REMEDY : BNSSG referral pathways & Joint Formulary
Covid -19 Specific information
Decision Support Tools 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) 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 Triage Service (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 Targeted Lung Health Check (TLHC) program
Cancer Support
Advice & Guidance Service Cancer and Severe Mental Illness (SMI) LD & Cancer Living with and beyond cancer (LWBC) Nutrition in cancer Physio for NBT Cancer patients Post cancer - Digital Remote Monitoring and Personalised Stratified Follow Up Rehab / prehab Toxicity Risk Assessment Tool
Cardiology
Advice & Guidance Service Angina Arrhythmia Atrial Fibrillation and Flutter Cardiac Rehabilitation Cardiac Rhythm Analysis Coronary Artery Calcification 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 (non-traumatic) Thoracic Aorta Disease
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
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 Medical Examiner End of Life Care End of life care - community support ReSPECT Plus SR1 Form (formerly DS1500) St Peters Hospice Weston Hospice
Endocrinology
Adrenal incidentaloma Adrenal insufficiency Advice and Guidance (Endocrinology) 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
Alpha 1 Antitrypsin Deficiency (AATD) 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 Inflammatory Disease Pelvic Organ Prolapse Persistent Pelvic Pain (women) Premature Ovarian Insufficiency 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) Lymphadenopathy (adults) 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
Infectious Diseases and Microbiology
Advice & Referrals - Infectious Diseases and Microbiology Antimicrobial Guidelines (Primary Care) Clostridioides difficile in the community COVID -19 (Coronavirus) Group A Strep Helicobactor Pylori Immunisation Schedules Infection Sciences Test Sample Quick Guide Influenza Lyme Disease Malaria Measles Mpox Mumps Public Health and Notifiable Diseases Syphilis Tuberculosis Varicella Viral Haemorrhagic Fever (incl Ebola) Whooping Cough
Investigations
Biochemistry Advice Chronic Disease Monitoring Community Diagnostic Centres Community phlebotomy Inflammatory Marker Testing Medical Calculators Pathology Services Transport and storage of samples
Learning Disabilities
Adult Learning Disability Health Service Constipation and Learning Disability Dyslexia Dyspraxia / DCD in adults LD & Autism Hospital Liaison LD & Cancer Screening LD and COVID-19 LeDeR - learning disability mortality reviews Mental Capacity & Best Interest Decisions Resources for Learning Disability Annual Health Checks and Health Action Plans Stop over medication (STOMP)
Lifestyle advice
Lifestyle advice
Max Fax and Dental
Advice & Guidance Service Cleft Lip and/or Palate (adult) Dental Care Reconstructive Prosthetics Services Salivary Gland Problems Temporomandibular Joint Disorders Trigeminal Neuralgia
Menopause
Alternatives and Adjuncts to HRT Cardiovascular conditions and HRT Contraception and Menopause Diagnosing menopause Early menopause - under 45 Genitourinary symptoms Gynaecology conditions and HRT Hormone Replacement Therapy (HRT) HRT and breast conditions HRT and Migraines HRT in over 60s Hormone sensitive cancers Premature Ovarian Insufficiency (Menopause <40y) Referral - Menopause Side effects and risks of HRT Testosterone for low libido VTE and HRT Resources for patients
Mental Health
24/7 Mental Health Support ADHD (adult) Autism-Spectrum Depression (adults) Eating Disorders Gambling Addiction HOPE programme ICU Follow-up NBT Insomnia Mental health and wellbeing Integrated Network Team (MINT) Mental Health - Social Prescribing Mental Health Support - Which Service Neuropsychiatry Perinatal Mental Health Primary Care Liaison Service - AWP Psychosis: Schizophrenia Safe Haven Mental Health Support Sanctuary (Bristol) Mental Health Support Second Step Wellbeing Services Self Harm Self-help Leaflets for Mental Health Sexual Assault / Abuse Support SMI (Severe Mental Illness) Physical Health Improvement Suicidal Thoughts Talking Therapies (IAPT) Unusual Appearance Veterans Mental Health
Nephrology
Advice & Guidance Service Acute Kidney Injury Chronic Kidney Disease Renal referrals (including urgent referrals)
Neurology
Advice & Guidance - Neurology/HOT Clinic Advice and Guidance - Neurovascular/Stroke Bell's Palsy Cognitive Disorders Concussion / mild traumatic brain injury First Seizure Clinic Head Injury Therapy Unit Headache (adults) Huntington's Disease Multiple Sclerosis Neuromuscular Neurophysiology Neuropsychiatry Parkinson's Disease Peripheral Neuropathy Restless Leg Syndrome Spasticity service Specialist Community Neurology Stroke Transient Ischaemic Attack Tremor Trigeminal Neuralgia
Neurosurgery
Advice & Guidance (Neurosurgery) Cauda Equina Syndrome Neurosurgery Spinal Surgery Trigeminal Neuralgia
Nursing
Community Nursing - Bristol Community Nursing -North Somerset Community Nursing - South Glos Lymphoedema
Obstetrics
Advice & Guidance Service Cholestasis of Pregnancy Diabetes in Pregnancy Early Pregnancy Assessment Clinic Family Nurse Partnership Folic acid and Vitamin B12 in pregnancy Group B Strep in Pregnancy Hyperemesis Gravidarum Hypertension in pregnancy Maternity Services Perinatal Mental Health Post Natal Care Termination of pregnancy Thyroid Disease and Pregnancy Vaccination in Pregnancy
Oncology
Advice & Guidance Service BHOC Acute Care Cancer Support Oncology Referrals
Ophthalmology
Acute Angle Closure Glaucoma Advice & Guidance Service Allergic Eye Disease Anterior Uveitis / Iritis Blepharitis Cataract Chalazion & Styes Chemical injury Conjunctivitis Contact Lens Related Keratitis (Corneal Ulcer) Corneal Abrasion Corneal Foreign Body Dry Eye Endophthalmitis Episcleritis Eyelid conditions Floaters & Flashes Giant Cell Arteritis Glaucoma Hyphaema Low Vision Neuro-ophthalmology Open Eye Injury Ophthalmic Shingles Orbital Trauma / Suspected Orbital Fracture Pingueculum & Pterygium Pre-septal and Post-septal Cellulitis Referral Guidance & Tips Subconjunctival Haemorrhage Urgent Ophthalmology Referrals
Orthopaedics
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 Ganglion getUBetter app Hand problems Hip Pain Knee Pain Meralgia Paraesthetica MSK Foot & Ankle service Musculoskeletal (MSK) self-help Musculoskeletal Interface (MSKI) Service Periprosthetic hip infection Shoulder Problems Sports Injuries Steroid injections Trigger Finger
Pain Management and CFS
