Clinical Services

Asthma

1. The practice will contact you by SMS (text message) to advise that your asthma review is due or you may notice an alert on your prescription to make an appointment.

2. Please call the appointment line on 0131 260 9226 and tell the receptionist you have been alerted to the need for a telephone asthma review.

3. The receptionist will enquire if you have a peak flow meter at home. If you do not, then a prescription will be arranged for you so you may measure your peak flow for a few days before your appointment. If you could please note the best of 3 readings taken in the morning and again in the afternoon then relay the average of these to the Practice Nurse during your telephone appointment.

4. The receptionist will also ask you to complete an Asthma Control Test (ACT) before your telephone appointment. This can be accessed here and the score discussed with the Practice Nurse: http://www.asthmacontroltest.com/en-gb/welcome/

5. The receptionist will arrange a telephone appointment with the Practice Nurse at a convenient time. Please provide the best phone number to be used and ensure your phone is switched on at the time of your appointment. Please note we cannot guarantee the Practice Nurse will be able to call you at the exact time of your appointment.

6. During the telephone consultation, the Practice Nurse will discuss with you:

• Your ACT score
  
• Your current inhaler(s) and medications
• Your inhaler technique using the websites provided in the SMS message
• If you have had any flare-ups
• Any new symptoms or concerns about your asthma control
• The triggers for your symptoms and how you manage these
• Your peak flow reading which you can do at home during the consultation
• Your Personal Asthma Action Plan (PAAC) including any changes to your treatment
• How to manage a flare-up or asthma attack
• Lifestyle measures to keep your asthma well-controlled including smoking cessation, exercise, weight loss and natural breathing techniques to help with anxiety and hyperventilation for example.
• Flu vaccine criteria
• When your next review will be

Chronic Obstructive Pulmonary Disease (COPD)

COPD is an umbrella term which includes Chronic Bronchitis, Emphysema and Chronic Asthma. In COPD, the airways in the lungs are damaged through constant irritation and the most common reason for this is smoking.

Around 2% of the population over 16 years old - 4.5% of all people aged over 40 - live with diagnosed COPD.

COPD is the second most common cause of emergency admissions with an increase of 13% between 2008 and 2014. Along with lung cancer and pneumonia, COPD is one of the three leading contributors to respiratory mortality in developed countries such as the UK.

30,000 people die each year in the UK from COPD compared to 2000 asthmatics.

COPD accounts for 5.4% of all deaths in men and 3.2% in women.

The disease is characterised by breathlessness, productive cough, wheeze and chest tightness. Diagnosis is by lung-function testing, normally performed at the hospital, and although there is no cure, the symptoms can be managed using inhalers to deliver medication to the lungs to improve their function. Some patients may require nebulisers or oxygen if the breathlessness is severe.

The most important measure is to stop smoking as this will help slow down or even halt the progression of the disease. It is also vital to exercise within your limitations, eat a healthy diet, get a yearly flu vaccine - and a one off pneumonia vaccine - and learn to recognise when your condition is worsening so that chest infections can be treated promptly to avoid hospital admission.

What happens at the COPD Nurse Led Review

• Discussion regarding symptoms
• Pulmonary function testing
• Inhaler technique review
• Change or addition of inhalers if necessary
• Referrals to physiotherapy (pulmonary rehabilitation) if required
• Issue of personal self management plan with antibiotics for use at home for worsening symptoms
• Breathing techniques shown
• Discussion regarding attendance allowance, blue badges and taxi cards if required and any need for help at home

Patients with COPD are invited twice a year to see the Practice Nurse for a review - this tends to be spring and autumn to tie in with the administration of a flu vaccine prior to winter.

Further advice available from: www.chss.org.uk Tel 0131 225 6963

Hypertension-  Nurse Led Clinic

Hypertension,  or persistently high blood pressure, is when the pressure in the blood vessels is unusually high and this can have serious consequences if it is not treated and well managed. Frequently high blood pressure does not have any symptoms and around one third of adults in the UK has high blood pressure but may not realise it. If blood pressure remains high and is untreated, it can cause a stroke or heart attack and can adversely affect kidney function and eyesight.

If you have a history of Hypertension and are on medications for this, you would normally be invited to the practice for a yearly review. Due to the COVID-19 pandemic, we have had to alter how we offer this review and so it may be partially by telephone and, dependent on the types of medication you take, may need a blood test to monitor the effects of these tablets. The practice will contact you to arrange the most appropriate review for you.

