Mandatory training includes any statutory or compulsory training that you are required to do. 

Information will be provided at your Induction on how to access LEARN, our eLearning platform, and complete your training. 

Remember your mandatory and statutory training must be completed within your first week and local orientation should be completed within four weeks of your arrival. Your line manager must also sign your local orientation form and update your records.

Depending on your role and responsibilities you may be required to undertake a number of clinical competencies.
 

We encourage staff to choose to travel to work in a way which will make a positive contribution to our commitment to reaching carbon net zero by 2030.

If you can, walking, wheeling or cycling to work are the best options, followed by public transport.

You can save money, improve your own and others’ health and wellbeing and help make air quality in the local area better.

Contact Travel Smart for more information on any of the options below.

Free personal travel plan

We can create a bespoke travel plan to identify all the ways you can travel to our sites, just send us your postcode and shift times.

 

 

 

 

Walk or run

• Shower, changing and personal locker facilities on site.
• Route planning support.

 

 

 

 

Cycle

• Secure cycle stores for parking your bike.
• Borrow an electric, standard or folding bike from us for a month, for free.
• Save money on a new bike and spread the cost over 6-18 months with the Cycle to Work scheme.
• Free bike safety checks, maintenance lessons and giveaways.
• Route planning support.

 

 

 

 

Catch a bus

• Discounted tickets from FirstBus and Stagecoach.
• Conveniently located bus stops.
• More than 25 buses arrive every hour during peak time.

 

 

 

 

Motorcycle

• Free parking on-site by applying for a free electronic permit, contact parkingenquiries@nbt.nhs.uk .
• Secure, undercover parking.
• Discounts at various stores and discounted CBT.

 

 

 

 

Car sharing with colleagues

• Free online platform Join My Journey matches you with other staff.
• Dedicated parking spaces alongside a car share passenger permit.
• Guaranteed Ride Home Policy.
• Save money by splitting petrol and parking costs.

 

 

 

 

Car parking

To park on-site, there is a Parking Permit System.

• You can apply on your first day of Induction. Further information will be provided.
• Must only park in dedicated staff car parks.

There are different permit types available:

 

Peak: For use 24/7, 365 days a year. Charged at 1.4% of your annual salary.

Off-Peak: For use on nights (from18:00 till 09:30 Monday to Friday) and all day on Saturday & Sunday. Charged at 0.6% of your annual salary.

Occasional: Limited to 90 days a year parking. This is a free permit but must be used in conjunction with a scratch card. Scratch cards cost £20 for a book of 10.

New starters are eligible for a one-off parking permit to cover the first day/s of induction. This will be sent with your induction information.  

 

Travel for work purposes

• Access to Pool Cars.
• Free for you to use and cheaper for your department.
• 24/7 online booking system.
• Can be booked from 15 minutes to 365 days in advance.

 

 

 

 

Instructions for day/night urine collection for cystinuria

Please read these instructions carefully, make sure that you are prepared, and follow each of the steps to ensure proper collection.

The collection bottles contain a preservative (strong liquid acid), this must not be thrown away.

Care should be taken not to spill or touch any as it could burn your skin, even when mixed with urine. If you spill the acid, advice for first air for skin/eye contact is on the back of the container.

How do I collect the specimen?

1. Choose a day when you will be at home.
2. When you get up in the morning, pass urine (pee) into the toilet. The collection of urine will start from this time. Please write
3. the date and time on the ‘Day’ collection bottle.

• Collect all the urine you pass into the the ‘Day’ collection bottle and finish this collection by emptying your bladder into the bottle before going to bed. Please write the date and time of this on the ‘Day’ collection bottle.
• Any urine passed overnight should be collected in the ‘Night’ collection bottle.
• When you wake the next day, empty your bladder and collect this urine. You should add this to the ‘Night’ collection bottle. Please note the date and time of this on the ‘Night’ collection bottle.

After the sample has been collected

Check the cap is screwed on firmly.

Carefully fill in all details required on the container labels including your name, date of birth, and hospital/NHS number.

Please note: any container received unlabeled cannot be accepted and you would have to repeat the collection.

If you don’t have your NHS/hospital number, or the barcode label, please contact your GP surgery, ward, or clinic.

What to do with the collected sample

Check that all the details have been filled in clearly on the label.

