REMEDY : BNSSG referral pathways & Joint Formulary
Covid -19 Specific information
Patient Information & Safety-netting Bone & Soft Tissue - USC (2WW) Brain & CNS - USC (2WW) Breast - USC (2WW) Cancer of Unknown Primary - USC (2WW) Children & Young People – USC (2WW) Family History of Cancer Gynaecology - USC (2WW) Haematology - USC (2WW) Head & Neck incl Thyroid - USC (2WW) Lower GI - USC (2WW) Lung - USC (2WW) Non-Specific Symptoms - USC (2WW) - suspended Pancreas - USC (2WW) Skin - USC (2WW) Upper GI - USC (2WW) Urology - USC (2WW)
Advice & Guidance for GPs
Advice & Guidance Services Advice and Guidance Best Practice RAS on e-Referral
Biochemistry
Alkaline Phosophatase Clinical Biochemistry in Primary Care Creatinine Kinase Hyperkalaemia Hyperlipidaemia Hypomagnesaemia Lipid Advice & Guidance Service
Breast
Advice & Guidance Service Axillary masses Breast Implants (non-cancer) Breast Pain Breast Surgery Breastfeeding Family History of Breast Cancer Male Breast Symptoms Mastitis and Breast Abscess Nipple conditions
Cancer Screening
Bowel Cancer Screening Breast Cancer Screening Cervical Cancer Screening Pancreatic Cancer Surveillance Programme
Cancer Support
Advice & Guidance Service LD & Cancer Living with and beyond cancer (LWBC) Nutrition in cancer Physio for NBT Cancer patients Toxicity Risk Assessment Tool Rehab / prehab
Cardiology
Advice & Guidance Service Angina Arrhythmia Atrial Fibrillation and Flutter Cardiac Rehabilitation Cardiac Rhythm Analysis Dilated Ascending Aorta ECG - Open Access ECHO - requesting Heart Failure Hypertension Inherited Cardiac Conditions NT Pro BNP Testing Pacemakers Postural Orthostatic Tachycardia Syndrome (PoTS) Rapid Access Chest Pain Clinics Syncope and TLOC
Care of the Elderly
Active Ageing - South Glos Advice and guidance - Care of the Elderly Assistive Technology Service Falls & Balance Fracture Liaison Service Frailty Hearing Services Live Longer Better Movement Disorders NHS@home - Frailty pathway Rapid Assessment Clinic For Older People
Community Therapy
Community Therapy
Coroner
Avon Coroner
COVID-19
Acute Assessment COVID Medicine Delivery Unit (CMDU) COVID Oximetry @ Home Virtual Ward COVID Testing Long COVID TeamNet and Latest updates
Dementia
Dementia - Assessment & referral Dementia Prescribing Mental Capacity & Best Interest Decisions
Dermatology
Acne vulgaris Actinic Keratosis Advice & Guidance and guidelines Alopecia Basal Cell Carcinoma Benign Skin Lesions Bowens Disease Community Dermatology Service Cosmetic skin treatments Eczema Hidradenitis Suppurativa Hyperhidrosis Leg Ulcer Mole Mapping/Surveillance Pityriasis Rosea Pityriasis Versicolor Polymorphic Light Eruption Pruritis Psoriasis Rosacea Scabies Seborrhoeic Dermatitis Skin Camouflage Tinea Tissue Viability/Wound Care Service Unusual Appearance - Outlook Urticaria Vulval Skin Care Warts and Verrucas
Diabetes
Community Diabetes Specialist Service Diabetes & Nutrition Diabetes Advice and Guidance Diabetes Foot Care Diabetes Mellitus - Guidelines Diabetes self-management Diabetes Structured Education Diabetic Eye Screening Monogenic Diabetes Neuropathic Pain (Diabetic) Non-diabetic Hyperglycaemia and the National Diabetes Prevention Program Pregnancy and diabetes Rapid Access Diabetes Clinic Type 2 diabetes management Type 2 Path to Remission Programme
Dietetics & Nutrition
Advice & Guidance Service Local Services Malnutrition & Oral Nutritional Supplements Vitamin D Deficiency Weight management
Drug and Alcohol Misuse
Alcohol Misuse Opiate Dependence Non-opiate drug dependence Bristol Drug and Alcohol Service North Somerset Drug & Alcohol Service South Gloucestershire Drug & Alcohol Service Bristol Shared Care Breaking Free (Bristol & South Glos)
DVT and PE
DVT and SVT Pathway Pulmonary Embolus (suspected) Secondary Care DVT Services Unprovoked DVT
Enablement
Bristol Centre for Enablement Wheelchair Services
End of Life Care and Hospice
Bereavement support Death Certification and Cremation Forms End of Life Care End of life care - community support ReSPECT Plus St Peters Hospice Weston Hospice
Endocrinology
