Clinics and Services

Asthma

You will be offered an annual review to assess how well your asthma is controlled and advise how you can help improve your asthma control with a self management plan. The appointment includes a review of your medication and inhaler technique. Management of asthma is in line with the British Thoracic Society (BTS) guidelines.

All patients with breathing problems will be offered support and review by our specialist nurse led respiratory service.

Influenza and pneumococcal vaccination is advised for all patients with respiratory disease.

COPD

(Chronic Obstructive Pulmonary Disease/Chronic Bronchitis/Emphysema)

We aim to make an early and accurate diagnosis using spirometry and advice on treatment. You will be offered an annual review of your COPD, treatment and lifestyle factors affecting your respiratory health. Advice regarding stopping smoking will also be discussed.

All patients with breathing problems will be offered support and review by our specialist nurse led respiratory service.

Influenza and pneumoccoal vaccination is advised for all patients with respiratory disease.

Heart Disease

Cardiovascular Disease – Coronary Heart Disease (CHD)

Annual Review

Every year all patients with coronary heart disease will be offered an appointment for review with our CHD nurse. At this appointment your symptoms will be reviewed and you will receive advice to reduce your overall risk. Concerns you may have about your cardiac health will be addressed at this appointment. The review will include an assessment of risk factors for heart disease including weight, waist measurement, cholesterol, blood pressure, smoking status, diet and exercise.

Follow up from CHD Clinic

If at your annual review it is decided that further assessment is required, an appointment will be made for you to see your GP.

More Information

More information is available in the British Heart Foundation Booklets and their magazine which are available at the surgery. You can also sign up for Heart Matters Magazine which is a free service from the British Heart Foundation offering support and information for people looking to improve the health of their heart.

Useful Websites

Stroke

Patients who have suffered a stroke will be invited for an annual review appointment. This is a nurse led service and at this appointment there will be a review of your symptoms and advice regarding how to reduce your risk of further stroke.

The review includes:

  • Blood pressure check
  • Test of cholesterol levels
  • Review of medication

Hypertension

All patients who have high blood pressure will be reviewed regularly and have a blood pressure check at least once a year. If you have not had a BP check within the last year we will contact you to make an appointment with our nurses. You are also advised to have a blood test to check cholesterol levels and renal (kidney) function on a yearly basis.

Diabetes Mellitus

We run a diabetic service for our patients. Your care will be by your own registered doctor along with our trained nurses.

Your care will include an annual diabetes check and a 6 monthly review if your condition is well controlled and stable. There may be times when you are seen more frequently to optimize your control and when your treatment is being changed or altered.

The Annual Diabetes Check

This will include a discussion about your diabetes and its treatment. Tests and measurements will be covered each year and sometimes more frequently. Some of these tests are to identify risk factors which can be altered to prevent you from developing complications of diabetes.

Dietician

Any newly diagnosed diabetic patient will be offered referral to an education programme which includes diet advice. Should a referral be clinically indicated a dietician referral can be made

Foot Emergencies

If you are concerned that you may have an infection in your foot, a new ulcer, sudden onset of pain and swelling in the foot or discolouration, please speak to your GP ASAP.

Sharps Bin

If you are on an injectable form of treatment for your diabetes you will be prescribed a sharps bin for the safe disposal of needles.

Epsom and Ewell Borough Council offer one free collection per year per patient. Please telephone the council on 01372 732000. After your initial provision of a sharps bin on prescription, further supply is to be accessed via the council.

Further Information

Diabetes UK is a good source of information and access to their website is free: www.diabetes.org.uk. Useful information can also be found on the Patient UK website: www.patient.co.uk.

Other Issues

  • Depression: you will be asked some screening questions, help and support is available if needed.
  • DVLA: Driving and when and if to inform the DVLA will be discussed.
  • Erectile Problems: This is a common problem and advice and treatment is available
  • Smoking: We have a smoking cessation advice service, an appointment for this can be booked at reception.
  • Prescription Exemption: If you take medicines to help control your blood glucose level you are eligible for free prescriptions. Ask for a form at reception.
  • Vaccinations: It is important that you have a pneumococcal vaccination and an annual flu vaccination as these infections can be serious if you have diabetes.

