Below is a list of common reasons why a patient might contact the practice.
It is important that they are booked with the right clinician or signposted to a different pathway if clinically safe to do so.
There are some ‘RED FLAG‘ Symptoms that you need to be aware of that may need to be escalated to a GP or redirected to A&E or other service.
ASYLUM SEEKERS
Due to the background of asylum seekers, this cohort of patients are deemed ‘at risk’ and many have suffered physical and mental abuse.
Please always book a double appointment when booking and confirm which language they speak so that a translator can be organised via Language Line.
Please double check the patients Identity as they often have very similar names and are staying at the same accommodation.
Asylum seekers requesting a routine GP appointment, that have not had a Health Check should be referred to Igpf.southasylumadmin@nhs.net via email and they will arrange an appointment with them. See alerts on patient records.
Please also be mindful that they also maybe sharing mobile phone numbers (to save on credit) and also emails. Please speak to Reception Supervisor if you need help or the patient is asking for a letter that you are not familiar with.
Searching the triage page:
How to easily search for specific symptoms:
- Press Ctrl+F; this should bring up a dialogue box in the top-right hand corner as seen here
- Type in the name of the symptom (i.e Depression); doing this should force your page to automatically jump to the symptom with the name you typed in the dialogue box
Red Flag conditions normally are considered as conditions that need to be dealt with as soon as possible. These include conditions relating to children under the age of 18.
Your lips, mouth, throat or tongue suddenly become swollen
- you’re breathing very fast or struggling to breathe (you may become very wheezy or feel like you’re choking or gasping for air)
- your throat feels tight or you’re struggling to swallow
- your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
- you suddenly become very confused, drowsy or dizzy
- someone faints and cannot be woken up
- a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)
You or the person who’s unwell may also have a rash that’s swollen, raised or itchy.
These can be signs of a serious allergic reaction and may need immediate treatment in hospital.
Patient at home: Call 999
Patient on site: Call 999, Alert Duty Doctor anaphylaxis kit needed
Non severe – see Allergies non- severe
Patient at home: Call 999 or go to A&E if you have any of these symptoms
Stomach pain came on quickly, such as a sudden severe-less than 24 hours.
You have a high temperature, or you feel sick
- a stomach ache came on very suddenly or is severe
- it hurts when you touch your stomach
- you’re vomiting blood or your vomit looks like ground coffee
- your poo is bloody or black and sticky and extremely smelly
- you cannot pee
- you cannot poo or fart
- you cannot breathe
- you have chest pain
- you have diabetes and you’re vomiting
- someone has collapsed
Patient on site: Call Duty Doctor
What to do?
If it is a new instance of bleeding (less than 48 hours);
GP appointment within 48 hours.
If it is an ongoing bleeding issue (they have had this before),
Book a routine appointment with any GP within 1 week. Needs to be Face-Face for examination.
If patient reports that they are feeling unwell, dizzy, bleeding heavily, or experiencing acute pain;
Discuss with duty doctor/take urgent same day slot.
!! PLEASE NOTE THIS INCLUDES MALE INSTANCES OF BREAST LUMPS TOO !!
What to do?
1. Ask if patient is experiencing pain
2. Ask if patient notices discharge from the nipple
3. Ask if patient is seeing redness on the skin
4. Ask patient if they are generally feeling unwell alongside other symptoms
If a few or more of these conditions are met;
Book a same day appointment with GP. Urgent same-day slot is appropriate to take if stuck.
If you are not able to accommodate patient on the same day, take embargoes for next day (maximum 48 hours).
Patient at home: Call 999
Symptoms : Sudden severe chest pain (NEW less than 24 hours) that:
- spreads to your arms, back, neck or jaw
- makes your chest feel tight or heavy
- also started with shortness of breath, sweating and feeling or being sick
- lasts more than 15 minutes
Patient on site: Call 999, Alert Duty Doctor
Patient at home: Call 999
Chest pain which the patient has had before or chest pain for more than 24-48 hours
Chest pain that comes and goes
Book GP same day appointment/Urgent same-day slot
Advice:
https://www.nhs.uk/conditions/chest-pain/
Patient at home: Call 999 or go to A&E
You have severe difficulty breathing or you have sudden shortness of breath and:
- your chest feels tight or heavy
- you have pain that spreads to your arms, back, neck and jaw
- you feel sick or are being sick
- you’re coughing up blood
- you have new pain or swelling in 1 of your legs
Patient on site: 999 and Alert Duty Doctor
Advice: Staff get emergency equipment ready
Patient at home: Book appointment with GP – Same day
Discuss with duty doctor if no capacity.
Dizziness includes feeling:
- off-balance
- giddy
- lightheaded or faint
- You’re spinning or things around you are spinning (vertigo)
Patient on site: Alert Duty Doctor
Advice:
https://www.nhs.uk/conditions/dizziness/
Patient at home: Go to A&E or call 999 if:
- a strong chemical, such as oven cleaner or bleach, is in your eye – keep rinsing your eye with water while waiting for medical help
- a sharp object has pierced your eye
- something has hit your eye at high speed – for example, while using power tools or mowing the lawn
- there are any changes to your sight after an eye injury
- you have a headache, high temperature or sensitivity to light
- you’re feeling sick or being sick after an eye injury
- you cannot move your eye or keep it open
- blood or pus is coming from your eye
Patient on site: Alert Duty Doctor or Nurse
Advise patient to go to Emergency Eye Hospital- Moorfields City Road – walk in Eye Casualty – they see children and adults
Advice: https://www.nhs.uk/conditions/eye-injuries/
Call 999 Go to A+E.
