Dietetic Led Coeliac Service

During the Covid pandemic, interim guidance was released by the BSG which allowed people to be diagnosed with coeliac disease without a biopsy if they had positive tTG antibodies and met certain criteria. However this guidance is no longer applicable. ]

Therefore, all patients with positive tTG antibodies, should be referred to Gastroenterology, through the eReferrals system for an endoscopy to be arranged. If biopsies are positive, Gastroenterology will directly refer the patient to the Dietetic Led Coeliac Service.

TIA Services

Ashford and St Peters are able to reinstate daily clinics to review suspected TIA patients from 2nd October 2023.

It is no longer necessary for clinicians to contact the on-call stroke nurse for every referral. The option of contacting the team remains available should referrers wish to discuss specific or complex cases, via switchboard (01932 872000 and bleep 5828 (8am-8pm)).

Please ensure patients are advised not to drive until reviewed in clinic, and start aspirin 300mg daily until their appointment; providing they are not already taking an antiplatelet or anti-coagulant agent (use 300mg clopidogrel stat dose, followed by 75mg daily if a history aspirin intolerance).

To support this an updated referral form is in the process of being uploaded to EMIS.

Text Validation

As discussed at the Alliance Professional Lead Group we are triallng a text validation service to support our patients whilst they are waiting for an appointment. A small number of patients in dermatology will be texted with an on-line survey to check that they still need their appointment with us in case they have been treated elsewhere, e.g. privately. This will allow us to make sure that our waiting lists are up to date to ensure we make best use of our appointments. The patients will also have the opportunity to let us know if they think they have deteriorated and then this will be reviewed by a clinician and their appointment brought forward if required.

You don’t need to do anything but we will let you know if, for any reason, we have removed the patient from our waiting list, otherwise the patient will remain on our waiting list and be seen in line with our access policy based on urgency and chronological order.

Please see further attached patient communications.


New Headache Pathway

Over the past year, Surrey Heartlands has been developing a standardised approach to managing headaches, borne from our desire to improve pathways and create consistencies for clinicians and patients.  This standardised approach will see guidance that captures patient presentations at primary care with a clear route to advice and referrals.  Many clinicians have been involved in this work and we are excited to share that we are launching this on 24th April 2023.  We are encouraged by our neighbouring ICS, southwest London, which successfully launched their headache pathway during the pandemic, and we are hopeful of achieving the same success. It hopes to pave the way for straight to test via secondary care where needed, more support for first line treatments in primary care and hopes to expand patients’ access to newer and advanced treatments.

We have introduced a 4-month transitional period and for this to work successfully all practices need to follow the new pathway.  Clinicians will have the opportunity to familiarise themselves with the guidance, advice and referral forms during the transition and any issues encountered can be addressed during this period too.  Local GP practices outside of Surrey Heartlands will be made aware of our new pathway as this will be applicable to them when dealing with Surrey Heartland registered patients.  From 4th September 2023, at the end of the transition period, any old referral forms will no longer be accepted.

The pathway will be available on your Teamnet Topic, or equivalent online site and the referral form available on EMIS and SystemOne by 11th April 2023 prior to launch so look out for this.  Please cascade this to your teams, as necessary.  Feedback and questions can be directed to Ruchika Gupta, GP and Clinical Director for Long Term Planning Delivery SH ICS at or Jan Coebergh, Consultant Neurologist and Neuroscience Lead in SH at We are happy to arrange educational sessions for local GP’s as well.


Briefing: Update on LIVI and primary care access in North West Surrey

Sent on behalf of NICS – GP Federation

30 November 2022

Patients in North West Surrey will be able to access free LIVI video GP consultation services until 31 March 2023.

This follows information shared recently about a decision made by GP practices in North West Surrey to discontinue LIVI over time due to the rising costs of this service meaning it offers less value for money for patients.

As background to this decision, practices in North West Surrey have been reviewing how patients access services and are introducing some changes in response to patient feedback.

