Our GP Practice is keen to ensure that we make the best use of our clinical staff, allowing them to provide the most appropriate care to those most in need of it. For the vast majority of patients, attending an appointment at the Practice is the best option for them and for the Practice staff. 

You may think that a home visit by a family doctor (GP) is best for patient care. However, while home visits are convenient for the patient, they actually offer a poorer standard of care compared to surgery consultations.

This is due to:

• poor facilities – for example, soft beds, poor lighting or lack of hygiene
• inefficiency – the doctor could see four to six other equally needy patients in the time taken for one home visit
• patient records, which are required to provide appropriate and safe care, are not immediately available; and
• patient chaperones, who are required to be present for some examinations, are not always available.

We have noticed that many patients are requesting visits that are inappropriate or unnecessary. This has a negative impact on other aspects of our service. Calling the doctor out unnecessarily takes the doctor away from patients who may have a greater clinical need. Most of the consultations during home visits could easily and safely be carried out in the surgery.

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Some myths about home visits

Myth	Fact
It’s my right to have a home visit.	Under the GP terms of service, it is actually up to the doctor to decide, in their reasonable opinion, where a consultation should take place.
I should get a visit because I’m old.	Our clinical work does not judge based on age alone.
I can’t bring my child out in this weather.	No-one will be harmed by being wrapped up and brought in to the surgery.
The doctor needs to check I’m ready to go into hospital.	Paramedics can provide initial lifesaving care, and patients will be cared for appropriately in emergency departments.
I’m housebound.	Being housebound does not always prevent use of transport.
I live in a care home.	Many patients living in care homes still go to hospital outpatients and take trips out.
Can the GP just pop in to see me?	We have fully booked surgeries and cannot simply drop everything to visit people at home.

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Where home visits are not appropriate

Please note this list only includes some examples, and is not exhaustive.

• Children, young people or anyone who is mobile
• Lack of money or transport. This is not a medical responsibility. It is up to the patient to organise transport
• Lack of childcare or been drinking alcohol and not able to drive. This is not a medical responsibility
• Can’t get out due to bad weather. Remember that medical staff are also affected by snow, ice or bad weather
• Timed visits between hairdressing and shopping appointments. Patients who are clearly mobile are taking doctors and nurses away from patients with greater need
• Feeling well, but need a check over to make sure everything is all right. Our priority is seeing those patients who are unwell.
• Other help may be more appropriate – for example, if you think you are having a heart attack or a stroke, please ring 999.

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Where home visits are appropriate and worthwhile

• Terminally ill patients: we have no problems seeing those who are at most clinical need
• Truly bedbound patients: we have no problems seeing those who are confined to bed
• So poorly, the patient would be harmed if moved: we have no problems seeing those who are at most clinical need.

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If you think you may need a home visit

If you are poorly and think you need an urgent same day visit, please call between 8:30am and 10:30am on the day.

• If you are mobile (own legs, using walking aids, wheelchair or scooter), we kindly ask that you see us in the surgery
• The triage nurse or doctor will always consider your request and ensure you are seen by the most appropriate health care professional in the most appropriate location
• An Emergency Hospital admission may be organised for the patient via the ambulance service without first seeing the patient, in cases where their medical condition make that course of action appropriate.

If we visit you at home and feel that your request was inappropriate, we may inform you so that you use our services more appropriately in the future. Please do not be offended, as we have a duty to use our resources effectively for the safety and benefit of all patients.

You can also be visited at home by a community nurse if you are referred by your GP. You should also be visited at home by a health visitor if you have recently had a baby or if you are newly registered with a GP and have a child under five years.

Appropriate	Not appropriate
Bedbound	No transport or money
Terminally ill	Children, young people and anyone who is mobile
Would come to serious harm if moved	Social reasons or for convenience

GPs do not provide an occupational health service as part of their NHS responsibility nor can they provide this service to you even if you are willing to pay for it.

Under Health and Safety Regulations, your employer or University/College has a duty to provide a safe working environment, and should provide this vaccination.

GPs are not obliged to provide the hepatitis B vaccine on the NHS if you’re not thought to be at risk.

We advise you to contact your employer or University/College and refer them to this page on our website. They will be able to make arrangements with an occupational health provider for the provision of any immunisation which you may require following an appropriate assessment.

There are a number of services that can help you when it comes to looking after yourself if you have diabetes.

https://youtube.com/watch?v=xuNEnhCZFLo%3Ffeature%3Doembed

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Routine care

The majority of people with diabetes are looked after by the Practice Diabetes Team.

We like to see all people with diabetes twice a year, once during their annual health check and again 6 months later.

