Cancelling radiology investigation - November 2025

Where you need to cancel a radiology investigation to avoid having to ring and in the absence of an easy solution at present within ICE- please note the following:

As an interim solution, we feel the most reliable option would be for GP practices to email any radiology cancellations toradiology.referrals@northumbria-healthcare.nhs.uk, 

We have establish an internal process to ensure these messages are picked up promptly on our side.

To support efficient processing, it would be helpful if the following information could be included in the email:

1. Type of examination requested
2. Date the examination was requested
3. Brief reason for cancellation

Pathway for diagnosis and FU of soft tissue Lumps including ganglions - August 2025

In most cases US needs to the first diagnostic modality.

If the lesion is concerning on US it will be reviewed by a Radiology Consultant,

1. it is concerning enough for Radiology team to organise an urgent MR (within Radiology) and then team will suggest the same in the MR report and any appropriate onward referral based on the MR findings.
2. If indeterminate but concerning and not requiring an urgent MR, report will be sent back to the GP/Original referrer to organise an MR as per below and then act on the MR report.
3. it is indeterminate but not concerning and so can be referred to a local Plastics team for further investigation/excision.
4. it is indeterminate but clearly dermal and so should go to dermatology.
5. it is indeterminate but too small to resolve on US/MR ( <1-2cm) it is best followed up clinically by the GP and rescanned if there is any subsequent growth/new symptoms or suggest a rescan after a set interval or suggest excision biopsy. Radiology will advise.

 For Lipomas 7 cm is an approximate guide, we will either advise plastic referral, follow up imaging or proceed to advise MR based on onset, duration, progress and location.  

If a lesion remains indeterminate on MR, then suggesting referral to the NUTH Sarcoma remains the most appropriate next step, Radiology team can suggest to the GP whether it needs to be done urgently or on a routine basis. 

Non-medical referrals for radiology - important for practices CQC - August 2025

The process for registering for entitlement and approval for non-medical referrers (NMR) is now digital which ensures it is more robust. All NMR are required to apply using the digital process to ensure compliance is up to date and held on one system.

The CQC may ask practices for your up to date plan and a list of NMR with their scope of practice. 

To make things easier a model Local Plan is enclosed for reference

We have also produced a video which explains these changes in more detail:

Please also refer to this document which explains the entitlement process for non-medical referrers (NMRs) 

Please note that the deadline for non-medical referrers (NMR) to be registered is Wednesday 1 October 2025. 

Simplifying MRI pathways - October 2024

We are aware sometimes for primary care-initiated tests a MRI is suggested, but GP’s then have no ability to request the MRI, frustrating clinicians and often necessitating a referral.

In discussion with the ICB, to reduce the workload on primary care where a MRI is specifically suggested by a secondary care team (normally in a radiology report), GP’s will soon see changes in the radiology requesting screen to enable them to do this directly.

Where a secondary care team is directly giving ongoing care to patients, we will expect them to request their own investigations as currently happens.

Guidelines on best practice for requesting an ultrasound - July 2024

Please follow the enclosed guidelines to avoid any scans being rejected - detailed clinical information really helps the report answer the problem you seek to address. 

MRI and CT - July 2023

All GPs in Northumberland and N Tyneside should have access to CT head and MRI brain where needed- CT and MRI should be requested using the following criteria:

Head MRI for: 

• Investigation of progressive, sub‑acute loss of central neurological function- Urgent 
• Investigation where suggested by Neurology for MS
• Investigation of First Focal Fit

Provided discussed directly with a GP in the case of other health professionals working in primary care

Head CT for:

• Investigation of headaches where a malignancy needs excluding- Urgent
• Investigation of Dementia or Personality Change

Getting the most out of FIT testing and common scenarios if it is negative - September 2023

FiT testing is an effective tool in the assessment of patients with suspected colorectal cancer (CRC)

FiT < 10 (negative result) confidently excludes CRC in patients without IDA; please do not refer to Colorectal 2WW service but consider other pathways below.

