- GPs Do Not Treat…
- Sexual health
- Cervical screenings
- Blood tests - who does what?
- External Services
- In-house Phlebotomy
- House-bound patients
- Long Term Condition Reviews
- Minor Eye Conditions Service (MECS)
- Fit notes (MED3 or statement of fitness for work)
- 1️⃣ First time fit note
- ♾️ Fit note extension
- Medical reports
- Repeat prescriptions
- Home visits
- Baby & birth mother postnatal checks
- Musculoskeletal (MSK) issues
GPs Do Not Treat…
GPs do not treat the following:
- Eyes: Suggest patient try Optician or MECs (see below for exceptions and places to which you can signpost patients).
- Dental: Suggest patient find a Dentist (this includes anything to do with mouth, teeth, tongue). If it is an emergency, signpost the patient → either call 999 or go to A&E.
Sexual health
- Some forms of contraception can be prescribed by our surgery's Nurses and Pharmacists.
- For sexually transmitted illnesses (STIs) and Long-acting Reversible Contraceptives (LARC) such as IUS, IUD and contraceptive implants, ask patients to attend a local sexual health clinic.
- For emergency contraception, patients should be referred to a local sexual health clinic or pharmacy.
- if available, they should be offered a same-day emergency appointment with a contraceptive-trained Nurse or Pharmacist
- it must be confirmed that it has been less than 120 hours (5 days) from the time of unprotected sexual intercourse (UPSI)
If the patient insists on speaking to someone at the practice:
Cervical screenings
AKA a smear test or cervical smear. All women and people with a cervix in certain age groups will be recalled to have a smear test.
- Aged 25 to 49 → every three years
- Aged 50 to 64 → every five years
If someone calls to book a smear test, always check their record to see if they’re due before booking an appointment → it should say in the Patient Warnings when you first open their record, and/or in the QOF box.
- Book single appointment with practice nurse / ANP
- Most surgeries can also book smears at their local PCN hub - see GP Enhanced Access (GPEA) for more information.
If your site nurse if male, please tell the patient this when booking the appointment in case they would prefer to be seen by a female nurse.
- Patient aged 24 can be booked in 6 months before their 25th birthday
- Patient aged 64+ that has never had a cervical screen should still be offered an appointment if they request one
- For trans men and non-binary people assigned female at birth:
- If they’re registered with us as female → they will be automatically recalled unless they opt out
- If they’re registered with us as male → they will not be automatically recalled, but can be booked for a smear if they ask for one
Blood tests - who does what?
External Services
For non-priority (healthy, young, mobile) patients requiring routine blood tests, we usually signpost them to external services, unless the surgery site has an in-house phlebotomist.
- Print the TQuest form for patient to take to external service, detailing the blood tests requested.
- Lewisham: Patients should phone the number at the bottom of the blood test request form to arrange a site & appointment.
- Southwark and Lambeth: From September 2023, patients are required to book test appointments online: Online Appointment Healthcare Platform | Swiftqueue
They will get a choice of locations on the Swiftqueue page.
In-house Phlebotomy
Three of our surgeries have a dedicated phlebotomist:
- Penrose Surgery and Maddock Way:
- book appointments before before 12:00 pm so sample can be collected same day
- Lewisham Medical Centre: (only on Wednesdays, Thursdays and Fridays)
- book appointment before 2:00 pm so sample can be collected same day
- Nightingale Surgery: (only on Mondays and Tuesdays)
- book appointment before 2:00 pm so sample can be collected same day
The HCA at all sites will perform blood tests for priority patients (e.g. patients who are elderly and/or cannot otherwise travel to external services, or patients that have a Long Term Condition)
- book before 12:30 pm
- Non-priority patients can be booked with the HCA if there is room in the diary, but this is a judgement call, not a rule
House-bound patients
Reception generate a District Nurse (DN) request, attaching the TQuest form. The DN will arrange the appointment with the patient.
How to arrange an appointment with the District Nurse:
- Fill out District Nurse referral form on EMIS
- Email referral form to the appropriate borough contact (see box for details)
- Attach blood TQuest form as a PDF to the email
For LMC, Kingfisher and Deptford:
Phone: 020 8314 7777, Option 2
For Penrose Surgery, Maddock Way and Knight’s Hill:
Phone: 020 3049 4020, Monday to Friday, 9am to 5pm
Phone: 020 7188 3299, out of hours
For Surrey Docks, check where patient lives as sometimes they are closer to GSTT.