One of the best ways to keep an eye on your blood pressure is to buy an automated machine that you can use at home. Your GP or Practice Nurse can then contact you to provide some blood pressure readings for them to review and you can monitor the effect of any lifestyle changes you make or medications you have been advised to take. It has been found that home blood pressure readings are more accurate than those taken in the clinic.

Lifestyle changes such as eating a healthy diet that is low in fat and salt and exercising regularly can help to lower blood pressure as can quitting smoking and ensuring alcohol consumption is within the recommended limits of less than 14 units a week. There is an excellent video by Dr Peter Churn from Harbours Medical Practice (provided for use here with their kind permission) which discusses these changes and gives ideas on how to instigate them - https://www.youtube.com/watch?v=Ut7JVvOnPgw

Another great source of information about Hypertension management, including the types of medications that are used, is available on the British Heart Foundation website - https://www.bhf.org.uk/informationsupport/risk-factors/high-blood-pressure

Coronary Heart Disease - Nurse Led Clinic

Cardiovascular disease i.e. coronary heart disease and stroke is the main cause of death in the UK accounting for 4 out of every 10 deaths.

Heart disease is the leading cause of death in women killing nearly 4 times more women each year than breast cancer. Women are not aware that heart disease is the number one risk factor to their lives while 1 in 6 men will die from heart disease.

There are many factors that can put you at greater risk of having a heart attack or developing heart disease such as angina and we know that controlling risk factors has been proven to reduce the risks of heart attacks and strokes. For example stopping smoking, eating a healthy low fat diet, keeping your weight at a normal level, taking regular exercise and drinking alcohol within recommended limits can all help reduce the risk of heart disease.

It is just as important to make lifestyle improvements if you have already had a heart attack or have existing heart disease as this can reduce the risk of further attacks. To this end the practice runs a heart disease clinic to which all of our patients with confirmed heart disease are invited once a year for a review with the Practice Nurse.

What happens at the clinic?

• You will be informed of your blood results (which are taken a few weeks before your clinic appointment) - cholesterol level, kidney function, blood glucose level and liver function tests
• Blood pressure will be taken
• Height, weight and BMI recorded
• Discussion regarding your diet regime, exercise and alcohol intake and how you can make improvements if needed
• Smoking cessation advice if appropriate
• Discussion about any symptoms you may have been experiencing such as chest pain or tightness or breathlessness which may be a sign of worsening heart disease
• Your current medications will be discussed with time to ask questions about their function, potential side effects etc
• Opportunity to ask questions about heart disease and any other concerns you may have
• Leaflet advice is provided as required

Further advice about heart disease can be found at:

www.bhf.org.uk Tel 0300 330 3322
www.chss.org.uk Tel 0131 225 6963

Cardiovascular Risk Assessment

The Practice Nurse offers these checks to both women and men aged 45+.

You will first be booked with the Phlebotomist to do the standard checks as noted below. Please collect the risk assessment form from reception in advance of this appointment (avoid between 1-2pm).

• Blood Pressure
• Height, weight and BMI
• Urine dip test for any abnormalities
• Risk assessment for coronary heart disease, diabetes and hypertension - blood tests may be taken if appropriate
• Family medical history (as per form)

Please contact appointments on 0131 260 9226 to arrange this appointment.

Wart Treatment (Verruca)

What are warts?

Warts are simply areas of skin which grow faster than normal and become toughened in appearance due to the presence of the wart virus. They are most common on the hands, feet and face but they can grow almost anywhere on the body. They are infectious and some people, especially children, are more susceptible than others. A verruca is simply a wart growing on the weight-bearing surface of the foot which grows inwards rather than outwards because it is pressed on when you walk. As warts are caused by a virus infection the body will build up resistance over a period of time and eventually the body will cause the warts to disappear. This may take months - or sometimes years - but is the natural way the body deals with warts. If you allow them to disappear in this way it is less likely that you will get any further ones as you will then be immune to that virus.

How can you get rid of warts?

These are two simple methods for getting rid of warts either by freezing with liquid nitrogen or using a wart paint or gel as described below. The second method takes a little time and effort but is usually effective within 2 to 12 weeks.

What you need?

1. A bottle of wart paint. 'Duofilm' or 'Diswart' are as good as any and are available without prescription from chemists.
2. A roll of surgical tape ('Micropore' or 'Blenderm' are good), either 1cm or 5cm wide depending on the size of wart(s) to be treated.
3. A pumice stone or emery board for use only on warts (Remember, warts are infections!)
4. Patience. It takes up to 12 weeks to get rid of warts and perseverance is the key.

