Shaping better health
REMEDY : BNSSG referral pathways & Joint Formulary


Home > Adults > Gastroenterology and Colorectal Surgery >

Community Gastroenterology Clinic - InHealth

Checked: 23-09-2021 by 3 Vicky Ryan Next Review: 23-09-2022

Overview

The Communty Gastroenterology Clinic is run by InHealth (formerly PRIME) and can be an alternative to secondary care referral. This service is in inaddition to their endoscopy service and is run by experienced GPwERs who can see patients with a range of gastroenterology problems where the diagnosis may be unclear and the GP is needing support or a second opinion. The InHealth website does not currently have information on this local service so please see below for details.

The Primary Care Community GI clinic cannot arrange any tests beyond in-house OGD and Colonoscopy. All other tests and interventions, therefore, need to be co-ordinated by the individuals’ registered GP. They are also not able to refer patients directly on to secondary care or to a dietician and if these things are advised the GP will need to make another referral.

If it therefore seems highly likely that a patient may need additional imaging or tests such as CT scans, SeHCAT or Hydrogren breath tests, for example, and/or MDT discussion with other specialties, or ultimately anything obviously complex please consider referring the patient directly to secondary care.

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

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

Referral guidelines

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 from 30th November 2020

Referral

Referrals should be made on the standard referral form 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

PRIME (InHealth Group) Service Guide 2021



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.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.