If a patient meets the 2WW criteria for referral with iron deficiency anaemia (IDA) then please refer on 2WW Colorectal pathway irrespective of FiT, as FiT may be less sensitive in this context.

If a patient is FiT negative but has other concerning symptoms such as significant weight loss, then please consider 2WW referral to the Non-Site-Specific Symptoms (SNSS) service (Flow chart at end of document)

If advice or review is needed for patients who do NOT meet Colorectal or SNSS referral criteria, then please refer to the Medical Gastroenterology “Advise and Refer” (GI A&R) service rather than the Colorectal 2WW. This is found in the list of Advice and Guidance Providers on eRS.

1.    Role of Fit Testing and positioning in CRC referral pathways:

FIT-Flowchart.pdf (bsg.org.uk)

*Consider SNSS Pathway (see below) 

Please also see the links below (links 1-3) regarding FiT, but note the following  points:

1. The FiT cutoff is different for the Bowel Cancer Screening Program (BCSP) and a recent negative BCSP FiT result is not sufficient to exclude CRC in symptomatic patients.
2. FiT CAN be used in the context of rectal bleeding – please see link 2 below.
3. Patients can be referred under suspected cancer pathways if they are unwilling or unable to perform FiT testing at home. Please indicate if there might be any implications for assessment e.g. unwillingness to undergo rectal examination, severe frailty

 2.    What to do if FiT is negative and SNSS pathway is not triggered?

A FiT result < means that CRC confidently excluded and referral under the Colorectal Suspected Cancer pathway is not indicated. Please consider other cancer pathways (esp pancreatic) if there are other red-flags such as weight loss (SNSS pathway)

Consider other causes and first line investigations to assess, noting that in a significant percentage of patients the diagnosis and treatment does not require a patient undergo colonoscopy.

Possible Cause

Clues and Investigations

Likely Next Steps

Functional bowel problems / Dietary effects

Negative investigations

Diagnostic criteria

Management as per NICE guidance (Link 4)

Consider dietary management (Link 5 or dietetics referral)

FODMAP diet only under supervision of dietician

Drug side effect

Consider common culprits:

NSAID

PPI

Metformin

Antibiotics

SSRI

Most medications have GI side effects

Adjust medications where possible.

Try Metformin MR preparation

Microscopic Colitis

Profuse watery diarrhoea day and night

Often in middle aged females

May have history of medications as per drug side effects, but more extreme symptoms

If suspected:

Stop culprit medications

Trial of loperamide

Refer to GI A&R for consideration of colonoscopy and biopsy

Bile Acid diarrhoea / Post cholecystectomy diarrhoea

Watery diarrhoea which may mimic IBS

Often no association with eating

Onset of symptoms post cholecystectomy.

Please see Link 6

Refer GI A&R if suspected.

Treatment may include bile acid sequestrant (e.g., cholestyramine) often with confirmatory medical physics scan (SeHCAT – Medical Physics scan at Freeman Hospital) for confirmation

Inflammatory Bowel Disease

Suggestive symptoms and investigations:

Weight loss

Inflammatory symptoms

High crp

Extra-intestinal manifestations

The key investigation is a raised Faecal Calprotectin. IBD is incredibly unlikely if this is negative.

If FCP is positive, then refer to GI A&R for likely direct-to-test colonoscopy.

Consider other causes of raised FCP however – NSAID use, GI infection prior to referral.

Coeliac Disease

Positive TTG / EMA

Referral for OGD with D2 biopsies

“Other”

Multiple other unusual conditions which may be considered e.g. pancreatic exocrine insufficiency.

Consider tests such as faecal elastase, but only if reasons to suspect chronic pancreatitis. Not recommended as a screening test in all cases of diarrhoea.

Discuss with GI A&R

1. 1.    Use Of GI A&R

We are very happy to discuss any cases you are unsure about, even if a clinic appointment or scope is not required.

Please see Link 7 for suggestions on pre-referral investigations.

Please include as much clinical detail in your referral as possible, including a copy of the 2WW referral if that was the original pathway used.