Someone has hit their head and has:
- been knocked out and has not woken up
- difficulty staying awake or keeping their eyes open
- a fit (seizure)
- fallen from a height more than 1 metre or 5 stairs
- problems with their vision or hearing
- a black eye without direct injury to the eye
- clear fluid coming from their ears or nose
- bleeding from their ears or bruising behind their ears
- numbness or weakness in part of their body
- problems with walking, balance, understanding, speaking or writing
- hit their head at speed, such as in a car crash, being hit by a car or bike or a diving accident
- a head wound with something inside it or a dent to the head
Patient on site: Alert Duty Doctor. Call 999
Advice:
https://www.nhs.uk/conditions/head-injury-and-concussion/
!!ASK IF THEY HAVE A RASH WHICH IS NEW WITH THE FEVER.
Symptoms in Adults:
- your chest or back feel hotter than usual
- you have other symptoms, such as shivering (chills), sweating or warm, red skin (this may be harder to see on black or brown skin)
- a thermometer says your temperature is 38C or above
- Symptoms in Children:
- A normal temperature in babies and children is about 36.4C, but this can vary slightly from child to child.
- A high temperature is 38C or more.
- If your child has a high temperature, they might:
- feel hotter than usual when you touch their back or chest
- feel sweaty
- look or feel unwell
Patient on site Alert Duty Doctor
If rash, isolate in a spare clinical room.
Patient at home: Discuss with Duty Doctor, offer same day urgent appointment.
Advice:
https://www.nhs.uk/search/results?q=high%20temperature
What to do?
If the onset of the vision problem is sudden, immediately visit your closest eye hospital.
Closest in this area is Moorfield’s Eye Hospital
Moorfield’s Eye Hospital
162 City Road
London
EC1V 2PD
Call 020752533411
If unwell – do Glass test/ if rash does not fade when pressing
At home call 999
On site – alert Duty Doctor immediately (isolate in spare clinical room)
Patient at home: Call 999 if you have any of the below symptoms:
- your lips, mouth, throat or tongue suddenly become swollen
- you’re breathing very fast or struggling to breathe (you may become very wheezy or feel like you’re choking or gasping for air)
- your throat feels tight or you’re struggling to swallow
- your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
- you suddenly become very confused, drowsy or dizzy
- someone faints and cannot be woken up
- a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)
Advice: https://www.nhs.uk/search/results?q=rashes
Call 999 and ask for an ambulance if:
- it’s the first time someone has had a seizure
- the seizure lasts longer than is usual for them (known Epilesy)
- the seizure lasts more than 5 minutes, if you do not know how long their seizures usually last
- the person does not regain full consciousness, or has several seizures without regaining consciousness
- the person is seriously injured during the seizure
Patient at home: call 999/A+E
Patient on site: Alert Duty Doctor/call 999
Advice:
https://www.nhs.uk/conditions/what-to-do-if-someone-has-a-seizure-fit/
Patient at home: Call 999
The main symptoms of stroke can be remembered with the word FAST:
- Face – the face may have dropped on 1 side, the person may not be able to smile, or their mouth or eye may have dropped.
- Arms – the person with suspected stroke may not be able to lift both arms and keep them there because of weakness or numbness in 1 arm.
- Speech – their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake; they may also have problems understanding what you’re saying to them.
- Time – it’s time to dial 999 immediately if you see any of these signs or symptoms.
Patient on site: Call 999 and Alert Duty Doctor
Advice:
https://www.nhs.uk/search/results?q=stroke
Patient at home:
- call a GP – ask for an emergency appointment
- contact your mental health crisis team – if you have one
Phone a helpline:
Samaritans – for everyone
Call 116 123
Email jo@samaritans.org
Campaign Against Living Miserably (CALM)
Call 0800 58 58 58 – 5pm to midnight every day
Visit the webchat page
Papyrus – prevention of young suicide HOPELINE247
Call 0800 068 41 41
Text 07860 039967
Email pat@papyrus-uk.org
Childline – for children and young people under 19
Call 0800 1111 – the number will not show up on your phone bill
SOS Silence of Suicide – for everyone
Call 0300 1020 505 – 4pm to midnight every day
Email support@sossilenceofsuicide.org
Shout Crisis Text Line – for everyone
Tasks “SHOUT” to 85258
YoungMinds Crisis Messenger – for people under 19
Text “YM” to 85258
Patient on site: Book appointment with GP or Alert Duty Doctor
Advice:
.
Patient at home: Call 999 or go to A&E
A baby or young child has any of these symptoms of sepsis:
- blue, grey, pale or blotchy skin, lips or tongue – on brown or black skin, this may be easier to see on the palms of the hands or soles of the feet
- a rash that does not fade when you roll a glass over it, the same as meningitis
- difficulty breathing (you may notice grunting noises or their stomach sucking under their ribcage), breathlessness or breathing very fast
- a weak, high-pitched cry that’s not like their normal cry
- not responding like they normally do, or not interested in feeding or normal activities
- being sleepier than normal or difficult to wake ‘floppy’
- acting confused, slurred speech or not making sense
- blue, grey, pale or blotchy skin, lips or tongue – on brown or black skin, this may be easier to see on the palms of the hands or soles of the feet
- a rash that does not fade when you roll a glass over it, the same as meningitis
- difficulty breathing, breathlessness or breathing very fast
- They may not have all these symptoms.
Patient on Site: call 999 and Alert Duty Doctor
Advice:
https://www.nhs.uk/conditions/sepsis/
What to do?
1. Ask if patient is experiencing pain
2. Ask if patient notices discharge from the penis
3. Ask if patient is seeing redness on the skin
4. Ask patient if they are generally feeling unwell alongside other symptoms
If a few or more of these conditions are met;
Book a same day appointment with GP. Duty doctor slot is appropriate to take if stuck.
