Referral information
The purpose of the information we require is to triage patients to the most relevant specialist to provide the quickest access to the most appropriate treatment and to avoid long delays when referring between services.

Email: painclinicclinical@nbt.nhs.uk

Exclusion
Pain Management Services are not always successful in relieving the patient’s pain. This may be for a variety of reasons. Whilst it may be helpful to review a previous patient after a period of time to ensure that no new treatments have been developed, multiple repeated referrals are not necessarily in the patient’s best interest. In these difficult and complex pain problems, discussion between the GP and the Consultant in Pain is indicated.

Whilst a therapeutic intervention may help some individuals this will often only have a limited effect and should be part of a multidisciplinary management programme. A decision on an intervention will only be made after a full discussion with the patient if it is considered appropriate. We do not perform procedures at the request of a referring individual unless it is part of a combined management approach with an associated team.

We aim to improve the quality of lives of our patients by controlling, reducing and where possible, curing their pain.

Download: 

Map of Medicine - guidelines for:

• Pathway for management of chronic widespread pain - Diagnosis of fibromyalgia.pdf117.45 KB
• Back pain
• Sciatic
• Pelvic pain

The following criteria should be filled for new referrals:

• The patient has not attended a Pain Clinic for the same condition before (see below)
• Any underlying cause for the pain has been eliminated
• The patient does not want or is not fit for a definitive procedure
• The referral has been discussed with the patient and the patient has agreed that this is the most appropriate management pathway
• Drug therapy has been tried (see flow diagrams) but has been ineffective
• Advice has been given about exercise and a healthy lifestyle. Rest can cause increased disability and patients should be encouraged to maintain as much mobility as possible
• An explanation about the aims of the Pain Service has been given to the patient so they can make an informed decision about whether they want to engage with our approach to management
• The patient has not been referred to a different specialty for the same condition at the same time
• The patient is not being referred for a specific intervention

Urgent referrals
We often have requests to bring forward appointments. In the interests of equity this is not possible unless there is a cancellation when we will endeavour to fill the slot with another patient. We are doing our best to keep the waiting times as short as possible.

Tertiary referrals
Patients already seen in another Pain Clinic and those referred from out of area for management of specific problems will be considered as tertiary referrals.

Rejections
We will not accept a referral for any specific intervention e.g. injections or acupuncture.

Colposcopy

Colposcopy is a simple procedure used to look at the cervix, the lower part of the womb at the top of the vagina. It can confirm whether cells in your cervix are abnormal and determine whether you need treatment to remove them. These abnormal cells can go away on their own, but sometimes there's a risk they could eventually turn into cervical cancer if left untreated. 

Find out more about colposcopy, what to expect at your appointment, and the results:

Colposcopy - NHS

©North Bristol NHS Trust. This edition published January 2025. Review due January 2028. NBT003776

EPAC

The Early Pregnancy Assessment Clinic (EPAC) is an emergency service available to all women referred by their GP or healthcare professional. EPAC at Southmead Hospital accepts women who are experiencing pain and/or bleeding between 6 and 18 weeks of pregnancy, and see over 5000 emergency patients each year. 

You must be referred to the clinic; it is not a drop-in service.

After referral you are usually contacted within 24 hours and have a first consultation on the phone with one of our experienced early pregnancy team. A time to attend will be given to you if you need to come to clinic for an ultrasound or blood test. 

To contact the EPAC phone 0117 414 6778. Leave your name and phone number, and we will call you back as soon as possible. 

If you require emergency medical assistance please contact NHS 111. In an emergency such as very heavy bleeding or severe pain, phone 999 or go to the Emergency Department. 

Management of miscarriage

EPAC at Southmead Hospital offers a choice of treatment following diagnosis of a miscarriage: conservative management, medical management and surgical management under both local anaesthetic and general anaesthetic.

Ectopic pregnancy 

Treatment varies between conservative, medical and surgical management.

Current Anti D guidelines

Anti D 500 IU is recommended for all rhesus negative women with vaginal bleeding after 12 weeks of pregnancy. If bleeding continues intermittently, Anti D 500 IU is repeated after 6 weeks. If bleeding is heavy or there is significant pain, Anti D 500 IU is repeated after 2 weeks.

© North Bristol NHS Trust. This edition published January 2025. Review due January 2028. NBT003772 

Outpatient clinics are held at Southmead Hospital Bristol and Cossham Hospitals.

GP referrals – outpatient appointments (NHS e-Referrals or letter) to be sent to:

Centralised Booking Centre
Trinity House
Trinity Business Park
First Floor T3
Filton Road
Horfield
Bristol     
BS7 0DD

Telephone: 0300 5550103
Fax:  0117 4149400

Outlook is based at Southmead Hospital, in Bristol. We welcome referrals from NHS healthcare providers.