Specific information that can be helpful might include:

• Previous investigations
• Medication history
• Patient concerns, and willingness to come “direct to test”
• Any information to help us identify the most suitable clinic – location, suitability for telephone or video consultation, morning of afternoon appts etc.

We hope this brief summary, which is not intended to replicate or replace any existing clinical documents provides a few pointers.

If you have any specific queries about the Colorectal Pathway then please email Iain.McCallum@nhct.nhs.uk

If you have any comments or suggestions for the GI A&R pathway then please contact matthew.warren@nhct.nhs.uk

Links:

1: GI and Colorectal - Northern Cancer Alliance Northern Cancer Alliance

General Advice regarding GI cancer referrals

2: https://www.northerncanceralliance.nhs.uk/wp-content/uploads/2020/10/LGI-2WW-FAQ_V1.pdf

Specific advice and information regarding the role of FiT testing

3: B2005_ii_Using-faecal-immunochemical-testing-lower-gastrointestinal-pathway_Secondary-care-letter.pdf (england.nhs.uk)

Letter describing the role of FiT testing and the reassurance value of a negative test.

4: Endorsed resource - British Dietetic Association (BDA) | Irritable bowel syndrome in adults: diagnosis and management | Guidance | NICE

5: Overview | Irritable bowel syndrome in adults: diagnosis and management | Guidance | NICE

6: Bile acid diarrhoea: pathophysiology, diagnosis and management | Frontline Gastroenterology (bmj.com)

7: Diarrhoea - adult's assessment | Health topics A to Z | CKS | NICE

Dyspepsia - Advice for management of patients who do not fulfil 2WW UGI referral criteria - July 2023

Dyspepsia is a common symptom usually caused by Functional Dyspepsia (FD) rather than any structural UGI pathology. It is often difficult to know how to treat and investigate patients who do not meet 2WW criteria but who do not respond to H Pylori eradication and PPI.

This document is to support management of patients who do not fulfil 2WW UGI criteria (including for suspected pancreatic cancer) and does not change management in these cases.

Key Messages

• In most cases investigations for dyspepsia such as UGI endoscopy will be normal.
• The commonest cause of dyspepsia in non-2WW referrals is Functional Dyspepsia (FD).
• FD may be underpinned by complex lifestyle and psychosocial factors including weight, diet and mental health.
• UGI Endoscopy may be appropriate in those > 55 yrs with resistant dyspepsia, or those > 40 yrs with particular risk factors for UGI malignancy but is otherwise of limited value.
• If H Pylori eradication and PPI / H2RA are ineffective then a trial of low dose amitriptyline should be considered.
• Please see references below for further information

Recommendations for Primary Care

• We are keen and happy to discuss any non-2WW patients with dyspepsia who are proving difficult to treat or are causing concern.
• Please direct any such referrals for dyspepsia, in patients who do not meet 2WW criteria, to GI Advise and Refer (A&R) rather than UGI Surgeons (found as an A&G Provider in eRS)

• British Society of Gastroenterology guidelines recommend that…

“… the diagnosis of FD, its underlying pathophysiology and the natural history of the condition, including common symptom triggers, should be explained to the patient. FD should be introduced as a disorder of gut–brain interaction (DGBI), together with a simple account of the gut–brain axis and how this is impacted by diet, stress, cognitive, behavioural and emotional responses to symptoms and post-infective changes”.

• Please reinforce the benefits of lifestyle change including weight loss, sensible eating and regular exercise - these are vital components in management of FD
• Please be aware that an UGI endoscopy will often not be useful or recommended  except in the groups described in Key Messages above; and that treatment advice only may be suggested.
• Consider high dose PPI (e.g. esomprazole 40mg BD) if standard doses are ineffective and check that the am dose is being taken 30 minutes before first meal of the day
• A trial of amitriptyline for FD may be recommended if first line treatment has not been helpful and it may be reasonable to offer this prior to GI referral.
• Please see links below for further information

 Any Questions?