If you are not able to accommodate patient on the same day, take embargoes for next day (maximum 72 hours)
If sudden and severe;
Must go to A&E
If not, please see green section “Headaches”
- you have sudden swelling in 1 ankle, foot or leg and there’s no obvious cause, such as an injury
- the swelling is severe, painful or starts very suddenly
- the swollen area is red or feels hot to the touch
- your temperature is very high, or you feel hot and shivery
- you feel short of breath or are struggling to breathe
- your chest feels tight, heavy or painful
- you’re coughing up blood
Alert duty doctor if no capacity
If associated with chest pain/unwell > A&E
otherwise > GP appointment same day
discuss with duty doctor if no appointment available
Offer GP appointment as soon as possible. Use same-day urgent appointment slots.
if not, signpost to A&E
These conditions are viewed as non-urgent most of the time and can be dealt with by the wider healthcare team and does not always need to be a GP. Please follow the instructions in the various drop-downs. –
Ongoing abdominal pain or gastro issues
1. Routine GP appointment – preferbally face-face
remember SUDDEN/severe <24 hour history- see red flag section
// to tidy
SEE PROCESS MAP;
- If general mental health concerns, appointment with GP
- If just requesting diagnosis > follow process map and send accuRx (right to choose link***)
!!All children must speak to GP
Who do I see?
Self-refer to Better Lives – sms link
accurx advice – better lives******
Advice:
Please visit alcoholics anonymous.
Symptoms of an allergic reaction can include:
- a runny nose or sneezing
- itchy skin or a raised rash (hives)
- diarrhoea
- feeling or being sick
- swollen eyes, lips, mouth or throat, wheezing or difficulty breathing- these are severe – see RED section**
Who do I see?
- Community pharmacy
- PBP
- GP – routine (only if no PBP appointments)
Advice:
NHS – Allergies
Who do I see?
Book appointment with GP
Ask patient to fill out Anxiety GAD7 score (there is an AccuRx template questionnaire to send) before they speak to GP.
Advice: ACCURX template Mental Health **
Further information about anxiety from NHS UK.
Who do I see?
1. Community Pharmacy for pain management
2. First Contact Physiotherapist – if new/first episode
3. Practice Based Pharmacist
4. GP
Self referral to Physiotherapy for treatment
ACCURX template (Physio GetuBetter)
Known Asthma patient with breathing difficulty (not severe)
Who do I see?
Our nurses and pharmacists can review your asthma inhalers and treat asthma.
1. For routine asthma care/reviews, please book to see a Practice Nurse (30 mins appointment) or PBP (30 min)
2. GP appointment (if patient thinks they have an infection and their asthma is playing up as a result)
Advice:
Who do I see?
Community Pharmacy/ PBP (1 appointment slot to be booked with PBP)
Advice:
Find your local community pharmacy.
Further information about athletes foot, available from NHS UK.
If you have back pain and:
- NEW tingling, weakness or numbness in both legs
- numbness or tingling around your genitals or buttocks
- loss of bladder or bowel control (peeing or pooing yourself)
A+E/999
Alert Duty Doctor
If none of the above symptoms, who do I see?
First Contact Physiotherapist back pain- first episode
Ongoing back pain, not new, worsening
– Routine GP appointment – within 1 week – tell them to do physiotherapy referral if not done already.
Advice:
Search for your nearest community pharmacist.
Who do I see?
Community Pharmacy or book via Islington Federation extended hours. We do not offer this service.
Shefali Healthcare Assistant can check ears only (no treatment)
Advice:
A pharmacist can help with earwax build-up
Speak to a pharmacist about earwax build-up. They can give advice and suggest treatments.
They might recommend chemical drops to dissolve the earwax. The earwax should fall out on its own or dissolve after about a week.
Do not use drops if you have a hole in your eardrum (a perforated eardrum).
Make sure sexually transmitted infection has been ruled out
- STI clinic or SHL link
see GP – routine appointment
First ask the patient:
- Do they have symptoms of a urine infection?
- If they do, follow the same advice for shown in the “Urine infection” section. (They can see community pharmacy/pharmacy first)
- If not, book patient with a GP within 48 hours.
If the patient in question is Female, ask if they could possibly be pregnant.
Who do I see?
1. Health Care Assistant (HCA) ( 20 mins appointment )
2. Nurse/PBP/GP – only if high or urgent
Advice:
These can also be performed at most local pharmacies. If the results are high e.g. 180/100 ALERT DUTY DOCTOR
If between 160/90-180/90 a GP appointment would be needed
Who do I see?
Book via Swiftqueue you need to register for an account. (add new protocol)
https://www.swiftqueue.co.uk/userlogin.php
Advice:
Appointments for blood tests MUST have been requested by your doctor or other health care professional. HCA (10min) only authorised to do bloods for frail or vulnerable patient over 65, otherwise patient must go to a Hunter Street, River Place or James Wigg surgeries.
Who do I see?
Contact your local Council directly or Apply online
Advice:
To apply for a Blue Badge parking permit, you need to contact your local council.
ACCURX TEMPLATE*
The Blue Badge Scheme is for people with severe mobility problems. Blue Badge holders are able to park close to where they need to go. The scheme is managed by local authorities who deal with applications and issue Blue Badges.
GOV.UK has more details about the Blue Badge scheme, including information about applying for a Blue Badge.
Who do I see?
1. First instance, patient should visit Community Pharmacy
2. Book an appointment with the Nurse – if discharging/needs dressing
3. Book with GP (eConsult helpful)
Advice:
Further information about boils and carbuncles from NHS UK.
What to do?
If patient reports they are breastfeeding;
1. Speak to health visitor
2. Book with GP
If patient is worried about Mastitis, breast lumps whilst breastfeeding same day GP appointment
Alert the Duty Doctor if patient also reports that they feel uncharacteristically unwell on top of other symptoms.
If patient reports Breast Lumps/Breast problems when NOT breastfeeding;
See above – red section “breast lump”
1. Book patient with GP within 48 hours.
Advice:
Visit NHS advice pages, or search for a breastfeeding support service near you.
Who do I see?
GP or A&E for severe symptoms
If known Asthma – see Asthma section
If not – book appointment GP/PBP
Advice:
Telephone 999 if symptoms are severe.
For less serious breathing issues such as COPD or chest infections.
