Alkaline Phosophatase
Clinical Biochemistry in Primary Care
Creatinine Kinase
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Lipid Advice & Guidance Service
Advice & Guidance Service
Axillary masses
Breast Implants (non-cancer)
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Family History of Breast Cancer
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Pancreatic Cancer Surveillance Programme
Targeted Lung Health Check (TLHC) program
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Cancer and Severe Mental Illness (SMI)
LD & Cancer
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Rehab / prehab
Toxicity Risk Assessment Tool
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Angina
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Coronary Artery Calcification
ECG - Open Access
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Heart Failure
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NT Pro BNP Testing
Pacemakers
Postural Orthostatic Tachycardia Syndrome (PoTS)
Rapid Access Chest Pain Clinics
Syncope and TLOC (non-traumatic)
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Active Ageing - South Glos
Advice and guidance - Care of the Elderly
Assistive Technology Service
Falls & Balance
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Frailty
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Live Longer Better
Movement Disorders
NHS@home - Frailty pathway
Rapid Assessment Clinic For Older People
Acute Assessment
COVID Medicine Delivery Unit (CMDU)
COVID Oximetry @ Home Virtual Ward
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TeamNet and Latest updates
Acne vulgaris
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Advice & Guidance and guidelines
Alopecia
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Benign Skin Lesions
Bowens Disease
Community Dermatology Service
Cosmetic skin treatments
Eczema
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Mole Mapping/Surveillance
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Skin Camouflage
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Tissue Viability/Wound Care Service
Unusual Appearance - Outlook
Urticaria
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Community Diabetes Specialist Service
Diabetes & Nutrition
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Monogenic Diabetes
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Non-diabetic Hyperglycaemia and the National Diabetes Prevention Program
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Local Services
Malnutrition & Oral Nutritional Supplements
Vitamin D Deficiency
Weight management
Alcohol Misuse
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Bristol Drug and Alcohol Service
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Bereavement support
Death Certification and Medical Examiner
End of Life Care
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ReSPECT Plus
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Adrenal incidentaloma
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Male hypogonadism
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Thyroid disease and pregnancy
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Advice & Guidance Service
Anosmia
Audiology (adult)
Dizziness and Vertigo
Ear wax and microsuction
ENT HOT Clinic
Epistaxis
Hearing Problems
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Moulded Ear Plugs
Nasal Treatment
Neck Lumps (including Goitre)
Otitis Externa
Rhinosinusitis & Nasal Polyps
Snoring
Speech & Language
Tinnitus
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Advice & Guidance Services
Anaemia (Gastroenterology)
Anal FIssure
Barrett's oesophagus
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Endoscopy
Eosinophilic Oesophagitis
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Gallstones (and polyps)
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Stoma care
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Alpha 1 Antitrypsin Deficiency (AATD)
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Abnormal vaginal bleeding
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Female Cosmetic Surgery
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Female Urinary Incontinence
Fibroids
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Menopause
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Mesh Complications
Open Access Gynae Imaging
Ovarian Conditions
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Premature Ovarian Insufficiency (POI)
Recurrent Miscarriage
Termination of Pregnancy
Vaginal Discharge
Vulval Skin Conditions
Advice & Guidance Service
Anaemia
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Guidelines for Primary Care