Long Term Condition Reviews
Many patients require regular blood and urine tests to monitor Long Term Conditions (LTCs) such as Diabetes and Hypertension.
When booking an appointment for an LTC:
- Check the relevant LTC page in our handbook for the tests required.
- Book LTC review appointment with the appropriate clinician (see relevant Hippo or LTC page for this info).
Blood tests
- Blood tests for LTCs will be performed by the attending clinician (Nurse or HCA) on the day of the LTC appointment.
Urine samples
- The patient must produce a fresh urine sample on the day of their LTC review with the clinician.
- They can collect a white top pot and produce the urine sample when they arrive at the surgery for their appointment if they are comfortable using the surgery loo for doing so.
- Some patients are not comfortable producing a sample in the surgery, so they can bring one from home as long as it is done on the same day as the appointment and in the appropriate specimen pot.
- If the patient doesn’t already have a urine sample pot to bring in, they can collect one from the surgery any time prior to their appointment.
Minor Eye Conditions Service (MECS)
Minor eye conditions are not treated by GPs, but instead are dealt with by the Minor Eye Conditions Service (MECS) at local opticians across South-east London.
If a patient requires a local MEC service provider, use Accurx to send a link to website listing them for each borough.
- Patients with significant pain, a sudden loss of vision in one or both eyes or a penetrating injury should go directly to the eye casualty at St Thomas’ Hospital or nearest A&E.
- MECs cannot prescribe for children under 2 years old → book with Paramedic.
For patients with learning disabilities/ASD, see Easy Eyecare Pathway
Fit notes (MED3 or statement of fitness for work)
If a patient calls Reception to request a fit note, first check how long they've been sick:
- 7 days or less → we can't issue a fit note unless they've been ill for more than 7 days. You can send them a link to the self-certification of sickness form here via Accrux
- More than 7 days → we may be able to issue a fit note. This is done by Reception Leads, but the patient may require an appointment for assessment, which receptionists can organise.
1️⃣ First time fit note
Clear documentation of illness/injury is required for a fit note. This should be in the patient's notes, but it may have come from a hospital (e.g. x-ray results for broken bone) or some other external service (e.g. mental health report from private therapist).
When you get a request for a fit note → check the patient's notes to see if there is any documentation of their complaint.
✅ If the patient has been assessed for their complaint recently (either by one of our clinicians or by an external service) → book onto Reception leads’ book on EMIS.
❌ If patient has not been assessed → follow POST instructions for booking patient with the appropriate clinician.
♾️ Fit note extension
The usual maximum sick note time is 3 months (exceptions can occur in a cancer diagnosis). Therefore, if a patient requires an extension to their fit note, they may need to be re-assessed by a clinician. Follow the same procedure as listed above for "First time fit note".
Medical reports
Repeat prescriptions
Repeat prescription requests can be made in any of the following ways:
- Via email to the surgery
- Via the form on the practice website
- Through Patient Access or the NHS App
- By requesting at their local pharmacy
Home visits
- Take details of the caller, the patient, and the nature of the medical problem
- Double check that we have the correct contact number and address on the system
- Advise that the request will be passed onto the duty doctor to make a decision
- Enter the request on the duty book on EMIS, and add a comment under the entry ‘Home visit request’
- Tell the Paramedic (if on site) or the duty doctor, either verbally or by screen message
Baby & birth mother postnatal checks
Baby & Birth Mother Checks should equate to three appointment slots with GP.
- Birth Mother postnatal check → single appointment with the GP. Book this at the earliest time of the three slots so that she gets a text for the first appointment.
- Baby Check → double appointment with the GP, after mother appointment.
Musculoskeletal (MSK) issues
For example: joint pain, sciatica, arthritis.
If a patient calls Reception with a MSK complaint, there are two routes of referral:
- If this is a new concern (i.e. the first time the patient has contacted us about the issue) → book the patient with Physio First
- If this is an ongoing concern (i.e. the patient has already been seen by Physio first or another clinician) → book with GP or Paramedic