Who do I see?
1. Community Pharmacist
2. FCP
3. Urgent care/minor injury unit
Advice:
For pain relief, please search for your nearest community pharmacy. For difficulty breathing, please book an appointment with the surgery/ GP appointment.
Further information about broken or bruised ribs from NHS UK.
Who do I see?
Practice Nurse/ Urgent Care Centre if severe
( 30 mins appointment with the Nurse)
Advice:
If severe, please search for your nearest Urgent Care Centre.
Who do I see?
1. HCA
2. Practice nurse if HCA is not available
(10 mins)
https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/treatment/
Who do I see?
GP (Nurse if dressing is required)
Advice:
Please book your appointment with the surgery.
Who do I see?
Book a 20 minute appointment with a Practice Nurse. Be ready to provide female practitioner if patient requests.
!!BEFORE BOOKING, PLEASE CHECK THAT PATIENT IS DUE USING THE ALERT BOX – IF UNSURE, TASK JORDON!!
Advice:
Once you are invited, please book an appointment with the Practice Nurse on a day that you are not bleeding or on your period.
Who do I see?
Community Pharmacy first
GP or other chest issues (Asthma/COPD)
Advice:
Who do I see?
Alert Duty Doctor or A&E for severe symptoms
Advice:
Telephone 999 if symptoms are severe.
If not severe and has lasted for more than a few days;
You can book an appointment with GP.
Who do I see?
Community Pharmacy first
GP – if unwell or concerned it is not chickenpox
You’ll need to stay away from school, nursery or work until all the spots have formed a scab. This is usually 5 days after the spots appeared.
Advice:
• 3 years and 4 months (up to 6 years if they have not yet received the 3 years 4 months vaccine)
- Locate your nearest sexual health clinic Find a sexual health clinic – NHS
- Visit SHL London website Sexual Health London • SHL.UK
- Patients over 25 should visit sexual health clinic.
- Patients under 25 that are symptomatic should be booked with GPs.
- Non symptomatic patients are to be booked with a Nurse
Who do I see?
Sexual Health Clinic
-ACCURX template LARC***
Advice:
You can book an appointment with the Practice Nurse.
Information about contraceptive implants.
Where to get an IUD
You can get the IUD for free, even if you’re under 16, from:
- contraception clinics
- sexual health or genitourinary medicine (GUM) clinic.
- some young people’s services
Who do I see?
Community Pharmacy
Who do I see?
1. Pharmacy
2.PBP (20 min)
3.Practice nurse (20 min)
Advice:
https://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/
Who do I see?
Community Pharmacy/GP if persists more than 1 week
Advice:
Search for your nearest community pharmacist.
You can book an appointment with your Doctor.
Who do I see?
Community Pharmacy
GP if persisting for more than 5 days
Advice:
Search for your nearest community pharmacist. Antibiotics are NOT needed for the common colds, as colds are caused by a virus.
Who do I see?
Community Pharmacy- self care advice
GP if feeling unwell or persists for more than 2 weeks
If patient is experiencing these symptoms alongside flu symptoms:
– New loss of taste or smell
– Shortness of breath or difficulty breathing
Check latest advice on NHS website
Who do I see?
1. Community Pharmacy
2. PBP
3. GP
If child – GP only
Advice:
Who do I see?
Dentist
Advice:
Please book an appointment with your dentist or find a dentist near you: NHS Find Dentist Services. NHS 111 can advise on an emergency dentist if needed.
Please note: The Doctors do not see dental problems.
Who do I see?
Practice Nurse (10min)
Advice:
Please ensure your smears are up-to-date.
Please book to see the GP for an initial assessment and then the nurse ( 20 mins appointment) for a review once you have completed your first 3 months of medication.
Who do I see?
GP
PBP (for long-term (6+months) medication review)
Please ask the patient to fill out Depression PHQ-9 questionnaire.
Advice: accurx template Mental Health *
Resources:
Good Thinking UK
Qwell
Apps:
Calm & Headspace
Mindfulness:
NHS – Mindfulness
Yoga:
NHS – Guide to Yoga
Self refer for therapy:
NHS – I-Cope
Who do I see?
1. Health Care Assistant
2. Practice Nurse
(20 mins appointment)
Advice:
Who do I see?
If symptoms less than 3 days > Community Pharmacy/Pharmacy first
If more than 3 days+ Seen pharmacist already > GP appointment
Advice:
You can usually treat yourself or your child at home.
The symptoms usually pass within a week.
The most important thing is to have lots of fluids, such as water or squash, to avoid dehydration.
Information:
Read about how to treat diarrhoea and vomiting
Important:Diarrhoea and sickness
Stay off school or work until you have not been sick or had diarrhoea for at least 2 days.
If not sudden/severe – more than 72 hours >
Who do I see?
GP
Who do I see?
Practice Nurse or HCA (Health Care Assistant)/Treatment Room Nurse
( First dressing 30 mins for all other dressings 20 mins). Appointments also available with I-Hub team.
Who do I see?
Talk to Frank or Alcoholic Anonymous
BETTER LIVES***
Advice:
Information about drugs please visit: Talk To Frank.
Please phone: 0300 1236600, for self-referral help.
For further information concerning alcohol please visit: Alcoholics Anonymous UK.
Call free: 0800 9177 650 or Email AA
Who do I see?
We are unable to provide letters of support – Magda?/Social prescriber?/Access hub
Advice:
The DWP will usually contact your GP or healthcare professional to obtain medical evidence when you submit a PIP or ESA claim, the information is then sent to the DWP as part of your claim process.
We are therefore unable to provide additional letters of supports as the information we provide, will normally be included in the report requested by the DWP. We therefore regret that we cannot provide additional letters of support. However you may request your medical records if you feel this may help your case. If you wish a copy of your medical records, please contact the practice who will advise you accordingly. There is no charge for a copy of your records.
We have provided some useful contacts shown below to help you:
Useful contacts
Action for M.E.
