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Community Gastroenterology Clinic - InHealth

Checked: 02-06-2025 by Rob Adams Next Review: 03-06-2027

Overview

The Community Gastroenterology Clinic is run by InHealth (formerly Prime Endoscopy) and can be a good alternative in some situations to a secondary care referral. Since November 2024, it has been based at North Bristol Community Diagnostics Centre (North Bristol CDC) at Asda Patchway, Bristol, BS34 5TL. The clinic is run by experienced GPwERs and sees patients with a range of gastroenterology problems where the diagnosis is unclear and/or the GP seeks additional management advice. The InHealth website does not currently have information on this local service so please see below for details.

The Community GI clinic cannot arrange any tests beyond in-house OGD and Colonoscopy, and so any additional imaging, blood or stool tests would need to be supported by the individuals’ registered GP. At present, they also cannot refer individuals on to secondary care gastroenterology although an update on this is anticipated towards the end of 2025. If it therefore seems likely that a patient will need more complex investigations and management please consider referring the patient directly to secondary care. However, the clinic is able to refer patients if necessary to Sirona and NBT/UHBW dieticians.

For details of endoscopy services available at InHealth and other providers across BNSSG please see the Endoscopy section

Referral Criteria

Referral criteria for the service are outlined in the InHealth Group Service Guide 2024 (1)

Inclusion Criteria

Diagnosis and Advice

Irritable Bowel Syndrome
Unexplained abdominal pain and/or bloating
Functional Constipation
Chronic diarrhoea without established diagnosis
Diverticular disease
Rectal bleeding where untreated fissure suspected (prefer to avoid flexi sig until excluded)
Poorly controlled/refractory GORD

First line Guidance and Management (but not more complex cases of):

Coeliac disease
Eosinophilic Oesophagitis
Microscopic Colitis
Proctitis
Iron deficiency anaemia
Barrett’s oesophagus

Exclusion Criteria

Patients meeting 2 week wait referral criteria
Patients already under secondary care
Liver or pancreatic disease
All pregnant women
Patients under 18 years old

Redirect to Secondary Care Gastroenterology….

Established diagnosis of Crohn’s Disease or Ulcerative Colitis
Proctitis if already known to local secondary care (NBT/UHBT/WGH) (InHealth see uncomplicated cases but continuity of care supports re-referral back to the initial hospital trust wherever possible, and in all cases where not responsive to rectal treatment)
Small Bowel Bacterial Overgrowth (especially if specifically seeking confirmatory Hydrogen breath test or long term use of antibiotics eg Rifamixin)

Redirect to Colorectal Surgeons….

Anal fissure not responsive to GTN/Diltiazem
Unexplained anal pain or mass
Treatment of Haemorrhoids not responsive to suppositories or enemas*
Faecal incontinence
Obstructive defecation
Past confirmed Acute Diverticulitis (eg raised CRP or complicated disease on Contrast CT)

*InHealth do not currently offer a banding service

Redirect to Upper GI Surgeons….

Known Gallstones disease (Biliary Colic/ Acute Cholecystitis)
GORD where surgical assessment ie fundoplication expressly requested

Redirect to ENT and/or consider Barium swallow in first instance…

High Dysphagia

Before Referral

Referrals should include details of investigations and treatments that have already been undertaken in primary care.

As a general guide, the following tests can be very helpful prior to referral depending on the clinical scenario:

Altered bowel habit and/or Bloating

Blood tests: FBC, CRP, LFTs, Coeliac Serology and TSH +/- ca125 (if >50yrs) +/- calcium (if constipation)

Stool tests: Faecal Calprotectin (typically younger adults)

FIT stool test*

Faecal Elastase (if steatorrhoea)

Dyspepsia

Helicobacter Pylori stool antigen test

Blood tests: FBC, CRP, LFTs and Coeliac Serology

Abdominal pain

Blood tests: FBC, CRP, LFTs, Coeliac Serology and TSH +/- ca125 (if >50yrs) +/- calcium (if constipation)

Consider abdominal ultrasound scan

FIT if indicated (refer via 2WW if positive*)

* Please see Lower GI - USC (2WW) Pathway

Referral

Referrals should be made on the standard referral form (available as EMIS template) via eRS and is available to all BNSSG patients.

For endoscopy services available at InHealth please see the Endoscopy section for the referral form.

Resources

(1) InHealth Group Service Guide 2024

For information and queries please contact primeendoscopy.bristol@nhs.net

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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