Advice and Guidance (Endocrinology) Adrenal incidentaloma Adrenal insufficiency Endocrinology Services - UHBW and NBT Gynaecomastia Hirsutism Hyperprolactinaemia Hyperthyroidism Hyponatraemia Hypothyroidism Male hypogonadism Polyuria Primary hyperparathyroidism (PHPTH) Secondary hypertension Sub Clinical hyperthyroidism Sub Clinical hypothyroidism Thyroid disease and pregnancy Thyroid eye disease
ENT
Advice & Guidance Service Anosmia Audiology (adult) Dizziness and Vertigo Ear wax and microsuction ENT HOT Clinic Epistaxis Hearing Problems Middle ear problems Moulded Ear Plugs Nasal Treatment Neck Lumps (including Goitre) Otitis Externa Rhinosinusitis & Nasal Polyps Snoring Speech & Language Tinnitus Tonsils Uvula
Fertility
Advice & Guidance Service Infertility Semen Analysis
Gastroenterology and Colorectal Surgery
Advice & Guidance Services Anaemia (Gastroenterology) Anal FIssure Barrett's oesophagus Coeliac Disease Colon Polyps Community Gastroenterology Clinic - InHealth Constipation in Adults Dyspepsia and Reflux Endoscopy Eosinophilic Oesophagitis Faecal Calprotectin FIT (Faecal Immunochemical Test) Gallstones (and polyps) Haemorrhoids and anal lesions Hiccups Inflammatory Bowel Disease (Confirmed) Inflammatory Bowel Disease (suspected) Irritable Bowel Syndrome Microscopic Colitis Pancreatitis (Acute) Pancreatitis (Chronic) and PEI Rectal Bleeding Stoma care Upper GI Bleed Urgent Gastroenterology Services
Gender Identity Genetics
Family History of Breast/Ovarian Cancer Family History of Colorectal Cancer Genetic Haemochromatosis Genetics - general Monogenic Diabetes
Gynaecology
Advice & Guidance Service Abnormal vaginal bleeding Cervical Conditions Dyspareunia Early Pregnancy Assessment Clinic Emergency Gynaecology Endometriosis Female Cosmetic Surgery Female Genital Mutilation Female Genitalia Surgery Female Urinary Incontinence Fibroids Hyperemesis Gravidarum Menopause Menstrual Disorders Mesh Complications Open Access Gynae Imaging Ovarian Conditions PCOS Pelvic Organ Prolapse Persistent Pelvic Pain (women) Premature Ovarian Insufficiency (POI) Recurrent Miscarriage Termination of Pregnancy Vaginal Discharge Vulval Skin Conditions
Haematology
Advice & Guidance Service Anaemia Blood Transfusions & Iron infusions Genetic Haemochromatosis Guidelines for Primary Care Leucocytosis (including neutrophilia and lymphocytosis) Macrocytosis Polycythaemia Sickle Cell & Thalassaemia Vitamin B12 Warfarin monitoring
Hepatology
Advice & Guidance Hepatology Service Genetic Haemochromatosis Liver disease Viral Hepatitis Urgent Hepatology Service
Homeless and Migrant Healthcare
Asylum Seeker and Refugee Health Homelessness Support
Imaging - see Radiology
Immunology
Immunology & Allergy Advice & Guidance Services Immunology & Allergy Guidelines
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Learning Disabilities
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Oncology
Advice & Guidance Service BHOC Acute Care Cancer Support Oncology Referrals
Ophthalmology
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Orthopaedics
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Physiotherapy
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Prescribing
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Respiratory
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Rheumatology
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Self Care
Better Health North Somerset Exercise on referral Live Longer Better Musculoskeletal (MSK) self-help One You South Gloucestershire Self Care Smoking Cessation
Sexual Health
Advice & Guidance Service Chronic Pelvic Pain Syndrome (men) Contraception Emergency Contraception Gonorrhoea HIV LARC LARC Complex referrals Loss of Libido Monkeypox Pelvic Inflammatory Disease Post Birth Contraception Psychosexual Service Sexual assault/ abuse support Sexual Health Guidelines and Referral Syphilis
Sleep Medicine
Circadian Rhythm Disorder Insomnia Obstructive Sleep Apnoea (OSA) Parasomnias Primary Hypersomnias Restless Leg Syndrome
Social Care
Carer Support Social Care Support Services
Social Prescribing Speech & Language
Speech and language therapy (SLT) - community and outpatient services
Surgery
Advice & Guidance Service Cosmetic Treatment (including scar revision) Foreign Body Removal (soft tissue) Hernias (adults) Burns (adult) Pre-operative assessment Reconstructive Prosthetics Services Surgical Emergency Care
