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
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
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 (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) 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
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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
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
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Advice & Guidance Service Acute Kidney Injury Chronic Kidney Disease Renal HOT Clinic
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Nursing
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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
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Pain Management and CFS
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Physiotherapy
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Podiatry
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Prescribing
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Radiology imaging
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Respiratory
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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
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Self Care
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Sexual Health
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Sleep Medicine
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Social Care
Carer Support Social Care Support Services
Social Prescribing Speech & Language
Speech and language therapy (SLT) - community and outpatient services
Surgery
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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
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Bristol Royal Hospital for Children guidelines
Bristol Childrens Hospital Guidelines
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Syncope in Children
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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
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Paediatric Phlebotomy
Physiotherapy
Community physiotherapy MSK Physiotherapy
Plagiocephaly
Plagiocephaly and Craniosynostosis
Podiatry for children Radiology
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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
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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
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Home > Formulary : Adult > Chapters > 6. Endocrine System >

BNSSG Adult Joint Formulary

6.6 Gonadotrophin responsive conditions

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Last edited: 07-05-2024

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

Gonadotrophin-releasing hormone analogues

Buserelin nasal spray (TLS Red)

  • TLS Red for uterine fibroid reduction & fertility treatments

Buserelin nasal spray (TLS Amber Specialist Recommended)

  • TLS Amber for endometriosis

Triptorelin (Decapeptyl® SR) (TLS Amber Specialist Recommended)

  • First line GnRH analogue where appropriate for licensed indications
  • TLS Amber (Specialist Recommended) for prostate cancer. 6 monthly formulation (22.5mg) preferred in Primary Care for patients requiring long term hormone suppression therapy (e.g. greater than 6 months) once patient tolerance has been established with a 1 month (3mg) or 3 month (11.25mg) trial
  • TLS Amber (Specialist Recommended) for endometriosis. 1 month formulation (3mg) and 3 month formulation (11.25mg)
  • Please see Chapter 6.8 for information about prescribing in gender dysphoria

Triptorelin 3mg injection (Decapeptyl® SR) (TLS Red)

  • TLS Red for uterine fibroid reduction

Leuprorelin (e.g. Staladex®, Prostap®) (TLS Amber Specialist Recommended)

  • Prostate cancer - second line, reserved for patients where Triptorelin is not tolerated
  • N.B. Staladex is not licensed for endometriosis and breast cancer indications – use Prostap see below.

Leuprorelin (Prostap®) (TLS Amber Specialist Recommended)

  • Endometriosis - second line, reserved for patients where Triptorelin is not tolerated

Leuprorelin (Prostap®) (TLS Amber 3 months)

Goserelin (Zoladex®) (TLS Amber)

  • If an alternative GnRH is not suitable
  • TLS Amber (Specialist Recommended) for prostate cancer. 3rd line GnRH of choice, reserved for patients where Triptorelin or Leuprorelin not tolerated
  • TLS Amber (3 months) for breast cancer (Breast Cancer SCP 2003 click here)
  • TLS Amber (Specialist Recommended) for endometriosis. Only 3.6mg formulation licensed

Goserelin 3.6mg implant (Zoladex®) (TLS Red)

  • TLS Red for uterine fibroid reduction & fertility treatments

 

6.6.1 Hereditary angioedema

Danazol (TLS Amber Specialist Initiated)

 

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