You will receive an invite for both the annual health check and normally a 6 month review. Both of the appointments will be with a Nurse and you will need to have a blood test before each appointment.

There are times when you will need to be seen more often than twice a year, for example after you are first diagnosed or if problems are detected during one of the routine reviews. We arrange these additional reviews as needed and they may be with either a Nurse or one of the Doctors.

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The Practice Team

The Practice Nurse and your GP will usually provide this service with assistance from other Healthcare Professionals. Please check with your Practice for clinic times.

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Specialist care

If there is a particular problem identified with your diabetes care that we cannot help you with within the Practice, then we will refer you to a specialist service.

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Type 2 Diabetes – Know your Risk

Finding out your risk of Type 2 diabetes only takes a few minutes. It could be the most important thing you do today.

Before you start, grab a tape measure and scales…

https://youtube.com/watch?v=qghTQxnVaMk%3Ffeature%3Doembed

It is very important that anyone who has problems with their memory has a proper assessment. If these problems are due to dementia then early diagnosis and referral has many benefits for the patient, their carer(s) and family. It can help them to plan and access the treatment and support they need and to improve their quality of life.

If you are having memory problems, please book an appointment with one of the GPs, who can make an initial assessment and refer you to the Memory Clinic if required.

• Cervical screening (a smear test) checks the health of your cervix, which is the opening to your womb from your vagina. 
• It’s not a test for cancer, it’s a test to help prevent cancer.
• All women and people with a cervix aged 25 to 64 should be invited by letter. 
• During the screening appointment, a small sample of cells will be taken from your cervix. 
• The sample is tested for changes to the cells of your cervix. 
• Finding abnormal changes early means they can be monitored or treated so they do not get a chance to turn into cervical cancer. 
• Approximately 2 weeks after screening, you will get your results by letter.

To arrange a cervical screening appointment, please telephone the Practice.

Cervical screening saves 5000 lives a year. It is not a test for cervical cancer, it is a screening test to detect abnormalities in the cells of the cervix at an early stage.

When you receive an invitation to cervical screening from the Practice, please, don’t ignore it. It takes just a few minutes and could save your life.

• First time being screen, or nervous? tell the Nurse/Doctor, and try to relax and distract your mind
• Worried about discomfort? Ask the Nurse/Doctor to use a smaller speculum
• Feeling embarrassed? Wear a skirt to your appointment as you can keep this on during the procedure
• Don’t want to go alone? Take a friend with you, to keep you company in the Waiting Room, and be there for you after the screening
• Undergone FGM/cutting in the past? Tell the Nurse/Doctor
• Not sure what to expect? Go to jostrust or call 0808 802 800

An advocate is a person who speaks up for you, acts on your behalf and, where required, puts forward your case for you.

They are:

• independent of Social Services and the NHS
• not a member of your family or one of your friends

An advocate’s role includes arguing your case when you need them to, and making sure health and social care services follow the correct procedures.

They are independent, so they represent your wishes without giving their personal opinion and without representing the views of the NHS or local authority.

An advocate might help you get information or go with you to meetings or interviews to support you.

Your advocate can also write letters on your behalf, or speak for you in situations where you don’t feel able to speak for yourself.

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Find an Advocate

Advocacy Services help people – particularly the most vulnerable in society – to:

• access information and services
• be involved in decisions about their lives
• explore choices and options
• defend and promote their rights and responsibilities
• speak out about issues that matter to them

• If we have an appointment available to suit your travel dates we will provisionally book the appointment(s) with our practice nurse. One appointment per person.
• The pre travel vaccination questionnaire is provided to you at the time you book your appointment, and is available either at Reception or via the link below.
• Not all vaccinations are covered by the NHS, in which case you will be advised to contact a travel clinic to receive private vaccinations at a cost to yourself.
• Once you have completed the vaccination request form, we shall be able to determine the vaccines you require and if they can be done by our practice nurse here at the surgery, or if you need to attend a travel clinic. Your form will be actioned within 10 working days, and then you will be contacted on your preferred contact number to confirm the outcome
•  When you attend the surgery to have the vaccine administered you are required to wait in the waiting room for a further 10 mins afterwards in case of any adverse reaction.

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Holiday Vaccination Questionnaire

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Vaccines

Some travel vaccines are ordered on a private prescription and these incur a charge over and above the normal prescription charge.This is because not all travel vaccinations are included in the services provided by the NHS.

Please note only the undernoted vaccines are available on NHS Prescriptions:

• Hepatitis A
• Typhoid
• Diphtheria
• Tetanus
• Polio

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Healthy Travel Leaflet

You may find the following leaflet helpful when making your travel arrangements.

Advice on Malaria will be given.

Please download and print our useful guide below about Mosquito advice.

