The following provides information on common tests provided in primary care. Please contact reception for further information or to book an appointment.
Blood Pressure Check
Blood pressure is the pressure created when blood is forced out of the heart and comes into contact with the walls of the arteries which transport blood around the body. The pressure of blood flowing in the arteries changes according to the different phases of the heartbeat cycle. The pressure in the arteries will be at its highest when the heart is ‘contracting’ and pumping blood out, and at its lowest as the heart relaxes before it pumps again.
Blood pressure is recorded as two numbers: the systolic pressure (as the heart beats) and the diastolic (as the heart relaxes between beats). The numbers are written one above or before the other, the systolic number on top and the diastolic on the bottom.
Your target blood pressure should be less than 150/90 unless you have been told otherwise. If you have angina or have had a heart attack or stroke, or have diabetes or kidney disease, your target blood pressure is likely to be less than 140/90.
High blood pressure – hypertension – means that your blood pressure is constantly higher than the recommended target blood pressure. Over time if this is not treated, you become more at risk of heart disease or having a stroke.
You may be asked to come to see a nurse for a blood pressure check and if it is found to be above the recommended target, you may also be asked to have a number of tests – blood tests, an electrocardiogram (ECG), a painless procedure which records the electrical activity of the heart, ambulatory blood pressure which records your blood pressure over a 12 hour period – to help determine if treatment is necessary.
Home Blood Pressure Monitoring
Blood pressure measurements taken at the practice do not always give a true picture of what your blood pressure is like over your normal day. Some people have a higher blood pressure when at the practice or when they are not relaxed.
A better way to check your blood pressure is to measure it yourself twice each morning and evening when you are at home, relaxed and comfortable. This will then give us an idea as to what your blood pressure really is, and whether the measurements we take in the surgery are similar to those you record at home.
If you have your own blood pressure monitor, you may be asked to record a series of readings over a week, which will be averaged and recorded in your notes.
If you do not have your own machine, you may be loaned a machine from the surgery which a nurse will demonstrate how to use. (Please check with reception regarding the availability of blood pressure monitoring equipment).
Spirometry
There are a number of chest conditions, which may cause breathing difficulties. Sometimes it is helpful to see how well you breathe out to help diagnose any condition or to see if the treatment you are having is working well. This may involve you blowing into a machine – a spirometer – which measures how well you can breathe out.
There are some requirements necessary before you have the test done, such as withholding use of your usual inhalers for a few hours, or usual tablets relating to any chest condition for 24 hours and avoiding vigorous exercise prior to the test.
Spirometry with reversibility
Sometimes you will be asked to undertake a spirometry test with reversibility. This means you will be asked to blow into the machine without using your inhalers first and then again after you have used your inhalers.
Doppler studies
A Doppler test measures the flow of blood through the arteries in your arms and legs using sound waves to make a noise when blood flow is detected. The Doppler is used in place of the stethoscope normally used when taking blood pressures. The test is to detect if there are any abnormalities in the flow of blood in your vessels.
A Doppler assessment is a painless procedure and often undertaken as part of an assessment for support or compression hosiery (full length or knee high stockings or socks).
Hearing Tests (Audiometry)
Damage to any part of the ear can cause a hearing loss. Problems may occur in the ear canal or the middle ear and hearing loss can be temporary or permanent. A hearing test checks whether there is a problem with any of the different mechanisms that allow a person to hear.
The test involves the use of a special machine called an audiometer, which plays a series of tones through headphones, which you will be asked to wear. The tones vary in pitch and loudness and the nurse conducting the hearing test will control the volume and tone of the sounds relayed through the machine. You will be asked to respond to each sound you hear even if very faint.
The results of a hearing test will form a graph called an audiogram. This will show if there is any pattern to the hearing loss you may be experiencing and help your doctor assess the most appropriate management.
First Contact Physiotherapy
First Contact Physiotherapy provides an opportunity to book in directly via reception for assessment and management of muscle and joint aches and pains without having to see your GP first.
The only time you should not do this would be if you are under 12 years old or acutely unwell. Alternatively, if you have spoken to your GP they may recommend that you book in for assessment.
This is not the same as being referred for a course of Physiotherapy.
Who will I be seen by?
A First Contact Physiotherapist (FCP) is highly experienced and is trained to work beyond the normal role of a physiotherapist.
Experience and additional skills/ qualifications (eg. requesting investigations, in some case joint injections and prescribing medication) enables them to manage most conditions without needing to involve your GP.
Non-urgent advice: What should I expect?
– You will be asked to describe your symptoms and how they started. – An expert assessment to confirm a diagnosis. – Advice based on the best evidence for managing your problem. – Requesting of investigations (scans, X-rays, blood tests) if required. – Onward referral to other services if appropriate (eg. Physiotherapy, Podiatry, Orthopaedics).
Social Prescribing & Wellbeing
Many things can affect our health and wellbeing. People often visit their GP because they feel isolated or lonely. Or they might feel stressed by work, money or housing problems. Sometimes it’s the stress of managing different long-term conditions.