If you have any queries about this, please contact:

Matthew.warren@nhct.nhs.uk (Gastro and A&R queries)

Iain.McCallum@nhct.nhs.uk (Cancer pathway queries)

References:

1. BSG Guidance on the management of dyspepsia

https://gut.bmj.com/content/71/9/1697

1. NICE Suspected cancer pathways

https://www.nice.org.uk/guidance/ng12

1. Patient UK information for sufferers of FD

https://patient.info/digestive-health/dyspepsia-indigestion/non-ulcer-dyspepsia-functional-dyspepsia

1. How to take omeprazole (links to other PPI also available)

https://www.nhs.uk/medicines/omeprazole/how-and-when-to-take-omeprazole/

Codeine - May 2025

Reminder to avoid codeine in any woman who may be breast feeding- this includes women>36 weeks pregnant who could reasonably go into labour.

Recommendation

The Medicines and Healthcare products Regulatory Agency (MHRA) advises that codeine should not be used during breastfeeding.

The risks of using codeine during breastfeeding cannot be easily managed.

Evidence against its use

Codeine used to be taken by many breastfeeding mothers for pain management. However, this changed due to a case report of an infant death whose mother was taking codeine and was breastfeeding her infant. The mother was reported to be an ultrarapid metaboliser, having additional copies of the CYP2D6 enzyme involved in codeine metabolism. Ultrarapid metabolisers convert codeine to its active metabolite morphine to a greater and much quicker extent than normal. In the case report, there were increased levels of morphine in the breastmilk which led to fatal morphine toxicity in the infant.

Although recent re-examination of this data has questioned codeine-containing breast milk being the cause of this fatality, codeine use during breastfeeding is still not recommended.

At present it is not practical to identify who might be an ultrarapid metaboliser. It is more likely in some ethnic origins, but cannot be predicted by ethnic origin alone. Identification needs to be done by genotyping, which is not readily available.

Effects in infants

Following maternal use of codeine, there have been several reports of serious side-effects. These include bradycardia, respiratory depression, sedation, apnoea, cyanosis. Lethargy, drowsiness and poor feeding have also been reported.

If codeine is taken accidentally

If a few doses of codeine are accidently used during breastfeeding, the mother should be advised to stop taking codeine and the infant monitored for adverse effects.

Since codeine has a short half-life, the mother can consider abstaining from feeding for a short period of time (at least 4 hours) to allow a reduction in her milk levels before feeding again. However, this is not always necessary or practical.

As a result, breastfeeding or potentially breastfeeding women >36 weeks will be discharged from Maternity where analgesia is needed with a short course of Dihydrocodeine, which is metabolised differently and hence not contra indicated in breastfeeding.

Prescribing in pregnancy - July 2024

The RCOG have updated their guidelines on Vitamin D as below:

Current guidance for implementation endorsed by the RCOG and the NHS is that: 

• All pregnant and breastfeeding women take a daily supplement containing 10 micrograms of vitamin D each day between September and March.

 Pregnant and breastfeeding women with dark skin or who cover their skin a lot (for example, those of African, African Caribbean or south Asian origin) may be at particular risk of deficiency and they may consider taking a daily supplement of vitamin D, 10 micrograms all year.

New gynae pathways - December 2023

Some colleagues have reported difficulties in finding the new 3 gynae pathway forms – benign ovarian cyst, pelvic pain and pre-menopausal abnormal uterine bleeding.

They are on S1 and EMIS via Ardens and CDRC forms, please see screenshots below: 

New gynaecology pathways - September 2023

3 New Gynaecology pathways are available following feedback from GP's about the most appropriate place to refer patients with the following conditions:

• Pre-Menopausal Abnormal Uterine Bleeding
• Benign Ovarian Cysts
• Pelvic Pain

Please use the associated template referrals These are available via Ardens or your clinical system in CDRC forms or searching by title in letters template.

Urine sample collection - simplified practice feedback guide - January 2026

Following feedback from practices we have produced a frequently asked questions document guide to support the implementation of the new urine monovettes.

To access this guide, please click here.

