointment with your GP.

---

Cervical screening test

Cervical screening, or smear test, is a method of detecting abnormal (pre-cancerous) cells in the cervix in order to prevent cervical cancer. The cervix is the entrance to the womb from the vagina. Cervical screening is recommended every three years for women aged 25 to 49 and every five years for women aged 50 to 64 or more frequently if smear results indicates abnormal changes.

Cervical screening is not a test for cancer; it is a test to check the health of the cells of the cervix. Most women’s test results show that everything is normal, but for 1 in 20 women the test will show some abnormal changes in the cells of the cervix.

Most of these changes will not lead to cervical cancer and the cells may go back to normal on their own. However, in some cases, the abnormal cells need to be treated to prevent them becoming cancerous.

Our nurses are qualified to carry out cervical screening and tests in the form of cervical smears. In order to have a cervical smear the patient must have received a letter requesting that they have a cervical smear and the appointment must please be made for when the patient is not menstruating.

These appointments typically take around 15 minutes. For any further information or to book an appointment, please call the surgery.

Useful links

• NHS Choices – Cervical Screening

National Diabetes Audit (NDA)

Helping to improve diabetes care.

This GP practice is taking part in an important national project about diabetes care and treatment in the NHS. The project is called the National Diabetes Audit (NDA).

To take part, we will share information about your diabetes care and treatment with the NDA. The type of information, and how it is shared, is controlled by law and enforced by strict rules of confidentiality and security.

Taking part in the NDA shows that this GP practice is committed to improving care for people with diabetes.

If you do not want your information to be used, please inform the receptionist.

This will not affect your care.

If you would like to book one of these clinics, please book your appointment online, or contact us on 020 8464 4138.

Clinics/Services

Asthma Health Checks

Child Health and Immunisations

Child Health Surveillance

Chronic Lung Disease Health Checks

Diabetes Health Checks (including Insulin starts)

Health Promotion

Health Visiting

Hypertension & Coronary Heart Disease Health Checks

Influenza & Pneumonia Vaccinations

Learning Disability Health Checks

Minor Surgery

Over 75 Health Checks

Phlebotomy

Post-Operative Wound Care

Sexual Health and Family Planning

Travel Clinic