That’s where social prescribing can help.
It often starts with a conversation. It might be a conversation with your doctor, or with another person in the practice team. They can refer you to one of the team, like a wellbeing coach, or you can contact the wellbeing coach yourself.
The wellbeing coach is there to listen to you, and give you strategies to enhance your wellbeing. They can also put you in touch with people and activities that might help you feel better.
Supporting you to improve your health and wellbeing by:
Focusing on what matters most to you
Helping you to reach your goals and your ambitions
Connecting you to local community services and activities
The NHS offers screening, free of charge, to identify pre-existing health problems of which you may not be aware, nor be exhibiting any symptoms.
The NHS screening may be as part of a national programme for specific demographic groups or may be opportunistic screening when a patient discusses a related problem with their GP.
Under Health and Safety Regulations, your employer or University/College has a duty to provide a safe working environment, and should provide this vaccination.
GPs do not provide an occupational health service as part of their NHS responsibility nor can they provide this service to you even if you are willing to pay for it.
GPs are not obliged to provide the hepatitis B vaccine on the NHS if you’re not thought to be at risk.
We advise you to contact your employer or University/College and refer them to this page on our website. They will be able to make arrangements with an occupational health provider for the provision of any immunisation which you may require following an appropriate assessment.
The NHS provides health care, free of charge, but there are exceptions: prescription charges have existed since 1951, and there are a number of other services for which fees are charged, for example, medical reports for insurance companies.
It is important to understand that GPs are self-employed and offer their services to the NHS, and they have to cover their costs – staff, buildings, heating, lighting, etc – in the same way as any small business.
Examples of non-NHS services for which GPs can charge their NHS patients:
Accident/sickness insurance certificates Certain travel vaccinations Private medical insurance reports
Examples of non-NHS services for which GPs can charge other institutions include:
Medical reports for an insurance company Some reports for the DSS/Benefits Agency Examinations of local authority employees Reporting regarding joining the Army
Our Fees
Accident or Sickness Claims: Insurance Certificate Freedom from Infection Certificate Private Sick Note
£42.00 £30.00 £25.00
Reports (insurance/solicitor/employment): Simple Statement of Fact Disability Student Allowance Form GP Report on Proforma without Examination Written Report without Examination Full Medical Examination and Report
£30.00 £25.00 £87.50 £125.00 £185.00
Medical Examinations: DVLA (HGV/LGV/PSV/Taxi/Elderly Driver)
£102.00
Adoption & Fostering: Form AH (requires medical) Form AH2 (update – no medical required)
£73.86 £24.36
Legal Services: Power of Attorney – medical examination & report
£105.00
Clarification of Fitness: Firearms / Shotgun Medical Proforma Health Club Form (not gym referral) Fitness to Perform Recreational Activity ~ report only (skydives/diving etc) Fitness to Perform Recreational Activity ~ examination & report Health Declaration Form (OFSTEAD / Police)
£78.00 £30.00 £87.50
£125.00 £42.00
Private Consultations: Doctors Appointment Blood/Swab (note: lab also charge a separate fee for processing the sample) Prescription
£125.00 £40.00
£15.00
Private Referrals: Referral that would be eligible to be made on the NHS Referral that is not eligible to be made on the NHS
£18.00 £48.00
Vaccines: BCG Cholera Hepatitis A Hepatitis B (per dose) Japanese Encephalitis (per dose) Meningitis ACWY Polio Private Vaccination Certificate Rabies Tick Borne Encephalitis (per dose) Typhoid
£48.00 No Fee No Fee £34.00 £57.00 £41.00 No Fee £21.00 £58.00 £47.00 No Fee
Please note: We are unable to do the following: visa applications, character references, references for employment, countersignatures (including passports).
Countersigning Passport Applications
Please be aware that GPs are no longer able to counter sign Passport Forms following new guidance from the Passport Office below:
“Previously applicants were able to contact their General Practitioners for a countersignature but this is no longer allowed. The high demand made it infeasible to maintain for doctors inundated with requests. The only exception is if a medical professional is a close friend of the person applying.”
Please note, our Nurses will not countersign for a passport application either.
The British Medical Association (BMA) suggests fees for non-NHS work, which is not covered under a GPS NHS contract, to help GPS set their own professional fees. However, these fees are guidelines only, not recommendations, and a doctor is not obliged to charge the rates suggested.
Why can it take a long time to get a form completed?
Time spent completing forms and preparing reports takes the GP away from the medical care of his or her patients. Most GPs have a very heavy NHS workload, and this paperwork is done at times aside for it.
I only need the doctor’s signature – why do I need to wait?
When a doctor signs a certificate or completes a report, it is a condition of remaining on the Medical Register that they only sign what they know to be true. In order to complete even the simplest of forms, therefore, the doctor might have to check the patients’ entire medical record. Carelessness or an inaccurate report can have serious consequences for the doctor.
How can I keep costs down?
Not all documents need signature by a doctor, for exampled passport applications. You can ask another person in a position of trust to sign such documents free of charge.
