Surgery clinics

Pregnancy testing kits, available widely from both pharmacies and supermarkets, are very reliable and can be used to confirm the pregnancy.

Once you know you are pregnant, you need to register with the midwives who run weekly clinics at the surgery.

Asthma is a condition which affects the smaller airways of the lungs. From time to time the airways narrow in a patient with asthma and this causes the typical asthma symptoms.

It is important that we check you on a regular basis to make sure that the inhalers you are taking are the right ones for you and that your asthma is kept tightly under control. Good control of your asthma means that you will have more energy, be less tired and have fewer chest infections. The aim of your asthma treatment is to keep you free of asthma symptoms during the day and the night.

Diagnosing asthma

Sometimes the symptoms are very typical and the diagnosis is easily made by a doctor. If there is any doubt simple tests can be arranged through the practice nurse. Asthma can be treated by inhalers and some tablets.

Reviews

Once your condition is stable you will be seen by the nurses every 6 months. It is important to have reviews on a regular basis to ensure you are receiving the correct treatment so that your asthma is kept under good control. At each visit you will be told the interval until your next appointment. If you are overdue an appointment you will receive a letter reminding you to make an appointment.

At the appointment we will:

• Measure your height and weight
• Measure your lung function
• Review your lifestyle
• Discuss any problems that you have
• Review your medication

Useful websites

Further information on asthma is available on the following websites:

• Asthma UK

Chronic Obstructive Pulmonary Disease or COPD is a term used by doctors to mostly mean chronic bronchitis and emphysema. COPD is a common condition affecting over one million people in the UK and in the vast majority of cases is caused by smoking.

Diagnosing COPD

Symptoms of COPD usually begin over the age of 40 and a test called ‘spirometry’ is done to confirm the diagnosis. The test measures how much air you can blow into a machine. A value is calculated from the amount of air that you can blow out in one second divided by the total amount of air that you blow out in one breath. A low value indicates that you have narrowed airways.

COPD cannot be cured, but there are many treatments that can ease the symptoms, including inhalers and tablets

Reviews

Once your condition is stable you will be seen by the nurses every 6 months. It is important to have reviews on a regular basis to ensure you are receiving the correct treatment so that your COPD is kept under good control. At each visit you will be told the interval until your next appointment. If you are overdue an appointment you will receive a letter reminding you to make an appointment.

At the appointment we will:

• Measure your height and weight
• Measure your lung function
• Review your lifestyle
• Discuss any problems that you have
• Review your medication

Useful websites

Further information on COPD is available on the following websites:

• British Lung Foundation

If you look after someone who is ill or disable, please register as a carer so that we can offer support and help.

Help from the surgery

Please feel very welcome to talk to any doctor or nurse about your caring role and how you are managing or not managing if the situation is becoming more difficult for you. Don’t worry about taking up time (a common worry for carers) just ask for a double appointment. There are things we can put in place to help you.

With your permission we can add you to our Practice Register of carers, and make a note on your computer medical record that you are a carer, and who for. This means that all the staff who have an involvement in your care will know that you are a carer and will take account of that, understanding the complications it can mean for you. However you may be involved in looking after someone but not want to be actually designated as a carer for them just tell us if you don’t want to be actually registered as a carer on your medical record.

Carers are entitled to a ‘carers assessment’ carried out by the local social services department which is a process by which the needs of both the carer and person cared for can be identified. Once identified, the necessary arrangements can be made for these needs to be met to access this service, please phone social services on 0845 603 7630.

Cervical screening now prevents approximately 5,000 deaths from cervical cancer per year in the UK, and the incidence of cervical cancer has fallen by 42% between 1988 and 1997. This fall is directly related to the cervical screening program.

Who should have cervical smears

If you are a woman between the ages of 25 and 65, it is important that you have regular cervical smears. There is a robust system of invitation and recall as well as provision of results by the local Cervical Screening Programme of North East Essex CCG. Women will be sent an invite to have a cervical smear when they are due or overdue a smear.

When you receive this invitation from the Cervical Screening Programme it is important that you make an appointment for a cervical smear. If you change your address you should let the surgery know your new address as soon as possible as if the invitation is returned as ‘gone away’ you will be deducted from our practice.

Protocol for invitations for cervical screening

• Age 25 – First invitation
• 25-49 – 3 yearly
• 50-64 – 5 yearly
• 65 – Only for those whose last 3 tests included an abnormal amount

Cervical smear results

The result of your cervical smear will take approximately 2 to 6 weeks to be available. The result will be posted directly to you at your home address from the cervical screening program.