Acupuncture Advice & Guidance - Pain Management Back Pack Fibromyalgia ME/Chronic Fatigue Syndrome Persistent (Chronic) pain Spinal Cord Stimulation Service
Physiotherapy
Advice & Guidance Service Divarication of Recti MSK Physio services Neurophysiotherapy Pelvic Health Physio Respiratory Physio Self-management Hip & Knee pain
Podiatry
Advice & Guidance (podiatry) Community Podiatry Services Ingrown Toenail
Prescribing
Alternative Medicine Antibiotics Cannabis prescribing Community Pharmacy Hosiery Medication to avoid in dementia patients Medicines for Self Care Medicines Quality and Safety NHS@Home - IV antimicrobials (OPAT) Opioid Conversion Prescribing in pregnancy and breastfeeding Psychotropic Medication Monitoring Toxbase Vitamin D
Radiology imaging
Advice & Queries Direct Access Radiology (adults) Image Guided Steroid Injections MRI considerations Radiology Guidelines for Primary Care Spinal Imaging in Primary Care Ultrasound guidance
Respiratory
Advice & Guidance Service Air pollution and health Asthma (adults) Breathing Pattern Disorders Bronchiectasis Chronic Breathlessness Support Chronic cough Chronic Obstructive Pulmonary Disease 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
Rheumatology
Advice & Guidance Service Axial Spondyloarthritis (including ank spond) Early Inflammatory Arthritis Fibromyalgia Giant Cell Arteritis Gout (Crystal Arthropathy) Hypermobility and EDS Osteoporosis Osteoporotic Vertebral Fracture Polymyalgia Rheumatica (PMR) Psoriatic Arthritis (PsA) Raynaud's Phenomenon Sjorgren's Sydrome Systemic Lupus Erythematous Young Adult Rheumatology Service
Safeguarding
Adult Safeguarding Domestic Violence and Abuse PREVENT Sexual assault/ abuse support
Self Care
Better Health North Somerset Exercise on referral HOPE programme 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 Admissions (Urology) - under review 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
Allergy Advice & Guidance Adrenaline Auto-Injectors (AAI) Food Allergy Milk Related Problems
Behaviour & Communication Breastfeeding
Breastfeeding problems Infant Feeding 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 PICA (eating non-edible items)
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 Incongruence in children and young people
Gynaecology
FGM in children (<18) Gynaecology (paediatric and adolescent) The Star Clinic Vulvovaginitis
Haematology
Anaemia Immune Thrombocytopenia (ITP) Neutropenia Paediatric Sickle Cell & Thalassaemia
Immunisation
Hep B vaccine for at risk infants Paediatric Immunisation TB screening and BCG
Infectious Diseases
Chicken Pox - parents guide Feverish illness Lymphadenopathy (Benign) in Children 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 Self-harm in Children and Young People
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
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
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 (including PBB) 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
Assessment of acutely unwell children 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
Weight Management for children (tier 1 and 2) Care of Childhood Obesity (COCO)
Service Guide
About the EFR Service List of Funding Policies
BNSSG Referral Service Datix Concerns Reporting Diagnostic Tests - locations available Greener Practice Hospital Discharge Pathways 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 Remedy Updates Second Opinions 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 Shared Decision Making DRAFT Hyperemesis Gravidarum DRAFT General Geriatrics - Draft Pyogenic Granuloma - Draft Unscheduled bleeding on HRT (DRAFT) Post-menopausal bleeding - not on HRT (DRAFT) Anaemia in Pregnancy _ Draft Employment Support (DRAFT) Overactive Bladder - Draft Family History of Breast/ Ovarian Cancer (DRAFT) Abscesses, Boils and Carbuncles (DRAFT)
BNSSG Joint Formulary
About the BNSSG Joint Formulary
Formulary Process and Paperwork
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
Recent Decisions
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024
Drugs A-Z
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Chapters
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
Local Guidelines
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
SCPs
SCPs
Wound Care / Formeo
Wound Care / Formeo
Patient Group Directions
Community Pharmacy Minor Ailment PGDs Healthcare professionals working in primary care PGDs NHSE PGDs BNSSG-wide PGD Policy and Process BNSSG PGD templates
NHS@Home
Community IV Charts Standard Operating Procedures
Community Pharmacy Information
Community Pharmacy Information
Stock Shortages
Management of Stock Shortages
Medicines Safety
Medicines Quality and Safety
Covid-19
COVID-19 Vaccines COVID-19 rapid evidence summaries
Medicines Optimisation Strategy
Medicines Optimisation Strategy
Contact Us Drug category
BNSSG Joint Formulary
About the BNSSG Joint Formulary
Formulary Process and Paperwork
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
Recent Decisions
No Date 2012 2013 2014 2016 2019 2020 2021 2022 2023 2024
Drugs A-Z
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Paediatric Chapters
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
Paediatric Local Guidelines
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
Paediatric Shared Care Protocols
SCPs
Stock Shortages
Management of Stock Shortages
Contact Us Drug category
About REMEDY
Contact Us
content owners
items
test pages
Referral Reviews
Bristol
MSK Interface Service Bristol - Dementia Wellbeing Service
North Somerset
Sirona / South Glos
Specialist Falls Service South Glos - Memory Service & Dementia Support South Glos - Active Ageing Assistive Technology Service
Bath RUH
Pain Clinic - RUH Bath
NBT
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
UHB Trust
Pain Clinic - UHBW Endocrinology UHBW UHBW - Geriatric Medicine
NBT and UHBW
Rheumatology - Back pain
Bristol City Council
Strength & Balance classes : Bristol City Council Everyone Active and ReACT - Bristol
North Somerset Council
North Somerset - Memory Service & Alzheimer's Society
South Glos Council
Age UK Somerset
Staying Steady : Age UK Somerset
AWP
Bristol - Psychosis Early Intervention South Glos - Psychosis Early Intervention North Somerset - Psychosis Early Intervention Primary Care Liaison Service
NHS Talking Therapies - Living Well with Chronic pain
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
Assessment of acutely unwell children Common Urgent Care Conditions Rapid Access Clinic Urgent Care Referrals Urgent Orthopaedic Referrals