Deliver the container and the form as soon as possible direct to the laboratory, hospital or your GP.

Laboratory Specimen Reception, Pathology Sciences Building, Southmead Hospital, Bristol BS10 5NB

Opening hours 08:00 to 22:00.

Further Information

Further information can be found at:

www.labtestsonline.org.uk

www.nbt.nhs.uk/severn-pathology

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT002316.

What sample container will I receive?

A sample container is provided for a 24 hour urine collection. Some containers contain a preservative (strong liquid acid or powder). This must not be thrown away.

The label on the container will tell you if there is a preservative, and you should take care not to spill or touch any as it could burn the skin, even when mixed with urine.

If you spill the preservative, advice for first aid for skin or eye contact is on the back of the container.

When do I collect the sample?

It will be easiest if you choose a day when you will be at home for a 24-hour period. If you have to go out, take your container with you. On your chosen day, begin at the usual time when you wake. The end of the collection is 24 hours later.

Start of collection: 8am or when you wake

Empty your bladder completely and flush the urine down the toilet. You will now have an empty bladder and the collection of urine starts from this point.

Write the date and time on the bottle. For the rest of the day and overnight collect all urine passed, into the container.

You may find it easier to collect the urine in clean smaller container, and straight away carefully pour it into the sample container.

End of collection: 8am or 24 hours later

After 24 hours (at the same time as the previous day) empty your bladder completely and add this urine to the container.

Don’t add any more urine. Write the date and time. This completes the collection.

Make sure that during and after the collection the container is kept in a cool place.

You will need to stop the collection and start again with a new container if:

• You have a bowel movement (poo) and are unable to collect the urine separately.
• Any of the urine is accidently discarded during the collection.

After the sample has been collected

Check the cap is screwed on firmly. Carefully fill in all details required on the container label including your name, date, and hospital/NHS number. 

Please note: any container received unlabeled cannot be accepted and you would have to repeat the collection. 

If you don’t have your NHS/hospital number or the barcode label please contact your GP surgery, ward, or clinic.

What to do with the collected sample

Check that all details have been filled clearly on the label. Deliver the container (and the request form if you were given one), as soon as possible directly to the laboratory, hospital, or your GP. 

Laboratory Specimen Reception 
Pathology Sciences Building 
Southmead Hospital 
Bristol 
BS10 5NB 
Opening hours: 8am-10pm

Further Information

Further information can be found at:

www.labtestsonline.org.uk

www.nbt.nhs.uk/severn-pathology

© North Bristol NHS Trust. This edition published July 2024. Review due July 2027. NBT002424

What is Basal Cell Carcinoma?

Basal cell carcinoma (BCC) is the most common type of skin cancer, which develops in the top layer of the skin (epidermis). They usually grow slowly, and they rarely spread to other parts of the body.

Basal cell carcinomas can occur anywhere on the body but are most common in areas that are exposed to the sun such as your face, head, neck, and ears.

If left untreated, Basal cell carcinomas will continue to grow and can eventually cause an ulcer; hence they can have the name ‘rodent ulcer’. They can start to destroy surrounding skin if they are left to continue to enlarge over time.

Most Basal cell carcinomas are painless, although sometimes they can be itchy or bleed.

What does Basal Cell Carcinoma look like?

Basal cell carcinomas can vary in their appearance.

• They are often first noticed as a scab that bleeds and does not heal completely or a new lump on the skin. Basal cell carcinomas can develop as a nodule that progressively and slowly enlarges.
• Some Basal cell carcinomas are superficial and look like a scaly red flat mark on the skin.
• Others form a lump and have a pearl-like rim surrounding a central crater and there may be small red blood vessels present across the surface.
• Any new lesions need to be shown to a doctor.

What causes Basal Cell Carcinoma?

Although the cause is not fully understood, those with the highest risk of developing a Basal cell carcinoma are:

• People with pale skin who burn easily and rarely tan (generally with light coloured or red hair, although some may have dark hair but still have fair skin).
• Those that have had a lot of exposure to the sun, such as people with outdoor hobbies or outdoor workers, and people who have lived in sunny climates.
• People who have used sunbeds or have regularly sunbathed.

What types of treatment are used?

Most Basal cell carcinomas are removed surgically, and the lesion is sent to the lab, to be examined under the microscope. It may take two to three weeks for the results of the biopsy to be sent back to the consultant.