Leucocytosis (including neutrophilia and lymphocytosis)
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Vitamin B12
Warfarin monitoring
Advice & Guidance Hepatology Service
Genetic Haemochromatosis
Liver disease
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Advice & Referrals - Infectious Diseases and Microbiology
Antimicrobial Guidelines (Primary Care)
Clostridioides difficile in the community
COVID -19 (Coronavirus)
Group A Strep
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Infection Sciences Test Sample Quick Guide
Influenza
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Public Health and Notifiable Diseases
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Biochemistry Advice
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Community Diagnostic Centres
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Adult Learning Disability Health Service
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Mental Capacity & Best Interest Decisions
Resources for Learning Disability Annual Health Checks and Health Action Plans
Stop over medication (STOMP)
Advice & Guidance Service
Cleft Lip and/or Palate (adult)
Dental Care
Reconstructive Prosthetics Services
Salivary Gland Problems
Temporomandibular Joint Disorders
Trigeminal Neuralgia
24/7 Mental Health Support
ADHD (adult)
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HOPE programme
ICU Follow-up NBT
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Mental health and wellbeing Integrated Network Team (MINT)
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SMI (Severe Mental Illness) Physical Health Improvement
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Talking Therapies (IAPT)
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Veterans Mental Health
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First Seizure Clinic
Head Injury Therapy Unit
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Huntington's Disease
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Lymphoedema
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Cholestasis of Pregnancy
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Early Pregnancy Assessment Clinic
Family Nurse Partnership
Folic acid and Vitamin B12 in pregnancy
Group B Strep in Pregnancy
Hyperemesis Gravidarum
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Maternity Services
Perinatal Mental Health
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Acute Angle Closure Glaucoma
Advice & Guidance Service
Allergic Eye Disease
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Pre-septal and Post-septal Cellulitis
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Subconjunctival Haemorrhage
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Acute knee & shoulder clinics
Advice & Guidance Service
Back pain/ Spinal pathway
Carpal Tunnel Syndrome
Dupuytren's Contracture
Foot and Ankle Problems
Fracture Clinics
Funding Policies for Orthopaedics
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getUBetter app
Hand problems
Hip Pain
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MSK Foot & Ankle service
Musculoskeletal (MSK) self-help
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Steroid injections
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Acupuncture
Advice & Guidance - Pain Management
Back Pack
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Divarication of Recti
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Respiratory Physio
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Alternative Medicine
Antibiotics
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Community Pharmacy
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Medication to avoid in dementia patients
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Opioid Conversion
Prescribing in pregnancy and breastfeeding
Psychotropic Medication Monitoring
Toxbase
Vitamin D
Advice & Queries
Direct Access Radiology (adults)
Image Guided Steroid Injections
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Radiology Guidelines for Primary Care
Spinal Imaging in Primary Care
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Air pollution and health
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Breathing Pattern Disorders
Bronchiectasis
Chronic Breathlessness Support
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Community Respiratory Service
Fit to Fly Assessments
Home oxygen ordering
HOT Clinics (Respiratory)
Interstitial Lung Disease
Long-term Ventilation (LTV) Service
myCOPD App
NHS@home - Respiratory pathway
Obstructive Sleep Apnoea
Pleural Services
Pulmonary Rehabilitation
Respiratory Triage Services (RAS)
Smoking Cessation
Spirometry and Lung Function Tests
Tuberculosis