If your smear is normal, you will be automatically invited to have another smear in 3 to 5 years, depending on your age group (see table above).

If you receive an abnormal result the letter will include information as to what will happen next. This may be a repeat smear at the surgery or a referral to the hospital for further tests.

Booking a cervical smear

Please book a double appointment with the practice nurse and let the receptionist know that it is a cervical smear. If you have regular period, it is best to arrange to have your smear taken mid-cycle.

For more information visit www.cancerscreening.nhs.uk.

The national routine childhood immunisation is shown below. Six weeks after you have your baby, you should make a double appointment with the doctor for a post natal examination for you and a check for your baby. At this appointment the doctor will check your own health following the birth and then weigh and check the baby.

At eight weeks, your child should commence a series of monthly immunisations over the next 3 months and you should make an appointment with the practice nurse. If you are concerned about any of the immunisations, please contact the surgery to discuss these. Further immunisations will be carried out at around 12 months and 13 months, also by the nurse.

At about three and a half, your child should receive an invitation to have a pre-school check and boosters. You should make a double appointment with the doctor who will carry out a health check (height, weight, listen to their heart etc) and then give the booster injections.

Please remember to bring your baby book that you were given when your child was born to all of these appointments. In the Colchester area, these books are either red or yellow. The immunisations will be recorded in this book for your convenience.

After your child starts school, the responsibility for the routine administration of immunisation schedule moves to the school nurses and the remaining injections will be administered at the school attended by your child. These injections are not always routinely given at private schools and you should check with the school secretary about arrangements for immunisations.

• NHS vaccinations and when to have them

Contraception services are provided free for all women and men of all ages through the NHS, at our surgery.

If you would like help finding the right contraception for you then you should make an appointment to discuss the issue with one of the doctors. Information on the different types of contraception is available on the Family Planning Association website.

If you are prescribed the contraceptive pill, you must have a ‘pill check’ every 6 months with one of the nurses to continue to receive your medication. At this appointment we will check your height and weight and your blood pressure.

Emergency contraception

If you have had sex without using contraception or think your method might have failed there are two emergency methods you can use:

• Emergency hormone pills – or ‘morning after’ pills – must be taken within three days (72 hours) after sex. They are more effective the earlier they are taken after sex.
• An IUD (coil) must be fitted up to five days after sex, or up to five days after the earliest time you could have released an egg (ovulation).

How to get emergency contraception

There are several ways you can get emergency contraception:

• From your GP or Nurse. Please ring and make an urgent, same day appointment with the nurse or doctor or ask to speak to a nurse or doctor over the telephone. Emergency contraception is free from your doctor/nurse.
• At school – you can see your school nurse who will be able to help you.
• At the chemist. The pharmacist will advise you how and when to take the emergency hormone pill. There is a charge of around £20.
• At the family planning clinics. These offer a drop-in, or appointment system clinic where you can get emergency contraception free of charge. Family Planning Service 01255 868686 (24 hour answerphone giving details of all family planning clinics).

Being diagnosed with diabetes can be bewildering and distressing. There is often a great deal of information to take in and it can mean starting one or more new tablets. At the time of diagnosis people often have preconceived ideas about the effects that diabetes can have on their welfare.

Whether you have recently been diagnosed, or have lived with diabetes for some time, we are here to help you adapt to living with diabetes, and minimise any impact that it might have on your life.

Newly diagnosed diabetics

Patients who have recently been diagnosed with diabetes will need to see the practice nurse a few times in the first few months. Patients are also referred to the North East Essex Diabetic Service (NEEDS). During this time patients and carers will be given support, information and advice about managing diabetes. This will involve some blood tests being done at the surgery but these will be kept to a minimum. It is not usually necessary for patients to check their own blood sugar right away unless they particularly wish to do so.

It is also important that all newly diagnosed patients are seen for a diabetic eye check. This is a more thorough and detailed examination than is usually done when being assessed for glasses, and involves having a photograph taken of the back of the eye. The Practice Nurse will arrange a referral for you.

It is also worth considering joining Diabetes UK, an excellent charity which will send out some very useful information about managing and living with diabetes, as well as advertising local events, www.diabetes.org.uk.

How often will I be seen

We aim to review all patients with diabetes on a regular basis – usually twice a year or more frequently if some aspect of control needs closer attention.

Even if you are seeing a doctor at the hospital for your diabetic care, we need to see you for review at least once a year.