Occasionally it is necessary to repair the area with a skin graft or other types of plastic surgery.

Some very superficial lesions can be treated with topical creams.

If all the cancer has been completely removed or treated, you should view yourself as ‘cured’. If no further treatment is required, you may be informed by letter, without the need to return to the hospital.

Looking ahead

If you have had one Basal Cell Carcinoma, new Basal Cell Carcinomas may sometimes develop over the years.

• Check your skin monthly for any existing or new skin lumps or moles that enlarge, change colour, bleed, or itch. Most changes are harmless, but they may indicate the start of a new skin cancer. See your General Practitioner if in doubt.
• Take care whilst in the sun by wearing protective clothing and using high factor sunscreens (SPF 30+).
• Wearing a hat with a large brim is recommended.
• Avoid strong sunshine from 11am to 3pm.
• Avoid using sunbeds.
• Pass on the message to friends and family about protecting themselves and checking their moles and skin.

How to contact us

Skin Cancer Clinical Nurse Specialists

0117 414 7415

What is a Squamous Cell Carcinoma?

• Squamous Cell Carcinoma (SCC) is a type of skin cancer that usually starts in the skin where the cells multiply and alter the skin’s appearance.
• SCCs are typically slow-growing forms of skin cancer and usually remain in the outer layer of the skin.
• They can differ greatly in their appearance, but most usually appear as a scaly or crusty area of skin or a lump, with a red, inflamed base.
• Squamous cell carcinomas are often tender, but most small SCCs are not usually painful.
• They have the potential to spread to other organs of the body (Metastases), but this is more common if left untreated for a long time.

What causes a Squamous Cell Carcinoma?

Although the cause is not fully understood, there is strong evidence to suggest that Ultra-violet (UV) rays from the sun or sunbeds can damage the skin, which may contribute to the development of a squamous cell carcinoma.

Other less common causes are radiation therapy, trauma, chemicals, and viruses. Some people who have lowered immunity are also at risk.

What types of treatment are used?

Surgery is usually the first choice for treating a suspected squamous cell carcinoma. The most common surgical procedure is to excise the lesion along with some normal looking skin around it. This is normally done as a day case operation, with the patient awake. The diagnosis is then confirmed by sending the lesion away to be examined under a microscope. It may take two or three weeks for the results of the biopsy to be sent back to the consultant. Occasionally, it is necessary to repair the area with a skin graft or other types of plastic surgery.

Looking ahead

If your squamous cell carcinoma has been caught early, it is curable. However, if you have had one SCC others may develop in future years. You need to examine your skin for any unusual changes once a month.

• Check your skin monthly for any existing or new skin lumps or moles that enlarge, change colour, bleed, or itch.
• Most changes are harmless, but they may indicate the start of a new skin cancer. See your doctor if in doubt.
• Take care whilst in the sun by wearing protective clothing and using high factor sunscreens (SPF 30+).
• Wearing a hat with a large brim is recommended.
• Avoid strong sunshine between 11am and 3pm.
• Avoid using sunbeds.
• Pass on the message to friends and family about protecting themselves and checking their moles and skin.

Although rare, in a very small percentage of people SCC may recur at the site of removal or in the surrounding skin. Even more rarely they may spread to lymph nodes producing swelling in the neck, armpit, or groin, depending on the site of the initial cancer. You will be given instructions about where and how often you should examine yourself for lumps.

Any new lesion or sore that develops either at or near the site of the original SCC or any lumps noted in the neck, armpit or groin should be reported to your doctor.

Follow-up

Many patients can be discharged once treatment is complete. If you need follow up appointments, which will depend on several factors, this will be discussed with you.

How to contact us

Skin Cancer Clinical Nurse Specialists

0117 414 7415

What is nintedanib?

Nintedanib, also known as Ofev®, is an antifibrotic medication designed to try and slow the development of scarring (fibrosis) in the lungs. It doesn’t cure the condition or get rid of any scarring already in the lungs. Nintedanib won’t improve any symptoms you are experiencing but it may slow down the rate of further lung function decline.

What monitoring do I need to have while I am on nintedanib?

