Harlow & Epping Central Referral Service
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1 Harlow & Epping Central Referral Service CRS, St Margaret s Hospital, Spencer Close, Building 1, Epping CM16 6TN Appointments and general enquiries Tel: (Option 2) Safe-haven Fax: CRS Manager: Anna Beeston Tel: CRS Assistant Manager: Amelia Palas-Smith Tel: Speciality GP with Special Interest (GPwSI) Referral Criteria Ophthalmology Clinic Co-ordinators: Kelly Curtis Dr Kamal Bishai Clinic days: Wednesday (a.m.) Thursday (p.m.) & Friday (a.m.) Clinic days: 2 nd & 4 th Tuesday of every month (a.m.) Location: Rose Opticians, Harlow Conditions Treated General ophthalmology conditions including: external eye disease such as: blepharitis, dry eyes, chronic conjunctivitis not responding to treatment, episcleiritis Eyelid disorders Watery eyes floaters, posterior vitreous detachment Early cataracts not requiring surgery but requiring assessment Preliminary glaucoma suspect and ocular hypertension assessment Assessment of age related dry macular degeneration Incidental pathology noted on routine sight tests Any eye condition which GP or Optometrist are not happy with, and feel that a delay in assessment at outpatients will be
2 detrimental to the condition or to the patient. Procedures Performed Chalazion incision and curettage Excision of minor lid lesions Syringing and probing of lacrimal passages Orthopaedic GPSI service Clinic Co-ordinators: Aditi Bhardwaj Dr Nabeil Shukur Clinic day: Tuesday (p.m.) Clinic Day: Wednesday (a.m.) Location: Princess Alexandra Hospital, Harlow Dr Abul Hasan Clinic days: Tuesday & Thursday (p.m.) Exclusions Eye trauma and acute sight threatening conditions 2 Week Wait Referrals Red Flag Conditions Referral Criteria Peripheral clinics Foot/ankle Arthritic pain that may respond to injection Chronic/recurrent ankle sprain (Plantar fasciitis to heel pain clinic) Knee Suspected meniscii/ligament injuries NOT confirmed on MRI Mechanical symptoms (giving way /locking) Patello-femoral pain General painful/restricted range Hip Painful/restricted hips Bursitis Suspected labral tears 2
3 Shoulder complex Sternoclavicular joint/acromioclavicular/ glenohumeral pain/restriction Capsular pattern Suspected cuff injuries Elbow Wrist Hand Painful/restricted elbows Suspected tendonopathy Suspected ulnar neuropathy Painful/restricted CTS for injection and EMG studies DeQuervains Painful/restricted joints Trigger finger Spinal clinics (Dr Nabeil Shukur, Gulten Dogan & Ed Kirby) Chronic neck and Low Back pain without progressive neurological symptoms Chronic non-specific low back pain Mechanical Neck, Thoracic and Low Back Pain Lumbosacral instability Degenerative disc disease Facet joint hypertrophy Mild to moderate disc prolapse where there is no clinical indication for surgery or the patient is refusing surgery Grade 1 Spondylolistheses which is stable Mechanical thoracic or low back pain due to Scoliosis - cobb angle less than 40 degrees Whiplash Exclusions 3
4 Severe Osteoarthritis, Any patient who is known to need a joint replacements/ major surgery, Children under the age of 16yrs, condition considered to be a red flag These should be sent to secondary care Orthopaedic SEPT Service Sarah Burnside (A.Adams, G.Dogan, E.Kirby) Sue Farrow (D.Newell) Amanda Adams ~ ESP (Extended Scope Physiotherapist) Peripheral Specialist Clinic day: Wednesday (p.m.) & Thursday (pm) Gulten Dogan~ ESP Spinal and Knee Specialist Clinic day: Tuesday (a.m.) Location: Herts & Essex Hospital, Bishop s Stortford Daryl Newell ~ ESP Peripheral Specialist Clinic day: Monday (a.m.) & Wednesday (pm) Ed Kirby ~ ESP Spinal & Knee Specialist Clinic day: Tuesday & Friday (a.m.) Location: Herts & Essex Hospital, Bishop s Stortford Referral Criteria Peripheral clinics Foot/ankle Arthritic pain that may respond to injection Chronic/recurrent ankle sprain (Plantar fasciitis to heel pain clinic) Knee Suspected meniscii/ligament injuries NOT confirmed on MRI Mechanical symptoms (giving way /locking) Patello-femoral pain General painful/restricted range Hip Painful/restricted hips Bursitis Suspected labral tears Shoulder complex Sternoclavicular joint/acromioclavicular/ glenohumeral pain/restriction Capsular pattern Suspected cuff injuries 4 Elbow Painful/restricted elbows Suspected tendonopathy Suspected ulnar neuropathy