The key changes are:

  • Providing more face-to-face appointments in the evenings and at weekends through acute illness hubs, based at Ashford Hospital, St Peter’s Hospital and Woking Community Hospital. These appointments are available now and can be booked via the patient’s GP practice (there is no walk-in facility for this service).
  • Introducing a new service called Rapid Health that allows patients to directly book and manage their own appointments for a range of different practice services. In early 2023 Rapid Health will enable patients to initiate their own care for services such as first contact physiotherapy, immunisations and cervical smears.

Extending the availability of LIVI until March 2023 means patients can benefit from this service while the wider changes to accessing primary care services are embedded.


GPs and Consultants Networking evening

Save the Date:

Tuesday 13th December 2022 6.30pm for welcome drinks, speakers from 7pm onwards

Location: DoubleTree Hilton, Victoria Way, Woking, GU21 8EW

Further information including finalised agenda to follow but please put the date and time in your diaries and share with any colleagues who would be interested in attending.

For any further information please call us on 01932 722420 or email on


Radiology waiting times

Please note that waiting times for radiology are currently at around 6 weeks.


Duplicate Audiology Referrals

We are having increasing issues with GP’s re-referring Audiology patients to us via eRS when the patient has already had their triage appointment.

If a patient returns to your practice saying that they have not had an appointment, please check with them whether they have had a telephone consultation. If they have, they are on a waiting list for a test. This wait is currently around six months, although we do triage for red flags at the call, for example patients who really need to see an ENT surgeon and not an audiologist, or dual sensory loss.

If the patient has not had their triage appointment, then please chase the referral with us before sending a repeat request, so that we can check whether it has been received.

Please do not make a repeat referral, as this will only result in a wasted second triage appointment, and a longer wait for other patients.

Please remember that existing patients can contact the audiology team directly on or 01784 884156. No repeat referral is required.

This message has also been emailed to all NW Surrey area practice managers on Friday 12/8/22.


Update re the Non-Specific but Serious Symptoms Clinic (NSSSC)

We are pleased to announce that the NSSSC has re-opened and referrals can be made using the updated referral form. Please search 2WW – Adult Non-Specific But Serious Symptoms in the document template finder on EMIS. Please note the patient information leaflet (PIL) has also been updated.

Due to current capacity issues the clinic is unable to operate under the previous model and certain changes have been made to the referral process. Please ensure that you complete ALL sections of the referral form and provide ALL supporting information. Any referrals received without the appropriate information will be returned to the referring clinician.

Please make special note of the following:

  • Complete the QCancer score using the EMIS template.
  • Send the full details of the QCancer score breakdown (this can either be drawn in to the referral form as a consultation or be sent as a separate document).
  • Your patient will be contacted within TWO working days of receipt of the referral and they should be offered an appointment within the next week (including CT scan where appropriate). Please provide them with the new updated PIL.
  • Please ensure that the patient has had ALL the requested investigations prior to referral since this will aid triage and appropriate further tests:
    • FBC, U+E, LFT, Bone profile, HbA1c, TFT, CRP, coeliac antibodies, serum amylase, GGT, INR, CA125 (female), PSA (male), HIV, haematinics, serum protein electrophoresis
    • FIT where appropriate
  • Referral criteria include a QCancer score of 3% or greater with one or more of the following:
    • Unexplained and unintentional weight loss (either documented > 5% or with strong clinical suspicion), not previously investigated.
    • Significant generalised fatigue / malaise together with one or more other criteria on this list
    • New onset or unexplained worsening breathlessness, where heart failure and non-malignant lung disease have been excluded, together with other criteria on this list (note that previously diagnosed cardiac or lung disease does not preclude referral)
    • Suspicious but non-specific and non-resolving constitutional/abdominal symptoms, for 4 weeks or more (less if very significant concern), for example persistent nausea, loss of appetite, pain, steatorrhoea (in absence of chronic pancreatitis), abdominal distension, constipation. Please state symptoms and length of symptoms.
    • Persistently abnormal laboratory tests which are not readily explicable including:
      • thrombocytosis (> 400 x 109/l) (persistent for >6 weeks; infection and inflammatory disease thought clinically unlikely)
      • alkaline phosphatase more than twice the upper limit of normal
      • significantly raised CRP (or ESR corrected for age) and infection/inflammation thought clinically unlikely
      • hypercalcaemia
    • Unexplained new or progressive pain (including bone pain for four weeks or more)
    • Persistent dyspepsia ongoing for 8 weeks despite normal UGI endoscopy
    • Painless jaundice without apparent cause
    • Significant GP concern/ GP “gut feeling” regarding a possible cancer diagnosis where there is no clear urgent referral pathway (for example unexplained thromboembolism, paraneoplastic syndrome, new onset diabetes without weight gain; please confirm details in free text box below)
    • Referral is due to clinical concerns that do not meet the above criteria (GP must give full details in the ‘additional clinical information’ box at the time of the referral)
  • Please note only referrals with a QCancer score of 3% or greater will be accepted. Should you have concerns about a possible malignancy with a value less than 3% then use the closest TWR referral route detailing why you are referring and what your suspected diagnosis is.
  • Please consider the Rapid Access Older Person Clinic or the local hubs for frail elderly patients if appropriate.