Information and support for people with M.E. and their carers General enquiries: 0117 927 9551 (Mon-Fri 9am-5pm).
Online M.E. Centre: Action for M.E
Welfare Rights Line: 0845 122 8648 (times vary)
Citizens Advice Bureau
Offers advice on a range of issues and may complete a benefits check for you. Find your local Citizens Advice Bureau.
Disability Information and Advice Line (DIAL)
To find your local DIAL office, contact Scope, 6 Market Road, London N7 9PW Tel: 0808 800 3333
Disability Rights UK
Factsheets on benefits, tax credits and independent living from disability rights uk
Local councils
Some local councils employ welfare rights workers. Your local council may also have information about other services that offer welfare rights advice in your area.
Who do I see?
Pharmacy
GP
Advice:
You can book an appointment with your Doctor.
Who do I see?
GP
Advice:
You can also talk in confidence to an adviser from eating disorders charity Beat by calling their adult helpline on 0808 801 0677 or youth helpline on 0808 801 0711.
https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/eating-disorders/overview/
Who do I see?
Community Pharmacy/GP if persists or is infected
What to do?
1. Community pharmacy or check shl.uk
2. PBP
3.Book for a same day appointment with GP – be prepared to provide female practitioner if requested.
If no GP appointments available, take Duty Doctor slot.
What to do?
If patient reports the seizure has happened within the last 24 hours, see red section named “Seizure/Fit” otherwise;
Book a routine GP appointment.
If urgent, less than 24 hours, see red section.
If gradual new/concerns about vision getting worse;
- Optician (enclose find nearest optician link)
Advice:
If severe, please go to your nearest A&E/Eye Casualty
Moorfields Eye department- they will see children and adults.
Please search for your nearest opticians or search for your nearest community pharmacist.
Who do I see?
Optician/Community Pharmacy/Minor eye clinic if it persists
Advice:
If severe, please go to your nearest A&E/Eye Casualty
Moorfields Eye department- they will see children and adults.
Please search for your nearest opticians or search for your nearest community pharmacist.
Who do I see?
Urgent Care Centre/A&E if severe
Advice:
Please search for your nearest Urgent Care Centre. If severe, please go to your nearest A&E department.
What to do?
Book appointment with GP
Advice:
Provide patient with NHS links pertaining to fertility. Can send via text
Infertility – NHS
Who do I see?
Community Pharmacy/GP
Advice:
Find a pharmacy near you.
Who do I see?
See reception
Advice:
A medical examination will be booked if necessary.
Completion of forms, certificates and medicals are not covered under the NHS. Payment for reports must accompany the request or appointment booking (i.e. in advance).
Charges are aligned with the BMA’s guidelines. Please read the form carefully and fill in and sign any parts that you need to complete before you bring the form to the surgery.
Please allow up to 21 days for the process to be completed, you will be contacted by phone when your form is ready for collection.
Please note we do not sign passport forms.
Who do I see?
Adults (including Pregnant Women) –
HCA (Health Care Assistant) / Practice Nurse/ PBP
( 5 -10 mins appointment)
Children – Practice Nurse only (5-10min)
Advice:
You can either book an appointment with the appropriate healthcare professional, or alternatively please phone the surgery to arrange your appointment.
Who do I see?
Community Pharmacy/GP if persists for more than 5 days or difficulty breathing
Who do I see?
Inform patient that we will generate TQuest form for them to pick up alongside a testing kit.
Testing:Create TQuest – Dermatophyte > Select Nail
GP will see results and action if treatment is required.
if patient is worried there is discharge, pain or redness; send picture and book with GP. Ideally eConsult.
Treatment: Community Pharmacy/PBP
Who do I see?
Genitourinary (GUM) Clinic/GP within 72 hours.
Advice:
Find a GUM clinic near you.
You can book an appointment with your Doctor.
(1 appointment slot to be booked with GP)
Further information about sexual health available from NHS UK.
Who do I see?
Self-Care/Community Pharmacy
Fill out eConsult if private or unclear what patient wants.
Advice:
Please visit the NHS UK information home pages. You can also telephone 111 for any non-urgent medical issues or you can search for your nearest community pharmacist.
- you have symptoms of gout for the first time
- you have gout and your usual treatments are not helping
An attack of gout usually lasts 1 to 2 weeks if left untreated. If you do not get treatment, future attacks may last even longer. Leaving gout untreated may cause lasting damage to joints.
- GP or FCP (appointment within 72 hours)
- If for pain relief or review of gout medication, consider PBP appointment.
GP will assess, ideally book face-to-face GP appointment
!!GPS DO NOT DO SMEAR TEST!!
Nurses can do swabs, so can sexual health clinics and SHL (at home discrete test kit)
Who do I see?
1. Community Pharmacy
2. PBP
Advice:
Hay fever medications are available from the chemist without needing to see your GP.
If not severe/sudden (A&E);
Who do I see?
- Community pharmacy
- GP
- PBP if medication review/known migraines.
Advice:
Keeping a headache diary helps the GP. Can get from the Migraine Trust
Who do I see?
Community Pharmacy/School Nurse
Adults only 40 – 74 years old.
+ over 75 year old Health check
Patient must not have had a Stroke or have a pre-existing condition (LTC)
Who do I see?
HCA ( 20 min)
Advice:
https://www.nhs.uk/conditions/nhs-health-check/how-do-i-get-an-nhs-health-check/
Who do I see?
Magda
Advice:
Please attend in person or post the documentation and payment.
Holiday Cancellation forms are not covered by the NHS, there will be a charge for this service.
Payment for reports must accompany the request or booking (i.e. in advance). Charges are aligned with the BMA’s guidelines. Please read the form carefully and fill in and sign any parts that you need to complete before you bring the form to the surgery.
We ask that you allow up to 21 days for the process to be completed, you will be contacted by phone when your form is ready for collection.