Urine sample collection – update - September 2025

Following the initial implementation process of the urine Monovette system, all hospitals, community sites and GP Practices should now have received direct user facing training.

If you have not received any training or an initial stock of Monovette products, please contact -  PathologyProjects@northumbria-healthcare.nhs.uk

Ongoing supplies can be ordered through the routine Pathology supplies ordering process via PathologySuppliesNSECH@northumbria-healthcare.nhs.uk

As previously communicated this collection method will replace the plain (white top) and boric acid (red top) universal tubes, which are currently used for Biochemistry and Microbiology urine samples.

From the 1 January 2026 the Pathology department will no longer be accepting plain (white top) universal tubes for Biochemistry urine requests and boric acid (red top) universal tubes for Microbiology urine culture and sensitivity tests.

Microbiology Culture and Sensitivity (C&S) requests in the Green Boric Acid Tubes

Biochemistry urine requests e.g. ACR in the Yellow Plain Tubes

User guides and instructional videos will continue to be available post implementation: 

Urine Monovette user guide 1 

Urine Monovette user guide 2 

Urine collection: Instruction for hygenic urine collection with the Urine Monovette® - YouTube

Frequently Asked Questions

 Will sending a sample require a different request on ICE?

The request will remain the same but the wording on the ICE label describing the tube type will be changing slightly. This change will not impact the way you order in ICE.

Please can you advise is there a plan for the old urinalysis bottles to be recycled?

If you wish to send old stock back to the Pathology Lab, we will be able to repurpose the bottles. If you do not wish to return stock, are advice is to run down the stock you currently have before moving over to the new tubes.

Will we still be able to order universal sterile white top bottles via pathology so patients can hand samples in and we can dip/transfer sample to correct bottle as needed?

Where possible please have the patient collect their sample into the boric acid sample tube if the sample is intended for culture, rather than into a white top universal, as the transfer of the sample between containers can compromise the sample quality and therefore the culture result.

Many standard urine dipsticks are compatible with urine preserved in boric acid tubes. However, it is essential to check the compatibility of the specific dipstick product with boric acid-preserved urine, as some components in the dipstick, like leukocyte esterase, can be affected by antimicrobials or preservatives. Always refer to the dipstick manufacturer's instructions to confirm compatibility. 

White top universal tubes will continue to be available to order, should there be extenuating circumstances where a urine sample can only be obtained via this sample container.

Where I could find further info on test strips which will be compatible with the new sample bottle?

Please contact the company you currently purchase your test strips from who will be able to advise further. Pathology does not supply test strips to users.

If you have a very small sample off an adult, can we still use the red boric acid paediatric tube for them?

If you have an adult patient who is unable to pass 10mL of urine required for the new boric acid tube, the paediatric 5mL boric acid tubes will still be available to order. However, we ask that these tubes are only used when necessary and not as routine for all patients.

Clostridioides difficile - GP specimens Guidance for GPs - January 2024

The following guidance has been developed by the Infection Prevention & Control Team (IPCT) at Northumbria Healthcare NHS Foundation Trust (NHCT) in order to summarise management of C.difficile cases.

 RESULT MANAGEMENT

•  Responsibility for management of C.difficile cases remains with the service who initiated the specimen
• For specimens sent via NHCT microbiology laboratory, the IPCT will be made aware of positive C.difficile results after Consultant Microbiologist authorisation
• Unless notified directly, NHCT IPC would not be aware of C.difficile cases not tested via NHCT laboratory

C.difficile toxin positive cases

 IPC TEAM SUPPORT

• IPCT will notify GP practice in-hours (111 service at weekends/bank holidays) via telephone when toxin positive result is reported
• Patients will be sent a letter (copy to GP), information leaflet and a small card which they can carry and present to any healthcare provider in the future to notify them of their previous C.difficile status
• Approximately 24 hours after result is reported, unless otherwise notified, the team will provide IPC follow-up to the patient via telephone. This includes advice around cleanliness, hand hygiene and general principles to reduce further transmission. GP can email infectioncontrol22@nhct.nhs.uk if they do not wish IPCT to contact the patient