What do I have to do?

Every night:

After washing the affected area:

• Apply the wart paint to the warts, getting as little as possible onto the surrounding skin
• Put a piece of tape over the wart big enough to stop the paint getting rubbed off on the bedclothes overnight

Every other night:

Before applying the paint, rub away at the white, dead warty skin with the pumice stone.

Points to remember

1. You will need to keep going until you get down just below the level of the surrounding skin to eradicate a wart completely. Stop when the base of the wart looks exactly like normal skin (i.e. no black dots or 'graininess). If they become sore or bleed a little, just leave off the treatment and carry on the following night.
2. You do not need to take special precautions if you go swimming or walk barefoot to avoid infecting other people. The risk to other people is very little.
3. If verrucas are painful to walk on, try covering them with a corn plaster - the type with a hole in the middle - to make them more comfortable until you have chance to get rid of them.

Ear wax & Ear syringing

The ear canal is a 3cm tunnel which ends at the tympanic membrane, more commonly known as the ear drum. The wall of the canal is covered with normal skin and hairs and has small glands that produce wax. Wax forms a protective film, has antibacterial properties and provides lubrication to the ear canal. It is the ear's self-cleaning mechanism, and traps dust and dirt, which are then excreted from the ear canal.

When this self-cleaning mechanism is disrupted, wax accumulates and can become impacted leading to narrowing or obstruction of the ear canal. An accumulation or build-up of wax is normal and does not require treatment unless you experience symptoms such as hearing loss, ear pain, itching, dizziness or tinnitus. The build-up of wax will often clear within five days without treatment but if symptoms persist then the first line option for treatment is to instil oil into the ear canal to soften the wax, allowing it to clear more naturally. This should be done in the following way and for the recommended length of time:

1. Use almond (unless you have a nut allergy) or olive oil with a dropper for ease of use which you can buy from the pharmacy.
2. It is easier to instil the oil if you are able to lie on your side with the affected ear uppermost.
3. Gently pull the pinna (outer ear) back and up to help straighten the ear canal.
4. Use the dropper to instil 5 or 6 drops of oil to the ear canal.
5. Try to stay on your side for 10 minutes then repeat the process in the other ear if necessary. Try to avoid inserting cotton wool as this soaks up the oil.
6. Never use cotton buds to try to remove the wax as this can push it further down the canal or damage the ear drum.
7. Insert the oil TWICE A DAY for 14 days (if the ear feels completely clear again, you can stop earlier)
8. If your ear still feels blocked after 14 days of twice daily oil instillation then try the following:

Patient Leaflet

Mental Health Services

We offer annual longer appointments for patients with long-term mental health problems. As with all appointments here, this service is entirely confidential.

In these appointments, you could talk with your usual doctor about recent problems and try to anticipate any future problems. This is often helpful as people can make it clear what they know might trigger a difficulty and what they would prefer us to do - or not to do! We also offer some basic checks on your physical health - for example weight, blood pressure, or advice on smoking. If appropriate, a review of your medications could be discussed

Diabetic Clinic

Diabetic (type II) results clinics are held by Dr Reid or Dr Lamb only.

Diabetes mellitus is a condition in which the amount of glucose in the blood is too high because the body cannot properly use it. Diabetes is becoming more common, most likely due to increasing levels of obesity, but there is a lot that can be done to reduce the severity of any complications from it.

NHS Scotland has an interactive diabetes website for patients and their carers. This website is for people with diabetes and their families and friends to help find diabetes information and resources https://www.mydiabetesmyway.scot.nhs.uk/ . You can also use this website to sign up and gain access to your own test results, clinic letters and your treatment plan. If you are having any specific problems, please contact your GP or another healthcare professional to get individual help.

Why do I need to come to the clinic ?

The aim of diabetic care is to minimise the number and severity of complications of diabetes by advising you about how to control your diabetes effectively.

Regular diabetic checks can help to prevent the complications of the disease

What are the complications of diabetes?

People with diabetes have a higher chance of developing certain serious health problems, such as: heart disease, stroke, high blood pressure, circulation problems, nerve damage, kidney damage, eye damage and sexual dysfunction. A healthy lifestyle and sometimes medication can greatly reduce your risk of developing any of these complications.

What happens at the diabetic clinic?

Our lead receptionist coordinates the clinics and will arrange an appointment for you to see our Phlebotomist. Please remember to bring your early morning urine sample.  Your blood pressure and weight will be checked at this appointment and some blood tests taken and the urine will be tested for glucose and protein. It is essential you attend your check-up appointment so that the GP/Practice Nurse has a full picture of your diabetic control.

