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.

Rapid Access Clinic

Cossham Hospital. Consultant responsible Dr Nigel Jones

This clinic is designed to provide a rapid medical assessment and management plan for a deteriorating patient who may otherwise end up in hospital. The service can help avoid unnecessary admission and support the intermediate care teams.

What does it involve?
A comprehensive geriatric assessment is performed by a consultant. Diagnostics including bloods, CAT scans and ultrasounds are preformed on the same day and a medical summary is dictated and faxed to the GP by the evening.  Medications are changed and dispensed as needed.

Which patients are eligible?

• Patients must be over 60 years old.
• Not obviously requiring acute emergency admission
• Social circumstances clear, no intractable social crises
• Deteriorating and threatening admission

Referrals should be made by telephone: 0117 340 8400 or by contacting the Consultant of the day on 07738 859048 or email referral to nbn-tr.olderpersonsrapidaccess@nhs.net

A series of questions will be asked (see direct access referral form). You will then be informed when a patient can attend. Up to three patients per day can be seen.

Patient travel
Please see if a relative or friend can take the patient to the hospital and collect them once they have finished. If this is not feasible then the PCT’s have an arrangement with WINGS. Please phone the Wings Ambulance service on 0117 9720999. You need to inform them that this is a Direct Access Patient. Please inform the Wings ambulance service of the urgency of the assessment. It is important that the patient gets to the Hospital as early as possible to enable all the investigations to be done in a timely way and to enable us to access the results on the same day.

Should results not be available by the time the clinic closes or the patient is deemed more ill than first thought, they will be transferred to Southmead Hospital Acute Assessment Unit under the care of the physician of the day.

Download Direct Access Clinic referral form PDF:

Palliative care aims to improve the quality of life for patients and their families facing life-threatening illness. This is achieved by paying particular attention to the prevention, assessment, and treatment of pain and other symptoms, and also the provision of psychological, spiritual and emotional support.

The Palliative Care Team may see patients at any stage of their illness and work alongside other hospital teams.

Palliative Care focuses on:

• Quality of life which includes good symptom control
• A whole person approach, taking into account the person’s past and current situation
• Care which encompasses both the patient and the people that matter to them
• Respect for patient autonomy and choice (e.g. place of care, treatment options)
• Open and sensitive communication

Palliative care is provided by two distinct categories of health and social care professionals:

• Those providing the day-to-day care to patients and carers in their homes and in hospitals
• Those who specialise in palliative care for example palliative medicine consultants and clinical nurse specialists. 

Pain Consultants
Dr Sarah Love-Jones
Dr Murli Krishna
Dr Gaurav Chhabra
Dr Kat Ng

Clinical Psychologists
Hazel O’Dowd (Head of Department)
Nicholas Ambler
Sebastian Eisenberg
Katie Egan
Oonagh Koppel
Lindsey Hume
Julia Cordey
Liz Rigby

Physiotherapists
Crispin Barker
Melanie Berry
Peter Gladwell
Jeannette Moxham-Mead

Sister and spinal cord stimulation specialist nurse
Rose Marriott

Senior Staff Nurse and spinal cord stimulation specialist nurse
Nicola Wade

Performance Manager
Kate Roche

Chronic pain is pain that lasts longer than three months. It is often present all the time but can be intermittent and it can vary in severity. Sometimes the cause of the pain is apparent but often there is no evidence of tissue damage.

Persistent pain can significantly interfere with quality of life and can be made worse by the anxiety, stress and anger that often accompany the pain.

Pain medication is often unhelpful and can have unpleasant side effects. It has been shown that the best management of patients with chronic pain is provided by a multidisciplinary team of individuals who can address psychological as well as physical aspects of the condition to help patients manage their pain and improve their quality of life.

It is important to rule out an underlying problem that requires treatment but often there is not a clear underlying cause that can be treated.

What are the symptoms of Chronic Pain?

If I have pain, there must be something wrong?

Is there a cure for chronic pain?

If I just ignore it the pain, will go away?

How will talking about my pain help?

Why is there a psychologist involved in some of the programmes?

Will I need a physical examination during the assessment?

We look after patients with complex infections acquired in the community and healthcare settings and have expertise in the management of general infections, complex tuberculosis, human immunodeficiency virus and infections acquired during travel to tropical regions.

We welcome referrals from GPs across Bristol and the Southwest. Unfortunately we cannot accept self-referrals from the general public.

For further details please select the appropriate service below:
• Tuberculosis
• Routine referrals and referrals from other hospitals 
• Urgent referrals and returning traveller assessments

The infectious disease registrar is available for urgent advice on weekdays via switchboard on 0117 950 5050. At weekends please ask for the on call microbiologist.

We aim to improve the quality of lives of our patients by controlling, reducing and where possible, curing their pain. We work in partnership with our patients, encouraging them to actively participate in the decision making process regarding their treatments.

The Pain Clinic is consultant-led, working with an excellent team of nurses and advanced pain trainees. The Pain Clinic works closely with the Pain Management Service who offer support from specialist physiotherapists, pain psychologists and occupational therapists. 

The Pain Service as a whole works closely with Primary Care teams, the spinal and musculoskeletal assessment services, orthopaedic and spinal surgeons, neurosurgeons, neurologists and rheumatologists. Through this joined approach, we formulate a  management plan that addresses the physical as well as the emotional well-being of our patients.

Our approach to care is personalised and we provide the support needed to encourage independence.

The aim of the Pain Service is to:

• provide a joined up, multi-professional patient specific assessment of your pain and put in place an individual management plan, enabling you to lead a more normal life with reduced disability.
• develop an individual management plan with the appropriate support required to live a fuller life in spite of pain.
• There may be different medications or treatments that can help to relive pain to some extent, but even if this is an option many people still need help to manage their pain optimally so that they can Increase social and physical functioning with reduced disability.
• We work to support both you and your GP to manage your pain with an aim to develop the best possible quality of life.