 Glutamate dehydrogenase (GDH) positive cases

 IPC TEAM SUPPORT

• IPCT will no longer notify GP practices or 111 service via telephone when GDH only positive results are reported
• The IPC team will not contact the patient unless the GP specifically requests IPC follow-up in individual circumstances. GP can email infectioncontrol22@nhct.nhs.uk  if they feel the patient would benefit from IPCT follow-up

 TREATMENT

• NICE guidance is available via https://www.nice.org.uk/guidance/ng199  
• Following review of the above resources, if the clinician requires additional advice from a Consultant Microbiologist at NHCT this can be sought via switchboard 0344 811 8111

RELAPSE/ONGOING SYMPTOMS

•  Where a patient has ongoing symptoms of infection or relapse, the case should be discussed with the Consultant Microbiologist prior to sending a repeat specimen

 INFECTION PREVENTION & CONTROL REVIEW (ICR’S)

•  ICR’s are completed for all C.difficile cases that are identified in both acute and community settings
• The purpose of completing ICR’s is to identify any potential areas of learning from the case
• IPCT will complete the majority of each review but may contact GP practices for additional information.
• Co-operation from all services is vital to ensure a comprehensive review is complete
• ICR’s for community cases with learning identified are shared with Integrated Care Board (ICB) colleagues

DMARD shared care queries - September 2025

If you need to communicate results etc about a patient under shared care with rheumatology please use the generic e-mail address for the nurses: RheumatologyNurse@nhct.nhs.uk

They are then forwarded by admin directly to our nurse reviewing abnormal bloods which happens daily.

If it is something deemed critically urgent/same day eg pancytopenia then call the Rheumatologist of the day via Switchboard.

Referral criteria for suspected Ankylosing Spondylitis – who to refer to Rheumatology and what information is helpful at triage - June 2025

We appreciate you have a lot of experience in caring for patients with back pain in primary care. This quick communication is to help identify who to refer to Rheumatology.

If the following information is in the referral it makes the process really simple. Patients who do not meet the criteria below will usually be advised to be seen by intermediate physio services.

Referral criteria

If a person has low back pain that started before the age of 45 years and has lasted for longer than 3 months, refer the person to a rheumatologist for a spondyloarthritis assessment if 4 or more of the following additional criteria are also present:

• low back pain that started before the age of 35 years (this further increases the likelihood that back pain is due to spondyloarthritis compared with low back pain that started between 35 and 44 years)
• waking during the second half of the night because of symptoms
• buttock pain
• improvement with movement
• improvement within 48 hours of taking non-steroidal anti-inflammatory drugs (NSAIDs)
• a first-degree relative with spondyloarthritis
• current or past arthritis
• current or past enthesitis
• current or past psoriasis.If exactly 3 of the additional criteria are present, perform an HLA‑B27 test. If the test is positive, refer the person to a rheumatologist for a spondyloarthritis assessment

Recommendations | Spondyloarthritis in over 16s: diagnosis and management | Guidance | NICE

If you are uncertain, please contact us via the Rheumatology advice and guidance system,

Many thanks, Dr Liz Coulson (consultant Rheumatologist and service lead for Rheumatology, Northumbria)

Frailty of old age - Death certification - Decemeber 2024

Sarah Robinson, Medical Examiner has put together some top tips for completion of MCCDs, please see attached.

Please note the section below where the sole use of Frailty is not longer appropriate it can however be used where justified by listing the medical conditions contributing to the frailty. 

Avoid ‘old age’ alone

Old age, ‘senility’ or ‘frailty of old age’ should only be given as the sole cause of death where all the following circumstances apply:

• The deceased was over 80 years old
• You have personally cared for the deceased over a long period - this is difficult to define, but we would suggest at least several months
• You have observed a gradual decline in your patient’s general health and functioning
• You are not aware of any identifiable disease or injury that contributed to the death
• You are certain that there is no reason that the death should be reported to the coroner

You may mention old age or frailty as a contributory cause, especially if it explains the severe effect of a condition that is not usually fatal.