Patient must be housebound in first instance
- urgent unwell > same day duty doctor. Alert duty doctor by either screenmessage/call/knock
Duty doctor will either arrange or refer to rapidresponse. If no DD, speak to partner GP - if routine, task named/known GP and sophie.
Who do I see?
Speak to Care Co-ordinator who can refer to Social prescribers
Access Hubs
Central Hub
222 Upper Street,
N1 1XR
North Hub
6-9 Manor Gardens
N7 6LA
South Hub
Finsbury Library,
245 St John’s Street,
EC1V 4NB
All open between the hours of 09:00am and 17:00pm
Access Islington Hubs | Islington Council
Advice and help is available from Shelter England
Advice:
From time to time GPs are requested to provide reports for the patients to Local Housing Authorities and Housing Associations. This is not part of our core services and therefore we may charge an appropriate fee for the work involved or we may refuse to do it. Please check with our reception team.
Further information and help is available from Shelter England
Who do I see?
1. PBP (slot to be booked for 20 min)
2. GP
Who do I see?
Practice Nurse (30 min) – Please send a Task to Bernice for her team to arrange appointment.
Advice:
https://www.nhs.uk/conditions/baby/babys-development/height-weight-and-reviews/baby-reviews/
Who do I see?
Practice Nurse (20 min)
Please check that there is at least 4 weeks between each of the 8-12 and 16 weeks injections.
1 year vaccine appointment should only be made once child turns one.
Advice:
https://www.nhs.uk/conditions/vaccinations/nhs-vaccinations-and-when-to-have-them/
Who do I see?
Practice Nurse (20 min, unless migrant then 30min)
Advice:
https://www.nhs.uk/conditions/vaccinations/nhs-vaccinations-and-when-to-have-them/
Who do I see?
1. Community Pharmacy
2. GP appointment if persisting.
Advice:
Please search for your nearest community pharmacist
Further information about indigestion available from NHS UK.
Who do I see?
- Community pharmacy
- Practice nurse
- See GP (if patient has diabetes or signs of infection – pus/redness/swollen around toe)
Further Advice:
Who do I see?
Practice Nurse (10min)
Advice:
You can either book an appointment with the appropriate healthcare professional, or alternatively please phone the surgery to arrange your appointment.
Who do I see?
1. Book with Practice Nurse (30 mins appointment with the Nurse)
2. Book with GP
Who do I see?
Community Pharmacy/Nurse
If severely infected (Photo Required) – GP
Advice:
Please search for your nearest community pharmacist
Further information about insect bites and stings available from NHS UK.
Who do I see?
Private Medicals Officer
(Please note the officer only works on Tuesday, Wednesday and Thursday. Please email your request to the practice in the first instance).
Advice:
Completion of forms, certificates and medicals are not covered under the NHS. Please read the form carefully and fill in and sign any parts that you need to complete before you bring the form to the surgery.
We ask that you allow up to 28 days for the process to be completed, you will be contacted by phone when your form is ready for collection.
Who do I see?
LTC
Anything LTC related, task Hamsa, Jordon, Jakia. They are the LTC team and will deal with any LTC matters
QOF
See QOF skillsheet – Speak with or Jordon if unsure.
- See red flag “allergic reaction” section
- Visit community pharmacy
- PBP
- GP appointment.
*** WIP
Who do I see?
GP/Mental Health Support Services/Samaritans
ACCURX TEMPLATE ****
Advice:
These are helplines with specially trained volunteers who’ll listen to you, understand what you’re going through, and help you through the immediate crisis.
Send Islington talking therapies AccuRx template
Samaritans operates a free service 24 hours a day, 365 days a year for people who want to talk in confidence. Call them on 116 123 or visit the Samaritans website.
Find out how to deal with a mental health crisis or emergency
Further information from NHS UK How to access mental health services
Who do I see?
Book an appointment with named GP.
Advice:
Send relevant links/accRx templates via text.
Who do I see?
Patient to send photo before appt.
GP
Advice:
Who do I see?
Family Planning Clinic/Community Pharmacy/PBP/GP
Advice:
For emergency contraception, please find your nearest community pharmacy. For other issues please search for your nearest family planning clinic .
Who do I see?
Community Pharmacy/Dentist/GP
For Dental abscess if no emergency dentist available call 111- GPs do not treat dental issues
Advice:
Please book an appointment with your dentist or find a dentist near you: NHS Find Dentist Services, or you may find your nearest community pharmacy.
Who do I see?
Community Pharmacy or Health Visitor
GP if persisting
- Midwife
- GP appointment
Who do I see?
Community Pharmacy/FCP- first contact physiotherapist if the first episode of neck pain
GP if it persists or ongoing
Who do I see?
Book an appointment with the Practice Nurse (10min)
Who do I see?
Urgent Care/A&E/999 if severe- bleeding is not stopping
GP if ongoing problem or multiple episodes
Advice:
Pinch nose (do not lean head back) and apply ice pack. Find out more information about nose bleeds. If concerned, you can search for your nearest Urgent Care Centre.
For a full list of clinical activities that our nursing team can do, please visit extranet
1. Book with FCP (Nikita) – 20 mins
2. PBP can review pain relief
3. Routine GP appointment within 1 week
1. PBP can review medication
2. Routine GP appointment.
Who do I see?
We do not sign passport forms
Advice:
Passport forms are not covered by the NHS.
Accepted occupations that can countersign your passport photo.
Who do I see?
1. PBP can start medication to help with periods
2. GP can diagnose and treat
Advice:
Further information about period problems available from NHS UK.
Who do I see?
1. Islington talking therapies self-referral
2. Routine GP appointment
Advice: ACCURX Mental health
Send Islington talking therapies AccuRx template
For children under the age of 5 years:
Physiotherapy drop in’s for children under 5
Self referrals:
Whittington Physiotherapy Service – Self Referral
Always recommend patients download the Get U Better app to help with self management.
Who do I see?