While you are on treatment with nintedanib you will need to have your liver function tests monitored regularly. You should contact your GP surgery to arrange an appointment to have the blood tests. Your GP will not contact you to arrange this. If your GP cannot help you with this, please contact your normal hospital to make arrangements.

It is very important you do not stop having blood tests. It is a good idea to mark these on your calendar as a reminder. If you do not have your liver function monitored, we are unable to supply medication.

You must have liver function blood tests monthly for the first 3 months you are on treatment and then every 3 months throughout the whole time you are on antifibrotic treatment.

How will I get my nintedanib?

Your nintedanib will be delivered to your house by a company called Polar Speed. They will usually contact you within 3 weeks of your appointment at Southmead hospital to arrange dates for delivery. If you have any queries about your deliveries, you can contact Polar Speed directly on 0800 783 3178.

It is a good idea to have 2 weeks extra supply of medication in case there are any issues with deliveries.

We ask you not to build up any more than 1 month extra supply of medication. Once a medicine is delivered to your house it cannot be returned even if it is in an unopened box.

If you want to stop or have stopped taking nintedanib for any reason it is important to let the Interstitial Lung Disease (ILD) team know. It can be safely stopped immediately, but we can advise and prevent further medication being delivered.

Is it safe to take nintedanib with other medications?

We will check nintedanib is safe to take with your regular mediations before you start taking it. If you are prescribed any new medications you should check with the prescriber they are safe to take with nintedanib.

You should not take nintedanib if you are allergic to peanuts or soya.

It is safe to have the pneumonia, COVID and annual flu vaccines with nintedanib.

How do I take my medication?

• The usual dose of nintedanib is 150mg twice a day.
• Nintedanib should be taken twice a day, as near to 12 hours apart as possible.
• Take the medication with, or straight after food and swallow the capsule whole (do not chew or crush).

What if I get side effects from my medication?

Nintedanib can cause some side effects although many of these can be managed with the help of your ILD specialist team.

You should read the information provided to you and be aware of the potential side effects of the medications.

Common side effects

Diarrhoea

If you are experiencing diarrhoea, please ensure you are taking your medications as prescribed with or after a meal, as this may help alleviate side effects.

You can take an anti-diarrhoea medication called loperamide that can be purchased over the counter from your community hharmacy or in most supermarkets.

You should take 2 loperamide tablets or capsules after the first episode of diarrhoea and 1 further tablet after each episode of diarrhoea up to a maximum of 8 in a day. You might need to take loperamide regularly to control the side effects.

If loperamide is controlling your symptoms, you can ask your GP to have this added to your repeat prescription.
If loperamide is not helping control your symptoms, please contact the ILD patient advice line on 0117 414 7762.

Sickness

If you are experiencing nausea or sickness ensure you are taking your medications as prescribed after food.

Some people find ginger useful for managing nausea. This could be in the form of tea, capsules or even biscuits.

It is safe to take anti-sickness tablets with antifibrotics, please see your community pharmacist for advice.

Weight loss and loss of appetite

Some people find that they lose weight or experience loss of appetite while on antifibrotic medication. It is a good idea to weigh yourself weekly to keep an eye on this. If you are finding it difficult to eat bigger meals, eating smaller meals more often or adding in snacks between meals can be helpful.

If you are losing weight and are worried about this, please contact your specialist centre for advice.

Uncommon side effects

• Yellowing of skin or eyes

• Excessive itching

• Unexplained bruising or bleeding

Please stop taking your medication and contact your GP or 111 for advice more urgently if you experience these symptoms/ signs.

Please inform the ILD team as soon as you are able.

Does nintedanib affect pregnancy?

Do not take nintedanib if you are pregnant, planning a pregnancy or might get pregnant. We do not know enough about the risk to the unborn child.

Patients who are able to become pregnant should have a pregnancy test before starting treatment and should use highly effective birth control at the start of treatment, during treatment, and for at least 3 months after your last dose.

Oral contraception (the pill) may not work as well in those with diarrhoea or other problems that may reduce the drug absorption.

It is also not known whether nintedanib passes into breastmilk. We therefore advise that you do not breastfeed
whilst taking this medication.

Contact details

• If you need any further advice you can contact the ILD team on 0117 414 7762. This is an answering machine service; leave a message and someone will get back to you within 48 hours (except at the weekend/bank holidays).
• If you prefer to use email you can also contact the team on ILD@nbt.nhs.uk.
• If you feel suddenly unwell please contact your GP or access emergency care via 111, your local A&E or by dialling 999.