You should also be aware that the representative of the deceased may not regard old age as an adequate explanation for the death and may request further investigation.

It is unlikely that patients would be admitted to an acute hospital if they had no apparent disease or injury. It follows that deaths in acute hospitals are unlikely to fulfil the conditions above. You can specify old age as a cause of death, but you should also mention in part 1 or part 2, as appropriate, any medical or surgical conditions that may have contributed to the death.

Please see the enclosed helpful guidance on death certificates - Guidance for medical practitioners completing medical certificates of cause of death in England and Wales - GOV.UK

A guide to possible testosterone deficiency in men - July 2024

Please see attached latest guidelines for possible testosterone deficiency in men.

GP Update: The Brainsafe Service at Northumbria - April 2024

Consultant stroke physician and head of service for stroke medicine, Mark Garside, would like to update you on the Brainsafe service at Northumbria. This update includes an overview of the service, information on how to refer into it, what to tell your patients to expect and who to contact if further advice is needed. Watch the short video below from Mark for more information:

We have made some changes to the GP Hotline information sheet which can be viewed here.

Please note you should only use this route of communication regarding an urgent admission or attendance. These numbers are not to be used for more general advice.

This update summarises current access routes, referral processes and key contacts for the Frailty Assessment Service (FAS), Elderly Assessment Units (EAUs), Frailty Virtual Ward, and local Care of the Elderly (COTE) services.

1. Frailty Assessment Service (FAS) Acute Frailty Team - NSECH

The team comprises Consultant Geriatricians and Specialist Frailty Nurse Practitioners.They provide urgent Comprehensive Geriatric Assessment (CGA) for patients with frailty requiring prompt review, enabling the “right place, first time” approach.

Advice & Guidance for GPs

Geriatrician advice line 0191 6072860

We welcome calls for frailty/COTE advice.

2. Frailty Virtual Ward (FVW)

The Frailty Virtual Ward delivers hospital-equivalent care at home for appropriate patients who have been assessed at NSECH or our Elderly Assessment Units.

Access Routes:

• Via FAS (0191 607 2822)
• Via EAU (Wansbeck: 01670 564087)

Admission Types:

Step Up:Patients in the community who require assessment/intervention but can be safely managed at home.

Step Down:Patients in hospital who can be discharged earlier with virtual ward support.

Escalation:

If higher-level intervention is needed, direct admission to:

• EAU, or
• COTE inpatient wards

This supports timely care, prevents unnecessary ED attendance, and improves patient outcomes.

3. Wansbeck Hospital Elderly Assessment Unit (EAU)

Covers: South, Central & North Northumberland, and North TynesideFunction: Same Day Emergency Care (SDEC) for older patients

Access / Referral:

• EAU Direct Line: 01670 564087
• Or via FAS: 0191 607 2822

Telephone triage determines urgency and the most appropriate assessment pathway.

Service:

• Rapid CGA delivered by MDT
• Same-day or up to 72-hour review
• Typical stay ~3.5 hours
• Open Mon–Fri, 08:00–16:30

Clinical Leads:

• Lead Consultant: Dr James Morton
• Lead ACP / Unit Manager: Kris Mole

Non-urgent referrals:CoteReferrals@northumbria-healthcare.nhs.uk

4. Hexham EAU – West Northumberland

Postcodes covered: CA8, CA9, NE18–NE20, NE40–NE49

Referral / Access:

Elderly Assessment Clinic:

• 01434 655406
• 01434 655407

Opening times: Mon–Fri 08:00–16:00Accepts GP, HCP, and paramedic referrals.

Presentations accepted:General COTE problems, frailty, falls, abnormal bloods, AF, heart failure, blood transfusion, ascites management.

Admission:Direct admission to Hexham if clinically appropriate. Same-day/next-day service.

