Back Pack is for patients who experience recurrent acute back pain episodes that have caused disruption and incapacity. They are at risk of decline towards more severe effects and this course aims to reverse the deconditioning and to build knowledge and confidence in reducing the risks for future back problems. 

Back Pack accepts referrals from

• GPs, physiotherapists
• Musculoskeletal Assessment and Treatment Service (MATS)
• spinal surgery services at Southmead Hospital Bristol
• Pain Clinic at Southmead Hospital Bristol.

Please include within the referral letter details of the patients’ history, previous treatments, current medication, and any relevant medical or social history  that would help our service to assess and support your patient effectively.

Once we have received the referral, we will invite your patient to attend an introductory meeting so that they can find out more about Back Pack. After this there is then an individual assessment with the specialist physiotherapist prior to starting the course.

A Self-Management Programme (SMP) can be accessed by a referral from anywhere in the care pathway such as a:

• General Practitioner
• physiotherapist
• Musculoskeletal Assessment and Treatment Service (MATS)
• the spinal surgery services at Southmead Hospital Bristol
• Pain Clinic at Southmead Hospital Bristol.

It is fast-track and we rely on the referrer to ensure that the patient is appropriate for a rehabilitative approach, with no planned or on-going investigations/intervention in respect of their pain condition. There should be scope and some motivation for improving how well they are coping with this.

The referrer should ensure that the patient is not suffering from an active disease process with escalating physically frailty, such as advanced osteoporosis, or joint instability such as that caused by Hypermobility Syndrome, or joint damage, possibly secondary to rheumatoid arthritis.

Once we have received the referral, we will invite your patient to attend an Introductory Meeting so that you can find out more about the course. Following this we will offer them a place on a course. These courses run in different venues around Bristol and we will try to offer a place on the most convenient and timely course.

Pain Management Programmes (PMP) is a likely route forwards. if it is the chosen path then the next step is for your patient to attend an information meeting about the Pain Management Programme so that they can make an informed decision about joining a course and consider the choices that are available for this.

These courses are run at Southmead Hospital Bristol on either a Monday, Wednesday or Thursday.

They start from the position of comprehensive assessment and the final preparatory step is a review with a physiotherapist before then beginning a group programme.

Possibly not, if the patient is being considered for SMP or Back Pack.

However, the majority of patients begin specialist pain care in the Pain Clinic before coming to the Pain Management Centre. Any possible options for pain relief can be considered and their pain medication is optimised.  The Pain Clinic Consultant contributes important information on overall health and medical condition(s) which is important for forming a plan of care for rehabilitative pain management.

The next step is then for the patient to attend a 1:1 assessment with one of the PMP team. This adds further information to build a profile of the ways they have adapted, their current level of functioning physically, psychologically and socially, along with any complications or barriers that need to be taken into account. We will work out together with your patient what the scope and priorities will be in forming a plan of care.

The main aim of the Pain Clinic is to improve quality of life.  Pain relief is not always possible.

A management plan will be prepared for all patients who are seen in the Pain Clinic. This will often involve attending a pain management programme to help them develop better coping strategies and an exercise programme. We can help them develop new skills but they may continue to have pain.

Once the patient has been through a programme we have little else to offer and a review in the clinic for the same problem rarely alters anything.

Patients must be encouraged with the support from their GP to develop their self-management skills and re-attending our clinic should be discouraged. We would be happy to provide support and advice and the Pain Management Team would be happy to offer a follow up appointment but this should be arranged through direct contact with the Pain Clinic and NOT through NHS eReferrals to one of the Pain Consultants.

If the patient develops a different pain problem we would be happy to offer further advice

You have been referred to the Pain Clinic because your pain is interfering with your quality of life and your ability to function effectively.  Pain that persists can be distressing and disabling. 

Most of the interventions we offer will help about one third of patients and will reduce the intensity of pain but not take it away.  Response to treatment varies from person to person, even if they seem to have the same symptoms. 
Your pain specialist will make an assessment of you and of your pain and decide which treatment(s) might be helpful in your case.

Injections may help some individuals but they often only have a limited effect and should be part of a multidisciplinary (joined up) management programme. A decision on an injection will only be made after a full discussion with the patient if it is considered appropriate.

With support, many patients can start to exercise, engage with hobbies and resume work (full or part-time). We want to help people move forward and for this reason it is unhelpful for us to disable our patients by saying that they are unfit to work.

Our Pain Service works to support you and your GP to manage your pain.  The treatments we offer are familiar to your GP and your GP will be experienced in managing day-to-day queries about your pain treatment. 

Your pain specialist may make a pain treatment plan for you and your GP to follow together. Your GP will be able to deal with queries and if you have a problem with medication you can also discuss this with your pharmacist

Treatments we offer include:

• Medication review
• TENS
• 1 Acupuncture course
• Injections as part of a multidisciplinary approach to pain management
• Stimulation techniques
• Pain Management Programme (PMP) courses are an internationally used approach to the rehabilitation of people with chronic pain conditions. They include specialist guidance about mobility and exercise, following a detailed assessment.
• Back Pack is group programme specifically for people with recurring episodes of back pain.
• Self-Management Programme (SMP). These courses are led by one of the specialist healthcare professional and a Lay Tutor, who is someone who has benefited from one of our courses as a patient and has gone on to train in the delivery of the courses. These SMP courses do not include guidance around exercise, and participants will usually have some form of exercise which they are already involved in, or which they could re-start at a low level themselves during the course.
• Sleep course for people with pain-related insomnia
• Individuals one-to-one sessions for a particular reasons. Individual work is usually a stepping-stone towards attending a program.