Targeted Lung Health Check (TLHC) program
Advice & Guidance Service
Axial Spondyloarthritis (including ank spond)
Early Inflammatory Arthritis
Fibromyalgia
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Gout (Crystal Arthropathy)
Hypermobility and EDS
Osteoporosis
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Polymyalgia Rheumatica (PMR)
Psoriatic Arthritis (PsA)
Raynaud's Phenomenon
Sjorgren's Sydrome
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Young Adult Rheumatology Service
Better Health North Somerset
Exercise on referral
HOPE programme
Live Longer Better
Musculoskeletal (MSK) self-help
One You South Gloucestershire
Self Care
Smoking Cessation
Advice & Guidance Service
Chronic Pelvic Pain Syndrome (men)
Contraception
Emergency Contraception
Gonorrhoea
HIV
LARC
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Loss of Libido
Monkeypox
Pelvic Inflammatory Disease
Post Birth Contraception
Psychosexual Service
Sexual assault/ abuse support
Sexual Health Guidelines and Referral
Syphilis
Circadian Rhythm Disorder
Insomnia
Obstructive Sleep Apnoea (OSA)
Parasomnias
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Advice & Guidance Service
Cosmetic Treatment (including scar revision)
Foreign Body Removal (soft tissue)
Hernias (adults)
Burns (adult)
Pre-operative assessment
Reconstructive Prosthetics Services
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Dementia Wrap Around Care - North Somerset
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HOT Clinics & Rapid Access
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Neonatal milk & vitamin guideline
Sleep Disorders
Speech and Language Therapy
Audiology
Bell's Palsy
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ENT HOT Clinic (paediatric)
Epistaxis
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Motion sickness
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Speech & Language
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Chicken Pox - parents guide
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Asylum & Refugee Clinic (ARC)
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Happymaps
Self-harm in Children and Young People
Hep B vaccine for at risk infants
Jaundice
Neonatal milk & vitamin requirements
Sacral dimples and pits
Umbilical Granuloma
Bell's Palsy
Febrile Convulsions
Fits, Faints and Funny Turns
Headache
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Tics and Tourette's in children
Accurx templates for CYP
Bronchiolitis - parents guide
Chicken Pox - parents guide
Common Childhood Illness - HandiApp
Constipation - A guide for parents
Cough - parent information
Croup - parents guide
Diarrhoea and vomitting - parents guide
Febrile Convulsions - parents guide
Feverish Illness - parents guide
Gastro-oesophageal Reflux - parents guide
Head Injury - parents guide
Healthier Together - Parent Advice
Increasing Iron Intake
Sore Throat - parents guide
Swallowing Pills Advice
Umbilical Granuloma - parents guide
Vulvovaginitis
Weaning to a Cows milk free diet
Wheezy action plan
Advice & Guidance - Respiratory
Asthma in Children- acute (including wheeze)
Asthma in Children - Chronic
Bronchiolitis
Community Acquired Pneumonia
Cough (including PBB)
Croup
Sleep Apnoea in Children
Tuberculosis (children)
Referrals & Procedures
Be Safe
Support for children
Children in Care and Care Leavers (also known as Looked After Children)
ADHD Care Pathway for school age children
Auditory Processing Disorder (APD)
Autism spectrum disorder (ASD)
Dyslexia
Early Years Support Practitioner (SEND) Service (BRISTOL)
SEND
Sleep Disorders
Stop over medication (STAMP)
Burns (children)
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Hernias in Children
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Umbilical Granuloma
Assessment of acutely unwell children
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Rapid Access Clinic
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Continence
Haematuria
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Penis abnormalities in children
Surgery & Urology
Urinary Tract Infections
Varicocele
Obsolete pathways
Anaemia - iron deficiency - draft
Back pain/ Spinal pathway - Draft
Cauda Equina Syndrome - DRAFT
Community Urology Service - GP Care (DRAFT)
Consumer Genetic Testing - DRAFT
Haematuria in Children - draft
ICE System (Draft)
Needlestick injury - DRAFT
Normal Pressure Hydrocephalus - Draft
Paediatric Rheumatology - Draft
Papilloedema - Draft
Pulmonary Hypertension - DRAFT
Septicaemia - Draft
Sexually Transmitted Infections - guide to swabs - DRAFT
Vitamin B12 - interim guidelines DRAFT
Shared Decision Making DRAFT
Hyperemesis Gravidarum DRAFT
Lymphadenopathy (Benign) in Children - Draft
General Geriatrics - Draft