At the appointment, we will:

• Measure your height and weight
• Check your blood pressure
• Check your feet and pulses annually
• Check your urine
• Review your blood test results
• Review your lifestyle
• Discuss any problems that you have
• Review your medication

Please make sure when you attend for your appointment you bring your personal diabetic plan together with a urine sample

Who is involved with care?

Diabetes can affect many organs in the body, and good care therefore needs a team approach, involving a number of health professionals. This can seem a bit daunting to start with, but with proper organisation the inconvenience and aggravation can be minimised. However, first and foremost, the patient must be involved in their own care, and health professionals are there to help and support the patient in their own management.

Some of the complications of diabetes may not cause any symptoms to the patient initially. It is only by having regular checks that these complications can be detected early, and appropriate treatment given before they start to adversely affect one’s health.

The following health professionals are the main ones involved in regular care to look for early signs of any complications, and offer advice about appropriate management:

• Chiropodist – to check the state of your feet.
• Dietician – to help gain optimal control by helping you adapt your eating habits.
• Practice nurse – to offer advice on any aspect of your care.
• District nurse – to help those patients who are unable to come to the surgery.
• GP – to help interpret your blood test results, and give advice about your medication.

The majority of patients are looked after within general practice only, and do not need to be referred to the hospital. However, patients with more specific or difficult problems may be referred to the hospital consultant or diabetic liaison nurses.

We do not hold specific diabetic clinics, because we believe it is easier for you to make an appointment on a date and time convenient to you. However we do ask that you let the receptionist know that you are coming for a diabetic review, so that the nurses can prepare appropriately for your visit.

At each appointment, you will be told the interval before your next review. You will be reminded by letter if you are late for this review

Although the clinic is an opportunity to ensure that all the necessary blood tests etc. have been done, it is also an opportunity for patients to raise any concerns or problems that they might have. If there is anything that you wish to ask or that you are not sure about, the nurses will all be happy to try to answer any questions.

If a patient is housebound, and therefore unable to attend the diabetic clinic, alternative provision can be made for home visits.

In addition to the annual diabetic clinic, patients should be seen by the eye screening service each year for a diabetic eye check. This is carried out in local opticians who are part of the programme and a reminder should be sent to your home address when an annual review is due. This service is run by the East Anglian Diabetic Retinopathy Service.

All the doctors and practice nurses are also happy to see people in surgery time to address any aspect of their diabetes that may be causing concern.

Other things to remember

If you take tablets or insulin to help control your blood sugar, you are entitled to a prescription exemption certificate, which enables you to get all your prescriptions for free (not just those that relate to your diabetes).

You must notify the DVLA if you are started on tablets for diabetes control or insulin. This does not mean that you will have your license taken away, but they do need to know about your condition. HGV and PSV drivers should ask the doctor or nurse when to notify DVLA.

Useful websites

• Diabetes UK

Flu vaccination

Every autumn we run ‘flu clinics’ for giving the annual flu vaccinations to patients in an ‘at risk’ group. The clinics are advertised in advance on posters within the surgery and often on reminder slips put in with dispensed medicines.

At risk groups eligible for free annual flu vaccinations:

• All those aged 65 years and older
• All those aged over 6 months in the following groups:
  • Chronic respiratory disease including COPD, chronic bronchitis, emphysema, cystic fibrosis
  • Asthma if treatment requires continuous or repeated use of inhaled or oral steroids, or with previous exacerbations needing hospital admission
  • Chronic heart disease
  • Chronic renal disease
  • Chronic liver disease
  • Diabetes
  • Immune suppression due to disease or treatment
  • Those living in long-stay residential care or nursing homes
  • Those who are the main unpaid carer for an elderly or disabled person whose welfare may be at risk if the carer falls ill.
  • Pregnant women

Pneumococcal vaccination

This is usually a ‘one-off’ vaccine and can be given at any time of year to patients in an ‘at risk’ group. We often offer it at Flu Clinics if an eligible patient has not already had one. Re-immunisation is not currently recommended for most people. Re-immunisation is only recommended after 5 years for people whose antibody levels are likely to decline rapidly, for example those with no spleen, with problems with their spleen or with nephrotic syndrome. Please do not hesitate to ask Doctor or Practice Nurse about your individual situation.