The Macmillan Upper Gastrointestinal Specialist Nurse Led Service provides a service to patients, their family and friends, that have been diagnosed with, undergoing investigations or are currently having treatment for an upper gastro-intestinal cancer.

The Nurses offer support and advise to patients that have been diagnosed with any of the below cancers throughout their entire pathway:

• Oesophageal
• Gastric (stomach)
• Duodenal (small bowel)
• Liver
• Pancreas
• Gallbladder
• Biliary

They can:

• provide advice face to face and over the telephone
• support you, your family and carers at time of diagnosis and afterwards
• discuss treatment options and support you in coming to important decisions
• offer specialist advice to other health care professionals
• answer any questions you may have about your treatment and care
• liaise with the community teams in order to support you at home
• assist you if any complications arise whilst you are under our care

Paediatric Venepuncture Clinics 

Paediatric Outpatients accepts referrals from community doctors and/or GP's. 

Prolonged Jaundice Service

Health Visitor, Midwife or GP may refer to this clinic for an assessment to see if a blood test is required.  

For all referrals and/or advice, please telephone us where you can leave a message. Alternatively, email both debra.sainsbury@nbt.nhs.uk and tracey.elvins@nbt.nhs.uk. 

My child has a disability is the unit accessible?

Our unit at Southmead Hospital has a ramp and metal bars running up to it and a wheelchair accessible door. The bathroom has easy access.

How can I cancel/re-arrange my appointment?

Don't worry, please phone us on 0117 414 5807 and we will help you rearrange it.

How do I contact my child's Doctor/Consultant?

For the Neonatal Consultants at Southmead Hospital:

• Dr Faith Emery
• Dr David Evans
• Dr Paul Mannix
• Dr Daniela Vieten-Kay
• Dr Madhavi Parvathareddy
• Dr Katie Farmer
• Dr Claire Rose
• Dr Maria Tsakmakis
• Dr Richard Wach
• Dr Libuse Pazderova
• Dr Charles Roehr
• Dr Amiel Billetop

Phone Julie Deady, Secretary, based in NICU on 0117 414 6815.

Doctors/Consultants based at the Bristol Children's Hospital, you will need to ring and ask to speak to your doctors secretary on 0117 342 8460.

Vaccination clinics are run by the Children's Nurses, phone 0117 414 5807.

Prolonged jaundice and your baby

Information for parents and carers

What is jaundice? 

Jaundice is when the skin and whites of the eye turn yellow. Jaundice is not always caused by liver disease. 

Newborn babies have a higher than normal number of red blood cells. The body continuously makes red blood cells and breaks down old ones. As these blood cells break down, the body produces a waste product called bilirubin. When bilirubin levels in the body are raised it causes jaundice. 

The liver removes bilirubin from the blood but the liver of a newborn baby can take a few days to work properly. Jaundice is more common in newborn babies, and even more common in premature babies. Jaundice that lasts more than 14 days in a full-term infant, and more than 21 days in a pre-term infant, is called ‘prolonged.’ 

Prolonged jaundice is more common in breast-fed babies than those having formula feeds. Up to 30% of breast-fed babies have jaundice at 3-4 weeks old. In most cases this is because of ‘physiological’ or ‘breast milk’ jaundice. Breast milk can jaundice can only be diagnosed by ruling other causes out. 

Breastfeeding jaundice does not harm your baby, we advise you to continue breastfeeding. 

Causes of prolonged jaundice

• A condition where the red blood cells break down more quickly than normal. This is usually discovered during pregnancy or soon after birth.
• A liver problem called biliary atresia - this is rare.
• Breastfeeding jaundice - this will go away with time, and you should continue to breastfeed.

What happens at the appointment? 

The nurse will examine your baby and ask about you baby’s feeding behaviour and general wellbeing. Your baby will be weighed and have a blood test. The blood test is taken from a vein in the back of the hand or foot. Many babies cry during the test but they soon settle afterwards. The tests are done to see if there is liver disease. You will be asked about the colour of your baby’s stools (poo) and urine.

What tests will my baby receive? 

After checking your child’s growth and an examination by a paediatric nurse, the following tests will be done:

• Bilirubin level – total, conjugated, unconjugated.
• Full blood count and blood film.

When will we get the results?

We aim to receive the results within 24 hours. We will phone you with the results and also tell your child’s GP. Occasionally we may ask you to return for further tests. This does not always mean that there is a serious problem. If you are recalled for further tests, please feel free to ask the nurse why the test is being repeated. 

The most common cause of prolonged jaundice is breast milk jaundice which has no impact on your child’s wellbeing. The benefits of breast-feeding are very important, so please continue to breast feed your baby.

For further information speak to your community midwife, health visitor, GP or ask the nurse you will see in the paediatric outpatient department.

Further information about jaundice

Newborn jaundice - NHS

Yellow Alert - Childrens Liver Disease Foundation

© North Bristol NHS Trust. This edition published December 2024. Review due December 2027. NBT003752