Please contact Ishbel Davis, NSSSC Coordinator, with any questions.

Telephone:      01932 723105


Please ensure the previous version of the NSSSC referral form is deactivated & archived within your practice EMIS.

Please contact NWS RSS ( if you require any support regarding referral forms


Update on Ultrasound Services

Due to the current increased demand for ultrasound we have commissioned some additional activity through Diagnostic World. This will reduce the waiting time for patients who have been referred for a  routine ultrasound by yourselves. We would be grateful if you could highlight to your patients when you refer for an ultrasound that they may be contacted by Diagnostic World and have their diagnostic test at a community site.

Please note the activity that Diagnostic World are delivering is over and above the activity that you have commissioned with the provider and you should continue to utilise their community capacity as normal.


Ashford and St Peter’s Specialist Menopause Clinic

 Most women with menopausal symptoms can be managed in primary care.  Patients can be referred to Miss Sadiya Hussain- a gynaecologist and menopause specialist for management in Ashford and St Peter’s Hospitals.

They will need to meet the following criteria:

  1. Primary care management has been proficient but failed to provide sufficient relief in symptoms. Management to-date needs to be adequately documented in the referral letter OR
  2. Management is too complex to be undertaken in primary care. Reasons for this need to be carefully documented in the referral letter


  1. Where there is Premature Ovarian Failure (<40y) and the patient would like to conceive.

In this case use:


Menopausal –          Age 45 or over

–          Symptoms significantly affecting quality of life

Multiple treatment failure –          3 or more regimens tried

–          List types of HRT attempted and detail problems experienced

Venous Thromboembolism –          Personal history/FMH in a 1st degree relative

–          History of event

Osteoporosis –          Confirmed or high risk eg POI, steroid use

–          Positive FMH in a 1st degree relative

–          Low body mass index

–          History of traumatic fracture

Previous or high risk of hormone dependent malignancy –          Eg. Breast/ovarian/endometrial cancer
Other –          Eg. Patient or GP directed

–          Multiple comorbidities


POI / Hypothalamic Amenorrhoea

Premature Ovarian Insufficiency (POI)
  • Under age 40 years
  • POI over 40-45 and symptomatic
  • POI over 40 with below normal bone density

Note: Included results for LH/FSH, TFT, and BMD. Shared care agreement with GP required

Hypothalamic Amenorrhoea
  •  Under the age of 40 with prolonged primary or secondary amenorrhea
  •  Secondary amenorrhea due to LH/FSH gonadotrophic suppression


Tinnitus Referrals – New pathway for referrals

For patients under our audiology service who wished to see the Tinnitus and Hyperacusis team at the Royal Surrey, previously we were required to ask GPs to refer to on our behalf. To reduce your workload and streamline the patient pathway we are now able to do this directly. We will advise you when this has been done in our clinic letters.


Action Being Taken on Long Waiting Surgical Patients

Currently the Trust has long waiting lists for surgery, as a result of the initial COVID-19 response and therefore in line with national protocols and agreements we have made arrangements for your patient to have their procedure at one of the local private hospitals. Together with Surrey Heartlands CCG we have made arrangements to transfer surgical care for around 800 patients to the Woking Nuffield, Circle Runnymede, Spire Ashtead or EpsoMedical (Cobham Day Surgery). This will enable patients to have their surgery much faster than if they waited for surgery at Ashford Hospital or St Peter’s.