How to contact us

Interstitial Lung Disease (ILD) team

0117 414 7762

ILD@nbt.nhs.uk

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

If you’re an overseas visitor, you may need to pay for your treatment or you could face fraud or bribery
charges, so please contact the overseas office: Tel: 0117 414 3764 Email: overseas.patients@nbt.nhs.uk

What is pirfenidone?

Pirfenidone, also known as Esbriet®, is an anti-fibrotic medication which has been shown to slow the progression of Idiopathic Pulmonary Fibrosis (IPF). It doesn’t cure the condition or reverse any existing scarring but it may slow down the rate of further lung function decline.

In the UK, pirfenidone is currently only approved for treating,IPF and not for other forms of pulmonary fibrosis.

Pirfenidone can be started if your lung function is within the criteria decided by NHS England (Forced Vital Capacity 50-80% predicted).

What monitoring do I need to have while I am on pirfenidone?

While you are on treatment with pirfenidone you must have your liver function monitored monthly for the first 6 months and then every 3 months for the whole time you are on treatment.

You should contact your GP surgery to arrange an appointment to have the blood tests taken. Your GP will not contact you to arrange this. If your GP cannot help you with this please contact your normal hospital to make arrangements.

It is very important you do not stop having blood tests. It is a good idea to mark these on your calendar as a reminder. If you do not have your liver function monitored we are unable to supply medication.

How will I get my pirfenidone?

Your pirfenidone will be delivered to your house by a company called Polar Speed. They will usually contact you within 3 weeks of your appointment at Southmead hospital to arrange dates for delivery. If you have any queries about your deliveries you can contact Polar Speed directly on 0800 783 3178.

It is a good idea to have 2 weeks extra supply of medication in case there are any issues with deliveries.

We would ask you not to build up any more than 1 month extra supply of medication. Once a medicine is delivered to your house it cannot be returned even if the box is unopened.

If you want to stop or have stopped taking pirfenidone for any reason, please discuss this with us. It can be safely stopped immediately, but we can advise and prevent further medication being delivered.

Is pirfenidone safe to take with other medications?

We will check pirfenidone is safe to take with your regular medications before you start taking it. If you are prescribed any new medications you should check with the prescriber they are safe to take with pirfenidone. It is safe to have the pneumonia, flu and COVID vaccinations whilst on pirfenidone.

How do I take my pirfenidone?

It is important that you take your pirfenidone at regular intervals with or after meals.

Week 1

One tablet (267mg) three times a day.

Week 2

Two tablets (534mg) three times a day.

From week 3 onwards

Three tablets (801mg) three times a day (full dose).

Pirfenidone is only effective for as long as you take it, so if you have a good response, we may recommend that you continue taking it for a long time.

We will usually advise that you stop pirfenidone if you are having difficult side effects or if your lung function continues to fall by 10% or more in one year despite taking the medication as prescribed.

What if I get side effects from my medication?

You should read the information provided to you and be aware of the potential side effects of the medication. We would advise that you contact the team in the event of persistent new symptoms.

Common side effects

Sun sensitivity

Pirfenidone can make your skin more sensitive to the sun. Therefore it is important that you wear a factor 50 sunscreen that blocks out UVA and UVB rays while you are taking pirfenidone.

It is a good idea to cover up and to try and avoid direct sunlight particularly during the hottest part of the day.

Some antibiotics such as doxycycline can make your skin more sensitive to sun you should avoid taking these alongside pirfenidone.

Weight loss and loss of appetite

Some people find that they lose weight or experience loss of appetite while on antifibrotic medication. It is a good idea to weigh yourself weekly to keep an eye on this. If you are finding it difficult to eat bigger meals eating smaller meals more often or adding in snacks between meals can be helpful.

If you are losing weight and are worried about this, please contact your specialist centre for advice.

Sickness

If you are experiencing nausea or sickness ensure you are taking your medications as prescribed after food. Splitting your doses through your meal may help.

Some people find ginger useful for managing nausea. This could be in the form of tea, capsules or even biscuits.

It is safe to take anti-sickness tablets with antifibrotics, please see your community pharmacist for advice.