If you are a healthcare professional and want to make a referral to our service or discuss the support we offer, please visit our referrals page or please email us at PsychologyOutlookAppearanceTeam@nbt.nhs.uk or call 0117 4144888 

Address:  Outlook & Clinical Health Psychology, Office 3, Level 3,Gate 38, Brunel building, Southmead Hospital, BS10 5NB
   

You can refer for DXA:

• If you are a postmenopausal woman over 50 with a low trauma fracture (defined as a limb fracture after a fall from standing height or less while stationary or walking, or a vertebral fracture of the spine)
• Or, if you are a woman or man over 50 with a FRAX score in the intermediate or high risk zone

To make a referral, download and complete a form, alternatively you can order DXA on ICE. [attachments]

In other circumstances, you may want to contact us first to establish eligibility. If your patient is ineligible for a scan under the NHS, we also offer this service self-funded at a cost of around £72.

All GP referrals from the Bristol and South Gloucestershire areas are initially triaged by the Musculo-skeletal Assessment and Treatment Service.

Orthopaedic Spinal Surgery

The Trust’s orthopaedic spinal surgery service has changed its GP referral criteria and is currently not accepting new adult routine (non-urgent) referrals.

Nationally, there has been a steady increase in the numbers of referrals in this field, with few hospitals across the country offering this complex spinal service, combined with a shortage of experienced spinal surgeons.

As a result, at North Bristol NHS Trust this situation has led to more than 100 patients, from across the region, waiting more than 12 months for surgery which we consider to be unacceptable.
With every new additional referral, there is a risk that existing patients could get moved further down the waiting list as clinical re-prioritisation takes place.

Our first duty has to be for our patients we have already accepted onto our waiting list. The altering of our referral criteria will mean we can work through the backlog, as well as carrying out new urgent and emergency cases, with the aim of restoring the service fully within 18 months.

We believe this decision is in the best interest of our existing patients. This decision has been taken with the full support of our commissioners, who will now identify and manage alternative arrangement for the non-urgent patient referrals.

Referral to Occupational Therapy

Referral to occupational therapy for inpatients on the wards at Southmead Hospital Bristol are made via an electronic referral by the nursing staff or other medical staff working on the ward.

Not all patients require the involvement of an occupational therapist.

Outpatient Service Referral:

GP referrals are accepted for the following outpatient services:

• Orthopaedic upper limb rehab
• Scar management, run by the burns and plastics team

Nutrition & Dietetics - For Clinicians

Inpatient Services

• Our acute services team is made up of dietitians who work within North Bristol NHS Trust providing a dietetic service to all the wards. The service is available between 8.30am and 4:30pm Monday to Friday.
• Referrals for an inpatient review should be made on Careflow.

Discharge Services

• Patients who continue to need support to increase nutritional intake following discharge from hospital will be referred to the community Nutrition and Dietetic team by the ward dietitian if appropriate.
• Patients who are being fed through a feeding tube will be referred to the Home Management Service (HMS). HMS will make arrangements to deliver feed products at home and to monitor progress.

Outpatient Services

• Please see Remedy for guidance 

Provide diagnosis, treatment and rehab of illness in older people.

The Complex Assessment and Liaison (CALS) service
The CALS service operates in the emergency zone, Level 0, Brunel building. It consists of consultant geriatricians (Dr Neubauer, Dr McCracken and Dr Richards), Advanced Nurse Practitioners, OTs, Physiotherapists, social workers and case managers. The team has developed strong links with the community to promote seamless care for the patient between primary and secondary services.

These patients will have a comprehensive geriatric assessment (CGA) which will address not only their initial medical presentation, but their co-morbidities, rehabilitation, psychological and social needs.

The team aims to improve the identification of patients with frailty syndromes such as, delirium, dementia, falls and incontinence and enable these problems to be addressed, improve sign posting to appropriate services, improve patient quality of life and ensure more patient centred and timely discharge planning.

The CALS team also cover some ward beds on Level 1, Brunel building for specific patients identified by the team as being able to be rapidly discharged with intensive input. They also provide advice to GPs via a “Geriatrician of the day” hotline.

Patients admitted with fractures
Medicine Older People is very active in the care of older patients admitted with fractures, particularly hip fractures.

Dr Harding's clinical work is now focussed on the trauma wards on Level 2, Brunel building and Level 5, Brunel building and all hip fracture patients are now admitted under shared care with the Orthopaedic Surgeons.

Dr Harding, Dr Walsh and Dr Srivastava now provide a daily consultant ward round (Monday to Friday) to assess and manage the medical needs of these patients, lead their multidisciplinary rehabilitation and contribute to planning discharges.

Undergraduate Teaching
The Medicine for Older People department teaches forth year University of Bristol students for over forty-four weeks a year. Twice yearly exams take place in the Learning and Research, Southmead Hospital Bristol. The Department is also involved with teaching and assessing second, third and fifth year students.