At the review clinic:

Depending on your results, you may be booked in with Nurse Becky to review things with you. If not, Dr Lamb or Dr Reid will review your results and, if necessary, a follow-up appointment will be made to discuss your treatment plan and next steps. This can be in person or over the phone - let us know what you would prefer! Please make an appointment with your usual doctor if you have problems to discuss that are not to do with your diabetes.

How often do I need a check?

Annual reviews are arranged unless your doctor has requested more frequent reviews.

What other checks do I need?

You will receive an annual appointment from the diabetes retinopathy screening service. This is to take a picture of your retina at the back of your eyes and to monitor any changes in your eyes from your diabetes year on year. You should also have your feet checked at least once a year by a healthcare professional and review the following information: 

Foot care advice: https://www.mydiabetesmyway.scot.nhs.uk/Content.aspx?id=30

Touch the Toes - Home Testing: https://www.diabetes.org.uk/guide-to-diabetes/complications/feet/touch-the-toes

Looking After Your Feet When You Have Diabetes: https://player.vimeo.com/video/412310489

How Diabetes Can Affect Your Feet: https://player.vimeo.com/video/412313912

These sites can offer additional help:

• www.diabetes.org.uk

• www.mydiabetesmyway.scot.nhs.uk

• http://www.edinburghdiabetes.com/information-faqs-2

Contraception

There are many different methods of contraception available and we aim to provide contraception services to everyone who requires it - from new users to people who have just had children and all other women up to the menopause.
We hope the information provided on the site will allow you to have insight into the methods which are available and what we can offer.
Contraception needs to be used until the menopause. That is, until a woman has not had a period or any bleeding for 2 years if aged under 50 and for one year if over 50.
Contraception is free. However over 16 years can buy the emergency contraceptive pill at most pharmacies. We recommend making an appointment with one of our practice nurses for a general discussion about contraception should this be something you are considering starting. Furthermore, the practice nurse is able to prescribe most birth control pills (with the exception of Co-cyprindiol, or "Dianette" as it is commonly referred, as this is something only a GP can prescribe).

Contraception can be divided into:

Non user failure - these do not depend on you remembering to take contraception

User failure - must be used according to instructions and depend on you remembering.

Long acting methods of contraception

Contraceptive Implant

The implant is a small flexible rod placed just under your skin in the upper arm. It releases the hormone, progestogen, similar to the one found in the mini-pill. It is very effective, long term contraceptive which protects you from pregnancy for up to three years. They are over 99% effective. The advantage of the implant is you don't need to remember to take it.
The implant, unlike the depot injection, does not affect your fertility and this will return to normal as soon as the implant is removed.
Periods will most likely change. In some women, they stop altogether and in others, periods will be irregular but generally bleeding will be lighter. Sometimes they are heavier and last longer. There is no method of predicting how the implant will affect you but generally, if you know what to expect, patients are happy using this method.
It is best fitted during the first 5 days of you period and the GP can insert it in a normal 10 min surgery appointment. It can also be easily removed and this only needs a double appointment.

IUD/IUS (coil)

Another long acting method, very popular, currently available at the surgery.  It is important to arrange a pre-assessment with a GP who can fit these - either Dr Martin or Dr Sayers - and this can be done in person or over the telephone. They will have a thorough discussion with you about what the procedure involves and any risk factors. The Mirena coil is very useful in women with heavy periods.

The Combined Pill

This is just usually called the pill. It contains 2 hormones - oestrogen and progestogen - which are the same hormones produced by your ovaries. There are many different pills. Generally you take the pill for 21 days and then have 7 days pill-free which will result in a withdrawal bleed, very much like a period.
This effectiveness depends on your age, how often you have sex and whether you follow the instructions.
There are certain people who will not be able to take the pill and this can be discussed with the GP or nurse at an appointment.
The pill does have some rare complications but it also has some great benefits, including protecting you against ovarian cancer.
The combined pill is not recommended in breast-feeding women.
It does not protect against sexually transmitted diseases.

The Progestogen Only Pill (POP)

This pill contains only 1 hormone - progestogen - similar to the natural one produced by ovaries.
It is also known as the mini-pill.
Like the combined pill, there are many types available.
The mini-pill generally needs to be taken at the same time every day and, unlike the combined pill, there is no 7 day break. It does not have any serious side effects but you may not have regular periods.
It does not protect against sexually transmitted diseases.
Can be used in breast-feeding women.