5 Wrist Hand Painful/restricted CTS for injection and EMG studies DeQuervains Painful/restricted joints Trigger finger Spinal clinics (Dr Nabeil Shukur, Gulten Dogan & Ed Kirby) Chronic neck and Low Back pain without progressive neurological symptoms Chronic non-specific low back pain Mechanical Neck, Thoracic and Low Back Pain Lumbosacral instability Degenerative disc disease Facet joint hyperthrophy Mild to moderate disc prolapse where there is no clinical indication for surgery or the patient is refusing surgery Grade 1 Spondylolistheses which is stable Mechanical thoracic or low back pain due to Scoliosis - cobb angle less than 40 degrees Whiplash Exclusions Severe Osteoarthritis, Any patient who is known to need a joint replacements/ major surgery, Children under the age of 16yrs, condition considered to be a red flag These should be sent to secondary care 5
6 Dermatology Clinic Co-ordinator/Medical Secretary: Sandra Pite Choose and Book pathway: Specialty: Dermatology Clinic Type: XXXX Service Name: CRS - Dermatology Harlow - WECCG 07H Stellar Healthcare CRS Dermatology Epping WECCG 07H Stellar Healthcare 6 Dr Phillip Pavlou Clinic days: Monday (a.m.) & Tuesday (a.m. & p.m.) Location: Keats House, Harlow Dr Martyn Rogers Clinic day: 2 nd & 4 th Tuesday of every month (am & pm) Location: Keats House, Harlow Diagnostic assessment of skin lumps/ bumps /cysts / naevi / basal cell papilloma (these lesions will not necessarily be excised but if there is any diagnostic uncertainty please refer) Pruritis Exclusions: Urticaria Eczema / Dermatitis (in the case of contact dermatitis, if patch testing is required, secondary care referral will need to be made). Light eruptions Bacterial infections/ fungal infections Molluscum Contagiosum (if diagnostic doubt) Psoriasis Skin tumours (Not SCC s or melanomas these should be referred under the two week rule) Undiagnosed bullious eruptions (if suspecting autoimmune blistering disease eg Pemphigoid refer directly to hospital) Lichen planus Acne (mild/moderate) Rosacea Disorders of hair Disorders of nails Pigment disorders Undiagnosed rashes Hyperhidrosis Assessment of difficult, symptomatic warts / verrucae, where treatment in primary care has failed to resolve the problem and the threshold for referral, according to the current benign skin lesion service restriction policy, is met. - Patients not registered with a West Essex GP - Patients with suspected squamous cell carcinoma or melanoma - Patients referred by their GP with a clinical diagnosis of BCC likely to
7 require biopsy/excision - Autoimmune bullous disorders - Mycobacterial infections - Sarcoid, connective tissue disorders - Extensive skin conditions in systemically ill patients - Rare inherited disorders i.e. Dariers, Neurofibromatosis - Severe psoriasis - Severe acne - Disorders that may require Hospital admission eg erythoderma - Disorders requiring Hospital only prescriptions eg.retinoids, leg ulcers, patch testing, - Genital ulcers / STDs, - Urgent referrals requiring an appointment within 24 hours Direct Access Scopes/Gastroenterol ogy Triage Coordinator/Medical Secretary: Charlotte Winnock Tel: Minor Surgery Inter Practice (LES) Clinic Co-ordinator: Louise Laskowski Choose and Book pathway: Specialty: Surgery Not otherwise Specified 7 TRIAGE service only: All referrals triaged by the Consultant; Scopes are carried out at the Rivers hospital in Sawbridgeworth. Referrals triaged by: Dr Kim Gerlis Dr Ken Menon Practices signed up to provide this service: Limes Medical Centre Ongar Surgery Please refer using the Upper or Lower GI Endoscopy referral proformas All referral criteria are listed on these. Referral Criteria Nail ablation / removal Ring pessary fitting Aspiration of joint bursa Tear duct syringing Injection of a therapeutic substance into a joint / soft tissue Aspiration of hydrocele Ganglions which interfere with joint function Incision & curettage of a Meibomian cyst Removal of hormone implant
8 Clinic Type: Lumps and Bumps Service Name: Minor Surgery WECCG 07H Stellar Healthcare Nasal cautery for epistaxis Vasectomy Diagnostic incisional / punch skin biopsy of benign condition* ( excluding face and neck) Complete excision of benign lump/ cyst/ skin lesion* (excluding face and neck) *Please note the Minor Surgery inter-practice LES pathway is intended for routine referral of BENIGN SKIN LESIONS where there is clinical justification to support excision as outlined in the CCG Service Restriction Policies at Lesions included in this service restriction policy and where there may be clinical justification to excise the lesion include Sebaceous cysts (epidermal or pilar), Benign pigmented moles, Fibro epithelial polyps, Seborroeic keratoses (basal cell papillomata), Warts, Lipoma, Giant Comedones and Neurofibromata. 8
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