Practice Nurse.
( 10 mins appointment with Nurse)
Advice:
Further information about the pneumococcal vaccine from NHS UK.
Routine GP appointment
can only be done once woman is 6 weeks postnatal (i.e is 6 weeks post delivery).
They offer pregnant women/mothers and young children vitamins for free.
Check if they are already under district nurses
if yes? > has patient contacted them ?
if not and new pressure sore > Speak to nurse or Sophie who will then refer to district nurses. (GP if concerns)
!!PLEASE NOTE, PRICES LISTED ARE A GENERALISED ESTIMATE, PRICES MAY VARY FOR EACH INDIVIDUAL REQUEST DEPENDING ON CONTEXT!!
Letters and Notes:
Sick certificates – £25.00
Fit for Sport/Free from infection – £25.00 (or £50.00 if examination is required)
To whom it may concern/General Letter/Proof of registration – £35.00
Holiday cancellation/Medical insurance claim form – Adults – £50.00 / Children under 15 years – £25.00
Medical Examination reports:
Private medicals: PCO and ML5 without vision examination – £240.00/h (minimum 30 minute service @ £120.00)
Medical report no examination (e.g Insurance, Driving) – £240.00/h
GPR – £120.00
BUPA/PPP Claim/AXA/Vitality Health Insurance – £25.00 – £50.00
Request for additional information – £30.00
Questionnaires – £25.00 – £50.00 (Depending on questionnaire’s length).
Prefilled questionnaire – £25.00
Fostering application – £73.86
Solicitor’s report – £100.00
Computerised medical notes – Free
Full medical notes print out – 1 free print out per year, subsequent prints in the same year cost £20.00
Occupational Health form – £80.00 standard / £100.00 with appointment.
Power of Attorney Report (examination + certificate) – £75.00
School report – £50.00
DS1500 form DWP – £17.00
Travel Vaccination
Hepatitis B – £135.00 for the full course / £45.00 per dose/booster
Paediatric Hepatitis B or any other immunisation not listed – £25.00 per dose/booster
Meningitis ACWY (including certificate) – £50.00
Malaria Prescription – £20.00
Private Work
Blood test (MUST CHECK WITH ASH FIRST) – £25.00
Private prescriptions (excluding Viagra) – £15.00
Arranging Blood/Saliva sample and collection for private labs – £50.00
DNA Swab – £50.00
Private Patient
First consultation including Prescription – £75.00
Subsequent consultations – £35.00
Nurse consultation (including blood test) – £50.00
GP hourly rate including private consultation – £240.00
Criminal Injuries
TCX1 form (patient to pay this) – £40.00
TCX2 form (CICA pay) – £40.00
Who do I see?
Practice Nurse (20min)
Advice:
Please ask patient to speak to specialist
- Send patient AccuRx template for information on PSA test (PSA Screening advice)
2. Book GP appointment
The parent/guardian needs to come with Photo ID to fill out a proxy form. We do not need to see the ID of the child/person consenting of proxy. If the patient is an adult and would like to grant access to another individual, then they will need to sign their section on the proxy form. This is then place in the tray of the GP that is known to them or named GP. The GP will then authorise this and place this in the scanning tray. Whoever is scanning the proxy form will then grant access on EMIS. Please see proxy access process map.
Process map location – Documents > General Documents > PROXY PROCESS MAP
!! IF FEVER AND UNWELL, SEE RED SECTION “RASHES” !!
If no fever/well:
- Pharmacy
- Econsult or get photo if possible (eConsult will ask all the right questions so that the GP can provide right treatment as soon as possible)- GP appointment face-face
Advice:
Who do I see?
Community Pharmacy
GP appointment if have already seen pharmacy / persisting – Face to Face for examination.
What do I do?
Inform the patient that their psychiatrist needs to email us a shared care agreement with what we need to prescribe and the dosage of the prescription. We then print this off, put in the GP tray for them to agree to taking over prescribing and sign. We then scan this on to EMIS, task pharmacy to add to repeats and issue. Then email signed shared care to consultant.
Who do I see?
Practice Nurse
( 10 mins appointment to be booked)
Advice:
Further information about the shingles vaccination available from NHS UK.
Who do I see?
Self certify for the first 7 days of illness (gov website link – self certify)
After this, if new illness/episode;
- eConsult
- GP appointment
If ongoing medical certificate/extension requested, task GP who last issued their med3 ( remember, these can be backdated)
Advice:
Employees unable to work because of coronavirus can now access a digital isolation note from 111.nhs.uk without having to go to the doctor.
You can book an appointment with your Doctor.
If you have been discharged from hospital, your hospital team will issue any fit notes for the entire period of your recovery. Please contact the ward staff (even after discharge). Schools should not request a GP letter to confirm absence, this can be written by a parent or guardian.
A Fit note can be backdated if required, please discuss this when you see the GP. Please do not request an emergency or urgent appointment for fit note.
Employees unable to work because of coronavirus can now access a digital isolation note
Self – Certificate.
You can obtain this form from your employer or by visiting the HMRC website. If you are unwell for more than four days you are advised to arrange an appointment to see a Doctor to assess your fitness to work.
Private Certificates
If you or your employer require further information concerning your period(s) of illness , then your Doctor may require to issue you with a letter. Please note that a charge may apply for this service. Please check with our reception desk. – Magda
Who do I see?
Community Pharmacy/GP if it persists
Who do I see?
Practice Nurse (20 mins appointment to be booked)
Please check before booking – Patient should not be pregnant, bleeding or has had a baby less that 12 weeks ago. Patient should not have a coil inserted or removed in the last 12 weeks.
Who do I see?
HCA (Shefali) ( 30 mins appointment to be booked)
Advice:
You can also visit Smokefree, or find out more from NHS UK.
Social Prescribers help patients connect with local community support services inc. unemployment, housing, loneliness and general support. They can also help you focus on ‘what matters to you’ helping you create action and support plans. Reception staff or a clinical staff member like a GP, Nurse, Pharmacist or Healthcare Assistant can refer you.