Urgent Care
Admission protocols Dementia Wrap Around Care - North Somerset Frailty - ACE Frailty - Urgent Care HOT Clinics & Rapid Access Live UEC Dashboard Medical Assessment/Admission and Weekday IUC Professional Line NHS@home Sirona Professional Lines Surgical Emergency Care Transport to Hospital Urgent Care, MIU & WIC Urgent Community Response - Sirona Urgent Urology Pathway
Urology
Acute Prostatitis Advice & Guidance Service Bladder & Bowel Self Care App Bladder & Bowel Services Chronic Prostatitis Circumcision in adults Erectile Dysfunction Female Urinary Incontinence Haematospermia Haematuria Hydrocele LUTS in men Mesh complications Penile Disorders Prostate - including PSA Renal Calculi Scrotal Swellings & Testicular Lumps & Pain Sterile Pyuria Trial Without Catheter (TWOC) Urgent Care and HOT clinic Urinary Tract Infections Urodynamics UTIs in Care Homes Varicocele Vasectomy
Vascular
Advice & Guidance Service Abdominal Aortic Aneurysm Aortic Dissection Arterial Leg Ulcers Carotid Artery Stenosis NHS Health Check Peripheral Arterial Disease Varicose Veins and Venous Leg Ulcers Vascular Hot Clinic Vascular Nurse Specialist Clinic
Weight Management
Digital Weight Management Introduction and Tier 1 Weight Management Low Calorie Diet Pilot Non-diabetic Hyperglycaemia and the National Diabetes Prevention Program (NDPP) Tier 2 Weight Management Services Tier 3 & 4 Weight Management Service - BNSSG Post Bariatric Surgery Monitoring
Advice and Guidance
Advice & Guidance
Allergy
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Behaviour & Communication Breastfeeding
Breastfeeding problems Breastfeeding support Tongue Tie
Bristol Royal Hospital for Children guidelines
Bristol Childrens Hospital Guidelines
Cancer Support Cardiology
Syncope in Children
Children's Community Services
Children's Community Services
Chronic Fatigue (ME/CFS)
ME/CFS
Continence - Enuresis & Constipation
Bladder Symptoms in Children Constipation in Children
COVID-19
COVID Medicine Delivery Unit (CMDU) Long COVID in children
Dental & Oral Health
Dental Referrals Mouth ulcers
Dermatology
Advice & Guidance - Dermatology Benign skin lesions in children Community Dermatology Services Dermoid Cysts Eczema Henoch-Schonlein Purpura Pilomatricoma
Development
Developmental impairment Dyspraxia / DCD in children Faltering Growth Motor Disorders Neonatal milk & vitamin guideline Sleep Disorders Speech and Language Therapy
Diabetes
Diabetes Mellitus in Children
Dietetics & Nutrition
Paediatric Nutrition and Dietetic Service
Drug and Alcohol Misuse
Drug and Alcohol Services for Children Other related services
Eating Disorders
Care Pathway
Education
Bristol Hospital Education Service (BHES)
Enablement End of life care (children)
End of life care - children When a child dies
Endocrinology
Endocrine Services Growth and Puberty
ENT
Audiology Bell's Palsy Cleft lip and / or palate Ear wax in children ENT HOT Clinic (paediatric) Epistaxis Middle ear problems Motion sickness Moulded Ear Plugs Nasal problems Sleep Apnoea in Children Sore throat Speech & Language Tongue Tie Tonsils and Adenoids
Gastroenterology
Chronic Abdominal Pain and IBD Coeliac disease (children) Constipation Diarrhoea and vomiting Faltering Growth Milk Related Problems Neonatal milk & vitamin guideline Reflux Disease
Gender Identity
Gender Identity in children and young people
Gynaecology
FGM in children (<18) Gynaecology (paediatric and adolescent) The Star Clinic Vulvovaginitis
Haematology
Anaemia Immune Thrombocytopenia (ITP) Neutropenia
Immunisation
Hep B vaccine for at risk infants Paediatric Immunisation TB screening and BCG
Infectious Diseases
Chicken Pox - parents guide Feverish illness Respiratory tract infections Scarlet Fever/ Group A Strep
Mental Health
Asylum & Refugee Clinic (ARC) Mental Health Resources for Children and Young People CAMHS mental health 24/7 emergency line CAMHS Referral information Happymaps
Milk Related Problems
Milk Related Problems
Neonatal
Hep B vaccine for at risk infants Jaundice Neonatal milk & vitamin requirements Sacral dimples and pits Umbilical Granuloma
Nephrology
Henoch-Schonlein Purpura
Neurology
Bell's Palsy Febrile Convulsions Fits, Faints and Funny Turns Headache Head injury Neuromuscular Neurosurgery Tics and Tourette's in children