Specialty Contacts:

• Dr Liesl Allcock – Parkinson’s clinic: 01434 655343
• Dr Paul Edmonds – Falls/COTE clinic: 01434 655648
• GP Advice:

•  
  • Dr Paul Edmonds: 07789 512805
  • Dr Liesl Allcock: 07816 753015

• EAC: 01434 655408

5. North Tyneside – Jubilee Day Hospital (NTGH)

Provides broad outpatient COTE services including:

• General COTE
• Specialist falls & syncope
• Complex case management for frail patients
• MDT CGA clinics

Daily MDT triage ensures referrals are placed in the most appropriate clinic based on need and urgency.

Referral Routes:

• GP electronic referral via NHS e-Referral Service:Select “Geriatric Medicine Assessment North Tyneside – Northumbria Healthcare”
• Internal referrals:CoteReferrals@northumbria-healthcare.nhs.uk

Key Contacts – Quick Reference

FAS Advice (Consultant): 0191 607 2860Urgent FAS Referrals (Nurse Practitioners): 0191 607 2822

Wansbeck EAU: 01670 564087 (Mon–Fri 08:00–16:30)Hexham EAU: 01434 655406 / 655407 (Mon–Fri 08:00–16:00)

Frailty Virtual Ward:

• Mon–Fri 08:00–20:00: 0191 607 2828
• Weekends & Bank Holidays: 0191 293 2580

Non-urgent COTE referrals:

As part of the sexual health services we provide in North Tyneside and Northumberland, home testing kits for STIs are available for over 18s.

These kits are free and can be requested online from www.northumbria.nhs.uk/sti-home-testing. They cover chlamydia and gonorrhoea, HIV, syphilis, hepatitis B and hepatitis C.

The kits come in plain packaging to the patient’s home and they then post it back. Results are texted to them within 10 days and treatment/contact tracing is also arranged via this service.

There is a dedicated number for queries relating to the home testing kits - 0344 728 0316. All calls are charged at local rate.

EAU is an urgent direct access pathway for all primary care services. The unit runs Monday-Friday from 8am-4pm and offers access to patients from across both Northumberland and North Tyneside.

The unit offers a dedicated frailty line for primary care services requiring specialist advice, and triage of patients who require urgent review.

Frailty syndromes are amongst our core acceptance criteria:

• Falls – without significant trauma or head injury
• Reduced mobility
• Delirium
• Infection (Excluding deteriorating COPD)
• Abnormal bloods

Please contact EAU direct on: 01670 564087 or via the GP hotline on 0191 203 1414 and ask to be put through 

Please see attached flyer for further details.

The following message has been circulated to our clinical teams.

This means that there should be no need to send or email referral letters to ED or SDEC if the issues are clearly outlined in the GP clinical consultation records in a timely manner - if the patient has declined information sharing via the HIE please do write a letter where appropriate.

When patients have been referred to our services by primary care teams, there is usually a specific concern that is being raised. Whilst most patients will be aware of this and be able to describe the issue, some patients may not. The receiving clinical team will always be able to view this information in the Great North Care Record Health Information Exchange (HIE) that you can access from OneView. The best place to look for the most recent consultations is under GP Records in the Encounter section. 

We wanted to remind you that our new Northumbria GP portal is now live.

Here, you will be able to find useful links, see the latest updates and view past bulletins.

Take a look around our new portal. 

If you have any questions or any suggestions on what should appear on this portal please email emily.lavin@northumbria-healthcare.nhs.uk

The Vasectomy Service at the Northumbria Sexual Health Service operates an open referral system. Gentlemen can refer themselves by ringing 01670 515151 or 0191 297 0441.

The Vasectomy Service at the Northumbria Sexual Health Service operates an open referral system. Gentlemen can refer themselves by ringing 01670 515151 or 0191 297 0441. They do not require a medical referral but should they request a GP referral please pass on our telephone number. There is no requirement to provide detailed information to the patient or to gain consent for the procedure.

On contacting our service, an initial counselling appointment will be offered and consent secured prior to the operation date. Any necessary follow up care and post-operative fertility testing will be included in the service delivery. Operations are now conducted in the purpose-build minor surgery unit in Morpeth NHS Centre.