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Hepatitis immunisation

Immunisation against infectious Hepatitis (Hepatitis A) is available free of charge on the NHS in connection with travel abroad. However Hepatitis B is not routinely available free of charge and therefore you may be charged for this vaccination when requested in connection with travel abroad.

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Suggested Travel Clinics

• CityDoc, Tel: 0334 145984 (option 1) or www.citydoc.org.uk to book online
• Boots, The Bridges, Sunderland Tel: 0191 5670933 (option 3)
• East Boldon Village Pharmacy, Tel: 0191 5367459

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Excess quantities of regular repeat prescriptions

Under NHS legislation, the NHS ceases to have responsibility for people when they leave the United Kingdom. However, to ensure good patient care the following guidance is offered. People travelling within Europe should be advised to carry a European Health Insurance Card, known as an EHIC.

Medication required for a pre-existing condition should be provided in sufficient quantity to cover the journey and to allow the patient to obtain medical attention abroad. If the patient is returning within the timescale of their usual prescription, then this should be issued (the maximum duration of a prescription is recommended by the Care Trust to be two months, although it is recognised that prescription quantities are sometimes greater than this). Patients are entitled to carry prescribed medicines, even if originally classed as controlled drugs, for example, morphine sulphate tablets.

For longer visits abroad, the patient should be advised to register with a local doctor for continuing medication (this may need to be paid for by the patient).

General practitioners are not responsible for prescriptions of items required for conditions which may arise while travelling, for example travel sickness or diarrhoea. Patients should be advised to purchase these items from community pharmacies prior to travel.

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Useful Links

NHS Overview – Travel Vaccinations

Foreign and Commonwealth Office

Lonely Planet’s website

International Society of Travel Medicine

Health Advice for the Diabetic 

Fit for Travel – an NHS site written at the Scottish

Medical Advice Services for Travellers Abroad

UK travel health – site developed by a nurse

Centre for Disease Control – in Atlanta

The NHS Health Check is a health check-up for adults in England aged 40-74. It’s designed to spot early signs of stroke, kidney disease, heart disease, type 2 diabetes or dementia. As we get older, we have a higher risk of developing one of these conditions. An NHS Health Check helps find ways to lower this risk. Please contact the Practice to arrange an appointment.

Long Term Conditions (LTC) are health conditions that can impact on a person’s life, and may require ongoing care and support. We organise appointments and provide support for people who have an LTC by putting in place a way of working called ‘Care and Support Planning’.

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What is care and support planning?

This way of working aims to give you the opportunity to get more out of your annual review appointments by reorganising the way things happen and giving you more information before you see one of our Nurses. It should help you talk about:

• What support you may need
• What is important to you
• What you can do to look after your health and stay well

Who is it for?

Any patient who has a Long Term Condition (LTC).

The Benefits

This way of working is nearly always preferred by patients. It will help both you and our Nurse make the best use of the time you have in your care and support planning appointment. All the important tests and results needed at your appointment will be available for discussion at your second appointment.

What does this mean for me?

This means that your care and support planning review will take place over two separate appointments and you will have time to think about what you want to get out of these visits.

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What happens at the first appointment?

At the first appointment, you will be asked to attend the surgery to have a number of tests done with a Practice Nurse or Healthcare Assistant. The tests may include a blood test (non-fasting), weight, blood pressure and, if you’re diabetic, a foot check. The Practice Nurse or Healthcare Assistant will either book your next appointment which will be with one of our Nurses, or ask you to arrange this appointment with the Reception desk.

What happens next?

Your test results from this appointment will be available when you attend to see the Nurse. The results of this test will be discussed with the Nurse and any appropriate action taken.

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What happens at the care and support planning appointment?

At your care and support planning appointment you will be able to ask questions and talk about what’s important to you. The Nurse will raise any issues she is concerned about. Once you both agree on the main things to work on, you will get the chance to work out a plan and identify any support you need to help you look after your health.

There are a number of services that can help you when it comes to looking after yourself if you have the following Long Term Conditions – Diabetes, Chronic Heart Disease, (CHD), Cardiovascular Disease (CVD) or Chronic Obstructive Pulmonary Disease (COPD).

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Further Information

Coronary heart disease (CHD) is a major cause of death both in the UK and worldwide. CHD is sometimes called Ischaemic heart disease.

Chronic obstructive pulmonary disease (COPD) is the name for a group of lung conditions that cause breathing difficulties.

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Useful Links

Diabetes UK

NHS UK Diabetes Information Site

Our prescribing advisor works with the doctors and practice nurses to advise on efficient treatment regimes for patients taking long term medications and she runs clinics to help patients manage their use of medications effectively.