Contraception

Family Planning

We provide family planning advice for all our registered patients. This includes contraceptive pill, contraceptive injections, advice on barrier methods and fitting of caps, IUS/IUD fitting and checks, general contraceptive advice and emergency contraception. We also provide basic screening for STDs.

Emergency contraception is most effective as soon after sexual intercourse as possible and must be used within 72 hours of sexual intercourse. Patients needing this need to inform reception staff that they need an “on the day appointment”. The emergency contraceptive Levonelle is also available over the counter.

Travel

We provide a travel immunisation service including all immunisations and prescribing of anti-malarial medication. We are now also registered as a Centre for Yellow Fever Vaccination.

Information about health risks and vaccination requirements is available on line at www.fitfortravel.scot.nhs.uk. Requirements especially malaria can change at short notice and up to date advice is essential.

If you are travelling abroad we ask that you contact the surgery at least 6-8 weeks before travel to allow time to complete travel courses. You will be asked to complete a form giving details of your trip, destinations and length of stay. Download the travel vaccination form.

The form can be completed

  • Over the phone
  • In person at reception
  • Printed and return it to us at the surgery
  • And returned by email.

Our nurses will then check the vaccinations required and you will be contacted and advised as to vaccination requirements, time schedule required to complete the vaccination course and any charges for the vaccine/s.

Many travel vaccinations and anti-malarials are not available under the NHS.

Please ensure you bring adequate means of payment with you. We can accept payment by cash or cheque.

Travel Resources

Anticoagulation/Warfarin

Anticoagulation

The Derby medical Centre run a clinic for monitoring anticoagulation medication. Anticoagulation is a medicine which is used to stop the blood clotting in blood vessels and is used in a variety of illnesses to prevent stroke and heart attacks.

The dose of your anticoagulation is calculated after testing the blood to see how easily it clots. It is important to have this monitored regularly. The anticoagulation is affected by many things such as other drugs, food and alcohol. When you are first advised to take these medicines our trained nurse provide education and on going support regarding your medicine.

Side Effects

The most important side effect is signs of bruising and bleeding, please report these to the clinic nurse. Signs to look for are listed below:

  • Nose Bleeds
  • Bleeding from gums
  • Red/Pink colour in urine
  • Blood in stools or black stools
  • Persistent headache
  • Excessive bruising

Monitoring of Warfarin

The practice runs a warfarin clinic for the monitoring of the drug and review of its dosage.

Warfarin stops the blood from clotting within your blood vessels. It is also used to stop existing clots getting bigger and stops parts of clots breaking off and forming emboli. Clotting is delayed because the warfarin inhibits the production of Vitamin k in the liver thus making it longer for the blood to clot.

Treatment is safe so long as you follow the advice from your doctor or nurse and in your Anticoagulant therapy Record

You will need to have a blood test at regular intervals. The reading obtained by testing your blood is called your INR. This may vary but will need to be kept within a certain range depending on the reason why you are taking warfarin. This is called the therapeutic range and will be decided by your doctor.

Immunisations/Vaccinations

Immunisation

We offer a full immunisation service. Appointments can be booked with the nurse.

Childhood Immunisation

One of the most important things that a parent can do for their child is to make sure that they have all their routine childhood vaccinations. It’s the most effective way of keeping them protected against infectious diseases. Ideally, kids should have their jabs at the right age to protect them as early as possible and minimise the risk of infection. All medicines have side effects, but vaccines are among the safest. The benefits of vaccinations far outweigh the risk of side effects.

Vaccinations shouldn’t hurt, although the area injected can be sore and red afterwards. Your child may develop a mild fever (a temperature greater than 37.5ºC) after the vaccination. If a fever develops, you can give your child infant paracetamol or ibuprofen to treat it.

Vaccination Schedule

This schedule is regularly being updated and modified. For the most up to date information please visit the ‘NHS vaccinations and when to have them’ page on the NHS website.

Vaccines for risk groups

People who fall into certain risk groups may be offered extra vaccines. These include vaccinations against diseases such as hepatitis B, tuberculosis (TB), seasonal flu and chickenpox.

Travel and other vaccines

There are also optional vaccines that you may be able to have free on the NHS from your local surgery, including travel vaccinations, such as hepatitis A, typhoid and cholera.

If you’re not sure whether you or your child have had all your vaccinations, ask your GP or practice nurse.