Pyogenic Granuloma - Draft
Premature Ovarian Insufficiency (Menopause <40y) DRAFT
Early menopause - under 45 (DRAFT)
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Gynaecology conditions and HRT (DRAFT)
Hormone sensitive cancers (DRAFT)
Cardiovascular conditions and HRT (DRAFT)
HRT in over 60s (DRAFT)
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HRT and Migraines (DRAFT)
Alternatives and Adjuncts to HRT (DRAFT)
Post-menopausal bleeding - not on HRT (DRAFT)
Contraception (DRAFT)
Referral - Menopause (DRAFT)
Resources for patients (DRAFT)
Anaemia in Pregnancy _ Draft
Second Opinions - Draft
Employment Support (DRAFT)
Overactive Bladder - Draft
Family History of Breast/ Ovarian Cancer (DRAFT)
Formulary Process
Joint Formulary Paperwork
Purpose and Format of the Joint Formulary
The Traffic Light System and Classification of Medicines
Non-formulary and Unlicensed Medicines
Shared Care
Meeting dates
APMOC Paperwork
1. Gastro-Intestinal System
2. Cardiovascular System
3. Respiratory System
4. Central Nervous System
5. Infections
6. Endocrine System
7. Obstetrics, Gynaecology and Urinary-tract Disorders
8. Malignant Disease and Immunosuppression
9. Nutrition and Blood
10. Musculoskeletal and Joint Diseases
11. Eye
12. Ear, Nose and Oropharynx
13. Skin
14. Immunological Products and Vaccines
15. Anaesthesia
16. Palliative Care
17. Miscellaneous Preparations
1. Gastro–intestinal System Guidelines
2. Cardiovascular System Guidelines
3. Respiratory System Guidelines
4. Central Nervous System Guidelines
5. Infections Guidelines
6. Endocrine System Guidelines
7. Obstetrics, Gynaecology and Urinary-tract Disorders Guidelines
8. Malignant Disease and Immunosuppression Guidelines
9. Nutrition and Blood Guidelines
10. Musculoskeletal and Joint Diseases Guidelines
11. Eye Guidelines
12. Ear, Nose and Oropharynx Guidelines
13. Skin Guidelines
14. Immunological Products and Vaccines Guidelines
16. Palliative Care Guidelines
17. Polypharmacy
18. Care Homes
19. Other
20. Appliances and Part IX
Botulinum Toxin A Pathways
Community Pharmacy Minor Ailment PGDs
Healthcare professionals working in primary care PGDs
NHSE PGDs
BNSSG-wide PGD Policy and Process
BNSSG PGD templates
Formulary Process
Joint Formulary Paperwork
Purpose and Format of the Joint Formulary
The Traffic Light System and Classification of Medicines
Non-formulary and Unlicensed Medicines
Shared Care
APMOC Paperwork
1. Gastro-intestinal System
2. Cardiovascular system
3. Respiratory System
4. Nervous system
5. Infections
6. Endocrine system
7. Obstetrics, gynaecology, and urinary-tract disorders
8. Malignant Disease and Immunosuppression
9. Nutrition and Blood
10. Musculoskeletal and joint diseases
11. Eye
12. Ear, Nose and Oropharynx
13. Skin
14. Immunological products and vaccines
15. Anaesthesia
16. Palliative Care
17. Miscellaneous Preparations
1. Gastro–intestinal system Guidelines
3. Respiratory System Guidelines
4. Nervous System Guidelines
5. Infections Guidelines
6. Endocrine system Guidelines
9. Blood and nutrition Guidelines
13. Skin Guidelines
20. Appliances and Part IX
Specialist Falls Service
South Glos - Memory Service & Dementia Support
South Glos - Active Ageing
Assistive Technology Service
Pain clinic - NBT
Back Pack - NBT & WGH
NBT - Cognitive Disorders Clinic
Endocrinology NBT
Arts on Referral for Chronic Pain - NBT
Falls Service : NBT
Neuropsychiatry Sleep Disorders clinic - NBT
Arts on Referral for Neuromuscular Condition - NBT
Bristol - Psychosis Early Intervention
South Glos - Psychosis Early Intervention
North Somerset - Psychosis Early Intervention
Primary Care Liaison Service
Contact lens wear increases the risk of infection of cornea. This is one of the most common conditions which presents to the BEH Emergency Department. A light sensitive and painful red eye in a contact lens wearer is typically an ulcer (an infection). These do not respond to chloramphenicol and require broader spectrum antibiotics (first-line: levofloxacin). On examination, you may see:
Please see diagnostic photographs
The patient should be reviewed in the BEH Emergency Department, the same day.
If the patient is out of hours, please discuss with the on-call ophthalmologist
Red eye and light sensitivity in a contact lens wearer should prompt suspicion of a corneal infection, this cannot be adequately diagnosed or excluded without a slit-lamp.
Refer to BEH Emergency Department
These guidelines have been written by Rhys Harrison, consultant ophthalmologist at Bristol Eye Hospital, with thanks to the patients who have kindly given consent to use their photos.
For full ophthalmology guidelines see: Primary Care Ophthalmology Guidance Document
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.