Plan in advance. Do not expect your GP to process forms overnight. You should expect the form to take up to 6 weeks to be processed.
How do I pay?
Payment can be made by cash, card or BACs. Prepayment is required for all non-NHS services.
Travel & Holiday Vaccinations
Prior to travelling please allow as much time as possible to arrange your appointment for the Travel Clinic (preferably at least 6 weeks or more), which will be with the Practice Nurse.
The Nurse will require to know which countries, and areas within countries, that you are visiting to determine what vaccinations are required.
It is important to make this initial appointment as early as possible – at least 6 weeks before you travel – as a second appointment will be required with the practice nurse to actually receive the vaccinations. These vaccines have to be ordered as they are not a stock vaccine. Your second appointment needs to be at least 2 weeks before you travel to allow the vaccines to work.
Please note only the following vaccines are available on NHS Prescriptions:
Polio Hepatitis A Typhoid Diphtheria Tetanus
Some travel vaccines are ordered on a private prescription and these incur a charge over and above the normal prescription charge. This is because not all travel vaccinations are included in the services provided by the NHS.
Private Travel Clinics
If you are unable to wait for our next available travel advice appointment, as advised by the reception staff, then you can attend any Private Travel Clinic (you can obtain these numbers in the Yellow Pages; i.e. type in “travel clinic” then “your area”, to display a list of clinics) charges will apply at these clinics.
Hepatitis Immunisation
Immunisation against infectious Hepatitis (Hepatitis A) is available free of charge on the NHS in connection with travel abroad. However Hepatitis B is not routinely available free of charge and therefore you may be charged for this vaccination when requested in connection with travel abroad.
Excess quantities of regular repeat prescriptions
Under NHS legislation, the NHS ceases to have responsibility for people when they leave the United Kingdom. However, to ensure good patient care the following guidance is offered. People travelling to Europe should be advised to apply for a Global Health Insurance Card.
Medication required for a pre-existing condition should be provided in sufficient quantity to cover the journey and to allow the patient to obtain medical attention abroad. If the patient is returning within the timescale of their usual prescription, then this should be issued (the maximum duration of a prescription is recommended by the Care Trust to be two months, although it is recognised that prescription quantities are sometimes greater than this). Patients are entitled to carry prescribed medicines, even if originally classed as controlled drugs, for example, morphine sulphate tablets.
For longer visits abroad, the patient should be advised to register with a local doctor for continuing medication (this may need to be paid for by the patient).
General practitioners are not responsible for prescriptions of items required for conditions which may arise while travelling, for example travel sickness or diarrhoea. Patients should be advised to purchase these items from community pharmacies prior to travel.
Further Information
The following websites will give you additional travel advice.
As we get older, we have a higher risk of developing one of these conditions. An NHS Health Check helps find ways to lower this risk. Please contact the Practice to arrange an appointment.
Long Term Conditions (LTC) are health conditions that can impact on a person’s life, and may require ongoing care and support. We organise appointments and provide support for people who have an LTC by putting in place a way of working called ‘Care and Support Planning’.
What is care and support planning?
This way of working aims to give you the opportunity to get more out of your annual review appointments by reorganising the way things happen and giving you more information before you see one of our Nurses. It should help you talk about:
What you can do to look after your health and stay well
What support you may need
What is important to you
Who is it for?
Any patient who has a Long Term Condition (LTC).
Non-urgent advice: The Benefits
This way of working is nearly always preferred by patients. It will help both you and our Nurse make the best use of the time you have in your care and support planning appointment. All the important tests and results needed at your appointment will be available for discussion at your second appointment.
Non-urgent advice: What does this mean for me?
This means that your care and support planning review will take place over two separate appointments and you will have time to think about what you want to get out of these visits.
What happens at the first appointment?
At the first appointment, you will be asked to attend the surgery to have a number of tests done with a Practice Nurse or Healthcare Assistant. The tests may include a blood test (non-fasting), weight, blood pressure and, if you’re diabetic, a foot check. The Practice Nurse or Healthcare Assistant will either book your next appointment which will be with one of our Nurses, or ask you to arrange this appointment with the Reception desk.
What happens next?
Your test results from this appointment will be available when you attend to see the Nurse. The results of this test will be discussed with the Nurse and any appropriate action taken.
What happens at the care and support planning appointment?
At your care and support planning appointment you will be able to ask questions and talk about what’s important to you. The Nurse will raise any issues she is concerned about. Once you both agree on the main things to work on, you will get the chance to work out a plan and identify any support you need to help you look after your health.
There are a number of services that can help you when it comes to looking after yourself if you have the following Long Term Conditions – Diabetes, Chronic Heart Disease, (CHD), Cardiovascular Disease (CVD) or Chronic Obstructive Pulmonary Disease (COPD).
Further Information
Coronary heart disease (CHD) is a major cause of death both in the UK and worldwide. CHD is sometimes called Ischaemic heart disease. – NHS CHD Information
Chronic obstructive pulmonary disease (COPD) is the name for a group of lung conditions that cause breathing difficulties. – NHS COPD Information