Or refer yourself:
Age UK – Self referral
or simply call 020 7281 6018
(Refer to AccuRx template “Social prescriber referral”)
Who do I see?
Sexual Health Clinics/GP if it persists
Advice:
Find your local clinic.
Further information about penis problems, available from NHS UK.
Who do I see?
Community Pharmacy/GP if it persists
Advice:
Please search for your nearest community pharmacist.
If you have a sore throat, there are a number of ways you can help yourself. Paracetamol can help with the pain, and gargling with warm, salty water may help shorten the infection (but this isn’t recommended for children). In most cases, you only need to see your GP if your sore throat doesn’t improve after a week.
Further information on how to treat a sore throat yourself .
Who do I see?
Community Pharmacy/FCP/Urgent Care Centre
Advice:
Please search for your nearest community pharmacist.
If it is a suspected serious injury, please search for your nearest Urgent care centre
Further information about sprains and strains available from NHS UK.
Who do I see?
Community Pharmacy
Who do i see?
Nurse appointment (see skillsheet)
If there are concerns about infections, see Cellulitis – Skin/Wound infection section
What to do?
If patient reports that they have a sore throat, refer to “Sore Throat” section.
If not, book a GP appointment within 48 hours.
See GP IF;
1 or both of your ankles, foot or legs are swollen and:
- it has not improved after treating it at home for a few days
- it gets worse
Who do I see?
If patient is unsure of options, can speak to GP but usually sexual health /family planning service are first point of contact
Sexual Health Services/Family Planning Clinic
ACCURX template -marie stopes****
Advice:
Termination of Pregnancy service is for women who are pregnant and want to discuss their pregnancy options, which might include having a termination. Your local clinic will offer advice and information, and can help you with a hospital appointment if that is what you decide to do.
Find abortion services – NHS
Further information about terminating your pregnancy
Who do I see?
Practice Nurse (10 min)
Who do I see?
Practice Nurse
( 10mins appointment with Nurse)
Who do I see?
Community Pharmacy
Advice:
Please search for your nearest community pharmacist.
Further information about threadworms, available from NHS UK.
Who do I see?
Self-Help Advice/Community Pharmacy/Sexual Health Clinic
GP if persisting or multiple episodes
Advice:
You find information on the NHS help page. You can also search for your nearest community pharmacist. If you are sexually active, you can also visit your local Sexual Health Clinic.
Who do I see?
GP appointment
Advice:
Self-Help – send accurx
Feeling exhausted is so common that it has its own acronym, TATT, which stands for “tired all the time”.
Further information and help is available from NHS UK
If you feel that you are still experience symptoms of tiredness, please book an appointment with your GP.e
Task Magda
Advice:
Provision of toilet passes is highly conditional.
What to do ?
1. First inform patient to collect travel form.
2. Inform 3 weeks are needed prior to departure date (for IHUB, its 2 weeks)
3. After receiving form, double appointment can be booked with IHUB nurses (normally on weekends)
!! DO NOT BOOK WITH GP!!
Advice:
Visit this link for more information about specific destination of travel NaTHNaC – Home
What to do?
First ensure that the patient is not worried that their urinary symptoms are not related to a sexual health infection.
If patient is sure that urinary symptoms are not related to sexual health infection;
Book with GP for 10 minutes
Who do I see?
- Community Pharmacy (ONLY WOMEN)
- PBP
- GP
Advice:
Please bring a urine sample into the consultation; sterile pots available at reception.
Women should also check if they could be pregnant.
Information about Urinary tract infections (UTIs) available from NHS UK.
- Ask if patient has contacted their midwife
- GP appointment (24-48 hours)
Request urine sample (MC&S)
Who do I see?
Sexual Health Clinic/GP
Advice:
You can search for your nearest community pharmacist.
If you are sexually active, you can visit your local Sexual Health Clinic.
Further information about vaginal discharge available from NHS UK.
Who do I see?
1. Ask patient to visit their pharmacy
2. Pharmacy referral
Advice:
Please search for your nearest community pharmacist who can advise on over the counter treatments available.
Further information about warts and verrucas available from NHS UK.
Most community pharmacies can help with mild acne – good over the counter treatments. If not helping or more moderate to severe acne, then :
- eConsult
- PBP
- GP
Who do I see?
Practice Nurse
( 10 mins appointment with Nurse)
Further information about Vitamin B12 or folate deficiency anaemia, available from NHS UK.
!!See “tummy bug” section!!
Who do I see?
If less than 3 days > Visit local pharmacy
If ongoing or unwell (not simple) > GP appointment
Advice:
Please search for your nearest community pharmacist.
Further information about diarrhoea and vomiting from NHS UK.
We do not do INR monitoring.
Who do I see?
1. Speak to PBP
Referral might be required
Advice:
If you are taking warfarin blood thinning tablets, we can refer you for this service.
Who do I see?
Community Pharmacy
Advice:
Please search for your nearest community pharmacist who can advise you on over the counter treatment options.
Nurses can do weight management referrals to Arsenal football club for men and More2life exercise programmes. We can book a double telephone or face to face with the Nurses.
MOUNJARO – (also available as AccuRx template)
NHS England has confirmed a programme but the NHS in North Central London is still working with GPs, hospitals and community trusts to make this available locally.
Due to the significant demand and limited capacity there will be several stages of prioritisation of patients.
See website for more info including resources on local weight-loss programmes.
https://nclhealthandcare.org.uk/news/weight-management-medication-in-north-central-london-nhs/
Who do I see?
Practice Nurse for vaccine
(10 min)
Advice:
https://www.nhs.uk/pregnancy/keeping-well/whooping-cough-vaccination/
Who do I see?
Practice Nurse (10min)
Advice:
If patient needs advice, ask them to contact the ir specialist or speak to nurse.