Emergency Contraception (The morning after pill)

If you have unprotected sex or think your contraception may have failed, you can use emergency contraception.
You must see your GP, Practice Nurse or pharmacist ASAP

1. Hormonal contraception, known as the "morning after pill", can be taken up to 72 hours after sex. It is more effective the earlier it is taken after sex.
2. The IUD (coil) can be fitted up to 5 days afterwards and can stay in to provide contraception. This method is not currently available at the practice.

The practice recognises the important and valuable contribution made by carers and we actively strive to identify and support carers and those being cared for, whether both are registered with the practice or not. If you are a carer, please advise our reception team.

Figures suggest there are over 650,000 carers in Scotland. Carers are more than twice as likely to suffer from poor health compared to people without caring responsibilities.

A carer is defined as:

A person irrespective of age who, without payment, provides help and support on a regular basis to a child, relative, partner, friend or neighbour who could not otherwise manage because of illness, disability, frailty, mental distress or impairment.

The term 'carer' would not apply if the person is:

• a paid carer
• a volunteer from a voluntary agency
• anyone providing personal assistance for payment either in cash or kind

We offer a carer review with the Practice Nurse on a yearly basis to every carer registered with the practice and we advertise this review in our newsletter, on our website and on the plasma screen in our waiting room.

At the carer review the Practice Nurse will assess the patient's own physical and mental health and determine if assistance is required to perform the carer's role. Referrals can be made regarding help with bathing, medication prompts, equipment required in the home, occupational health or physiotherapy reviews, and arranging power of attorney. Help can be given regarding finances, disability badges, taxi cards etc. Referrals can also be made to carer support groups such as VOCAL and the Eric Liddell Centre.

More information can be found on these websites:

www.vocal.org.uk - Voice of Carers across Lothian

www.carers.rog/professionals - The Princess Royal Trust for Carers.

www.alzscot.org - Alzheimers Scotland. Tel 0808 808 3000

www.edinburghparkinsons.org - Parkinson's disease support in Edinburgh

www.eric-liddell.org - project for carers that provides a drop-in social & health based courses.

www.sharedcarescotland.org.uk - short break service. Tel 01383 622 462

All registered carers are entitled to a free seasonal flu vaccination, please contact reception on 0131 260 9226 to find out when our flu vaccine clinics are.

Data Protection and Confidentiality

The principles of confidentiality and data protection do not diminish if the patient is a carer or is being cared for. Written permission needs to be obtained before any identifiable details can be entered into a register and/or medical records:

• The Practice must obtain consent from both parties (where reasonable and practicable) before any medical conditions, treatments, prognosis, results and needs for support and/or assistance can be discussed. If permission is not granted then information can only be released at the GP's discretion.

Joint Injections

Dr Lamb, Dr Gilson and our physiotherapist, Catriona, are trained in steroid joint injections which can be useful for the treatment of inflamed, swollen or painful joints. If you are interested in this procedure, we would be more than happy to discuss it further. Please let the reception desk know and they can offer you an appropriate appointment (0131 260 9226).

Both Dr Martin, Dr Sayers and Dr Gilson can offer the removal of cysts or other skin lesions during a minor surgery appointment. Before you can book in for this service, you must first be reviewed by a GP who will then refer you for minor surgery with us if appropriate. These appointments usually take place on a Monday morning during one of our clinics. As we plan our appointment diary normally a month in advance, you may be added to the waiting list and we will be in touch once we have our next available clinic date for you.

Physiotherapy

As of May 2019, the practice gained its own physiotherapist, Catriona Hewitt. She has a specialist interest in sports injuries and has worked with professional and amateur athletes at international and age group levels. Her aim is to give early diagnosis and advice and, when appropriate, refer on to sources such as physiotherapy rehab or orthopaedics. She can refer patients for x-rays, offer steroid injections, can suggest exercises that may help with problem areas and can also arrange medication - with a GP's help - that may help relieve any musculoskeletal discomfort. Catriona works Tuesday and Friday morning and all day Wednesday and Thursday at the practice and does not see children under the age of 16. Should you wish to make an appointment, please call our appointments line on 0131 260 9226.

Amalia is our Community Link Worker and is available to the benefit of our patients (aged 16+) who might need a bit of social help rather than medical help. Amalia is able to visit at home should patients not wish to come in to the practice. Her services are completely free of charge. She specialises in helping patients who may be looking to do the following:

• Join a group or activity
• Get out of the house more
• Make new friends
• Housing issues
• Bereavement
• Get some help at home
• Volunteer - and more!

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