At risk groups eligible for free Pneumococcal vaccinations:

• All those aged 65 years and older
• All those aged over 2 months in the following groups:
  • People without a spleen or with problems with their spleen
  • Chronic respiratory disease including COPD, chronic bronchitis, emphysema, cystic fibrosis
  • Severe asthma if treatment requires continuous or frequently repeated use of inhaled or oral steroids
  • Chronic heart disease
  • Chronic renal disease
  • Chronic liver disease
  • Diabetes
  • Immune suppression due to disease or treatment
  • Individuals with cochlear implants
  • Children under 5 years who have previously had pneumococcal disease
  • Individuals with the potential for cerebrospinal fluid leaks.

If you suffer from coronary heart disease (angina or you have had a heart attack in the past) or have heart failure, that it is important that we see you regularly for reviews.

Reviews

Once your condition is stable you will be seen by the nurses every 6 months. It is important to have reviews on a regular basis to ensure you are receiving the correct treatment so that your symptoms are kept under good control. At each visit you will be told the interval until your next appointment. If you are overdue an appointment you will receive a letter reminding you to make an appointment.

At the appointment we will:

• Measure your height and weight
• Check your blood pressure
• Review your lifestyle
• Discuss any problems that you have
• Review your medication
• Once a year we will take blood and urine samples

Useful websites

Further information on hypertension is available on the following websites:

• British Heart Foundation

Any patient on regular medication for hypertension (blood pressure) will normally be reviewed every six months. It is important to have blood pressure under control as high blood pressure can cause strokes.

Diagnosing hypertension

A single high blood pressure reading does not mean that you have hypertension. In order the make the diagnosis, we will see you on a frequent basis to take your blood pressure. If it remains high, you will be started on a low dose of medication to help to lower it. You will continue to be monitored closely to check that this has returned your blood pressure to an acceptable level. If it does not, the medication may be increased or other drugs added.

Reviews

Once your hypertension is stable you will be seen by the nurses every 6 months. At each visit you will be told the interval until your next appointment. If you are overdue an appointment you will receive a letter reminding you to make an appointment.

At the appointment we will:

• Measure your height and weight
• Check your blood pressure
• Review your lifestyle
• Discuss any problems that you have
• Review your medication
• Calculate your cardio-vascular (CVD) risk
• Once a year we will take blood and urine samples

Useful websites

Further information on hypertension is available on the following websites:

• Blood Pressure Association
• High Blood Pressure Foundation

If the doctors have prescribed warfarin tablets for you, it is important that the practice nurses do regular blood tests to make sure you are always taking the right dose. The blood test is done at the surgery using a special machine and a drop of blood from a finger prick. The result (called the INR) will be in a ‘target range’ that all patients who are taking warfarin will have been told and have written down for reference. This is usually written in your warfarin yellow treatment book. The dose will be adjusted according to the result, i.e. whether it is inside or outside the target range.

The nurses will always write down the result for you in your warfarin book and give you an appointment for the next test before you leave the surgery.

In some cases, we may take a blood sample from the vein in the arm, particularly if you are due any other blood tests and send it to the hospital laboratory in Colchester. In this case you will be asked to contact the surgery the following day for the result.

Please try to remember to bring your warfarin yellow reference book with you when you come to the surgery. It is very important that you take the correct dosage of warfarin. The tablets are colour coded to help you to take the right dose and your current dosage will be written in your warfarin yellow book. If you are in any doubt of your dose, please contact the surgery.

For the convenience of patients, we offer a range of minor surgical procedures at the surgery. These may otherwise require referral to the hospital, which would involve a lengthy delay, and less flexibility and choice of when the procedure is carried out.

If you have a problem that you think might require a minor operation, please see a doctor first to discuss what might be involved. If the doctor agrees, you will then be invited to make an appointment for the procedure, but please stress to the receptionist that it is for a minor operation. This is so that a longer appointment can be made with both the doctor and the practice nurse at the same time.

When you attend for the minor operation, the procedure, risks and possible complications will be explained, and you will usually be asked to sign a consent form. Any tissue that is removed during the procedure will usually be sent to the hospital laboratory for further analysis to ensure that there is no unexpected or sinister cause for the problem. It usually takes about eight weeks for these results to come back. You will be asked to contact the surgery after this time for the results.

We can help you if you are struggling to lose weight.

You should make an appointment to see the practice nurse – a double appointment for your first visit. We will talk about your health, what you normally eat and how much exercise you do. Then we will recommend what sorts of food to eat and when. If you wish we will also recommend a healthy target weight for you to aim for. We will then weigh you once every 2 weeks. A record of your weight is kept.

In addition, we can refer you to the local leisure centres for exercise programmes and to weight loss courses.

A variety of diet information sheets are available on request from the practice nurses, including diabetic diet, low fat diet and low cholesterol diet sheets.