Uncommon side effects

• Yellowing of skin or eyes

• Excessive itching

• Unexplained bruising or bleeding

Please stop taking your pirfenidone and contact your GP or 111 for advice more urgently if you experience these symptoms/signs. Please let the Interstitial Lung Disease (ILD) team know as soon as you are able.

Contact details

• If you need any further help or advice you can contact the ILD team on our patient telephone advice line: 0117 414 7762. This is an answering machine service; leave a message and someone will get back to you within 48 hours (except at the weekend/bank holidays).
• If you prefer to use email you can also contact the team on ILD@nbt.nhs.uk.
• If you feel suddenly unwell please contact your GP or access emergency care via 111, your local A&E or by dialling 999.

How to contact us

Interstitial Lung Disease (ILD) team

0117 414 7762

ILD@nbt.nhs.uk

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

If you’re an overseas visitor, you may need to pay for your treatment or you could face fraud or bribery charges, so please contact the overseas office: Tel: 0117 414 3764 Email: overseas.patients@nbt.nhs.uk

Completing an Activity Diary: guidance notes

Activity Diaries can be helpful for several reasons:

• They can help people to develop successful pacing skills.
• They can help people to work out a "baseline" for different activities so that they can decide how to make progress with these activities.
• They can help people to monitor their sleep patterns so that they can work out where the problem areas are and make appropriate plans.
• They can help people to monitor their balance of activity and rest.
• An Activity Diary can offer clues about where there might be room for new activities in the day.
• An Activity Diary can set a "benchmark" for someone's activity and rest levels at a given time. If somebody keeps their diary, they can look back at it and spot the areas where progress has been made.

How To Complete an Activity Diary

We have two types of activity diary that you can try. The first one has been developed so that it can be used by people with a visual impairment who use a screen reader, but it is also a good option for someone who wants to write some detail about their activities. We are grateful to the West of England Sight Loss Council for their advice about this diary. You can download the Word document below and fill it in on your own computer. Follow the steps below.

1. The first column is for you to record the time of day that you started each different activity.
2. The second column is for you to write a short description of what you were doing: for example, walking, showering, listening to the radio.
3. The third column is for you to write in whether the activity was high, medium or low demand, or restful. It is up to each individual to decide which activities are high, medium, low demand or restful. Think about how much energy (physical, mental or emotional) each activity might demand from you. In this way, you'll be able to make the diary suit your own current situation. You can also record any time spend sleeping.
4. If your sleep is broken, make a rough estimate of how long you were awake, and fill in the diary with the colour for rest, high, medium or low demand activity depending on what you did whilst you were awake.

The second type of activity diary is visual: it involves using colour to record and show levels of activity. You can download the pdf activity diary which can be printed out and shaded in, depending on how long you did an activity for.

1. Look at the Key at the bottom of the diary: it has five boxes, one for sleep, one for rest, three for different levels of activity. Choose a colour or a pattern for each of these boxes, and fill it in. Choose colours or patterns which will contrast well.
2. Now look at the first line of the diary: it starts at midnight on the first day, and each box represents an hour. Use your colour or pattern to fill in the boxes, showing what you're doing at different times of the day.
3. It is possible to fill in only part of the box if an activity lasts for part of an hour. Complete the rest of the box with other colours or patterns, depending on what you did next.
4. It is up to each individual to decide which activities are high, medium, low demand or restful. Think about how much energy (physical, mental or emotional) each activity might demand from you. In this way, you'll be able to make the diary suit your own current situation.
5. If your sleep is broken, make a rough estimate of how long you were awake, and fill in the diary with the colour for rest, high, medium or low demand activity depending on what you did whilst you were awake.

Week one

Date: __/__/___

	Midnight to midday													Midday to midnight
	12	1	2	3	4	5	6	7	8	9	10	11	12	1	2	3	4	5	6	7	8	9	10	11
...day
...day
...day
...day
...day
...day
...day

Week two

Date: __/__/___

	Midnight to midday													Midday to midnight
	12	1	2	3	4	5	6	7	8	9	10	11	12	1	2	3	4	5	6	7	8	9	10	11
...day
...day
...day
...day
...day
...day
...day

 

Sleep

Rest

Low demand

Medium demand

High demand

© North Bristol NHS Trust. This edition published August 2023. Review due August 2026. NBT003472