In the majority of cases the surgical team will remain the same as if they had their surgery at St Peter’s or Ashford Hospitals. The discharge information will be provided by the hospital where their surgery is undertaken and will follow the discharge protocols of that particular organisation.

All patients will be asked if they want their care transferred.

If you need any further information or clarifications then please use the GP helpline email address ( and either Emma Jackson or Debbie Beesley will respond to you.


Reminder of regulations for chargeable fertility services for patients who have paid the NHS surcharge

Following changes to the ‘Immigration Health Surcharge’ coverage and the removal of Assisted Conception/Fertility treatment from August 2017, we are seeing an increase of patient who are unaware they will incur costs for this treatment path.

Therefore could we request that when referring patient for this service you have made them aware that if they paid the ‘Immigration Health Surcharge’ (HIS) as part of their Visa application they will be required to pay full estimated costs in advance of attendance.

The full guidance can be found here. 5 p36, 5.15).

Please can you highlight this to your patients prior to referral for fertility services. 


Direct Access ECGs

The ECG service at Ashford Hospital is still running but we are not accepting walk-in patients as we need to control the number of patients in the department at any one time. All referrals are being triaged. Please send your referrals to


Ultrasound-Guided Injections

Under Covid-19 National Guidance ultrasound guided injections have been paused. Until this guidance changes it has been recommended that referrals are sent via the MSK pathways so that Consultants can triage the referral and consider if an alternative pathway is available.


GP Blood Tests

Due to Covid-19  all GP patients must now book online for blood tests, the walk in service is limited to patients attending consultant appointments.

This decision is to decrease the volume of patients on site at any one time to reduce the risk of cross infection

To book appointments please visit

For ALL appointments please remember to put in the details of the patient and not the person making the booking.   If it is impossible for you to gain access online please phone 01784 884565 between 09.00 – 15.00

Thank you for your cooperation.


New NICE Guidance on Planned Care Pathways for Covid-19

NICE has recently published some new guidance on planned care pathways for Covid-19.  This has been ratified for use by our Clinical Reference Group.   The headlines are that patients are no longer recommended to have 14 day pre-op isolation.  Instead they are being asked to follow social distancing/hand hygiene best practice for 14 days prior to surgery, have a Covid swab up to 3 days before, and self-isolate from the day of the test until admission.


Change of E-Mail Address for Gastroenterology

Please be aware that the e-mail address for Gastroenterology has been changed. Details of the change and an updated contacts list have been emailed to practice managers this morning (16/7/20).


TIA Covid Update

Our Stroke TIA service is continuing to accept referrals for both high and low risk patients.  Please continue to refer appropriate patients promptly.

All referrals are now reviewed by our consultant team and patients are offered face to face or virtual appointments based on their clinical risk. We would be grateful if you could provide us with as much information as possible about the clinical events leading to the referral. This will help the consultant triage the referral correctly and in a timely manner.

Our Specialist Stroke Nurses, in cooperation with the consultant in charge for the day, are available to advise on all high risk referrals and any queries you may have.  They can be contacted via ASPH switchboard bleep 5828

The goal of the TIA clinic activity is to identify and prioritise the treatment of patients that may have sustained a transient cerebrovascular event in order to minimise their risk of stroke. We would be grateful therefore only to use this service for patients who you suspect have suffered a “a transient episode of neurologic dysfunction caused by focal brain, spinal cord or retinal ischemia”  TIA.  Neurology conditions, even if presenting subacutely, should be referred to our Neurology Department and can be discussed via consultant connect.


Amendment to Ultrasound Referral Protocols

In response to the concerns expressed by GPs regarding the new criteria for requesting US scans which was previously agreed with the CCG, we have decided to return to the previous US referral protocols with immediate effect whilst we review this current vetting system.

If we have any concern regarding a request we will contact the referring GP to discuss further.  This was a process we used previously.

Please convey my apologies for any inconvenience we have caused.

If you require a reminder of the previous protocols please contact Alanna Marvin