Occupational Therapy Ophthalmology
Advice & Guidance Referral Guidance Orbital Cellulitis
Orthopaedics
Back pain Hip Dysplasia Limping - acute limp in children Lower Limb Urgent & Non-urgent Referrals
Pain Management
Chronic/ Complex Pain Management
Palliative Care
End of life care - children Lifetime Service
Parents Information Leaflets
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 Functional gastro-intestinal disorders Gastro-oesophageal Reflux - parents guide Head Injury - parents guide Increasing Iron Intake Respiratory tract infections Sore Throat - parents guide Umbilical Granuloma - parents guide Vulvovaginitis Weaning to a Cows milk free diet Wheezy action plan Healthier Together - Parent Advice
Phlebotomy
Paediatric Phlebotomy
Physiotherapy
Community physiotherapy MSK Physiotherapy
Plagiocephaly
Plagiocephaly and Craniosynostosis
Podiatry for children Radiology
Paediatric Radiology
Reconstructive Prosthetics Respiratory
Advice & Guidance - Respiratory Asthma in Children- acute (including wheeze) Asthma in Children - Chronic Bronchiolitis Community Acquired Pneumonia Cough Croup Sleep Apnoea in Children Tuberculosis (children)
Safeguarding Children
Referrals & Procedures Be Safe Support for children Children in Care and Care Leavers (also known as Looked After Children)
School Nurse and Health Visiting
Health Visiting School Nurse Service
Self Care
Self care (paediatric)
Special Educational Needs & Disability (SEND)
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)
Speech & Language
Speech and Language Therapy
Surgery
Burns (children) Chest Wall Deformity Hernias in Children Paediatric Surgery Inc. Urology Umbilical Granuloma
Urgent Care
Common Urgent Care Conditions Rapid Access Clinic Urgent Care Referrals Urgent Orthopaedic Referrals
Urology
Circumcision in children Continence Haematuria Hydrocele (paediatric) Penis abnormalities in children Surgery & Urology Urinary Tract Infections Varicocele
Vitamin D Deficiency
Vitamin D Deficiency
Weight Management
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Service Guide
About the EFR Service List of Funding Policies
BNSSG Referral Service Datix Concerns Reporting Greener Practice Hospital waiting times Language Services - Interpreting and Translation Live Urgent and Emergency Care Dashboard Managed Referrals in EMIS NHS Health Checks Patient Initiated Follow-up Patients with a visual impairment Special Allocation Scheme Development Area
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 Waiting list test area Shared Decision Making Alpha 1 Antitrypsin Deficiency (AATD) DRAFT Hyperemesis Gravidarum DRAFT Self-harm in Children and Young People (DRAFT) Plagiocephaly and Craniosynostosis - DRAFT Paediatric Sickle Cell & Thalassaemia (DRAFT) Coronary Artery Calcification - Draft Targeted Lung Health Check (TLHC) program - Draft
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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
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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
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BNSSG Adult Joint Formulary
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14. Immunological Products and Vaccines

First line drugs Second line drugs Specialist drugs Secondary care drugs
Recommended in both primary and secondary care Alternatives (often in specific conditions) in both primary and secondary care Where a specialist input is needed (see introduction for definition) Prescribing principally within secondary care only


This chapter of the Joint Formulary has been produced to provide prescribing guidance in conjunction with the following resources:      

Immunisation:

 

Health Protection Teams:

  • Avon, Gloucestershire and Wiltshire HPT 0300 3038162 option 2

  • Devon, Cornwall and Somerset HPT 0344 2253557

The Department of Health ‘Green Book’ Department of Health publication Immunisation against infectious disease – The Green Book

Current UK routine immunisation schedule

 

Travel:

 

The Specialist Pharmacy Service (SPS) website hosts a variety of useful resources that may support answering questions about vaccines and immunisation.