Home > Formulary : Adult > Chapters > 4. Central Nervous System >

BNSSG Adult Joint Formulary

4.7 Sleep disorders

Share Print Feedback
Last edited: 06-09-2024

4.7.1 Insomnia

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

  • Before a hypnotic is prescribed, the underlying cause should be identified and addressed, and realistic sleep requirements should be discussed with the patient
  • All hypnotics should be used for the minimum length of time due to the risk of dependence
  • If required on a hospital discharge prescription, a maximum of 14 days should be dispensed
  • See BNSSG Benzodiazepine and Z-drug Prescribing (including withdrawal) Support Document

 

Benzodiazepines

Recommended: (TLS Green)

Temazepam

 

CNS depressants 

Recommended: (TLS Green)

Zopiclone

 

Other

Melatonin modified-release and immediate-release (TLS Amber 3 months)

  • Intrinsic sleep disorder with one of:
    • Autism Spectrum Disorder (ASD) diagnosis,
    • Learning Disability (LD) diagnosis,
    • a neurodevelopmental disorder / disability (e.g. cerebral palsy) (excluding those with Attention Deficit Hyperactivity Disorder as a standalone diagnosis)
  • REM sleep disorder
  • Shared Care Protocol

Melatonin (TLS Red)

Melatonin modified-release (TLS Red)

  • For use in the Intensive Care Unit for the prevention of delirium in at risk patients. Local protocol to be developed
  • For Consultant Neuro-psychiatrist initiation only for short term use of insomnia at NBT only. To be reviewed by Joint Formulary Group

Melatonin for all other indications are non-formulary.

Specific Cohort:

Daridorexant (TLS - Blue)

  • NICE TA922 Daridorexant for treating long-term insomnia

BNSSG Insomnia Pathway Final 2024

 

4.7.2 Narcolepsy

Dexamfetamine (TLS Amber 3 months) (SCP click here)

Methylphenidate (TLS Red)

Modafinil (TLS Amber 3 months) (SCP click here)

Solriamfetol (TLS Red)

  • NICE TA758 for treating excessive daytime sleepiness caused by narcolepsy 

Sodium oxybate (TLS Red)

  • For symptom control of narcolepsy with cataplexy under the care of a sleep specialist

 

Contact Us

Got a question or comment about the Joint Formulary? 

Please use the email address below to contact us and we will endeavour to respond within 2 working days.