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Family planning and Sexual health Smear testing Maternity care
Child health surveillance Immunisations Travel clinic
Tests in the surgery Well person checks Diabetes care
Chest disease monitoring Minor surgery Joint injections
Physiotherapy Dietician Psychological therapies
Addiction counselling Private services  

Family Planning and Sexual Health

Our doctors and nurses provide a full range of contraceptive services, including coil fitting, depot injections and implants. We offer a symptom based sexual health service for both men and women. We can test for sexually transmitted diseases in the surgery with simple non invasive tests. We are part of the national chlamydia screening programme for 16 to 24 year olds. We are are currently not commissioned to do routine sexual health screens, you will need to go to local GUM clinics for these.

Oral contraception - The most popular form of contraception is still the pill. We like to check all new patients to whom we prescribe the pill, taking a full history and measuring blood pressure. We take the opportunity to do a cervical smear and chlamydia test as appropriate. We follow up after three or six months. If the pill is well tolerated, we only need to check you every year. The nurses run a drop-in pill clinic at 8:30 every Thursday morning; otherwise, you need an appointment for a pill repeat.

Condoms - We cannot prescribe condoms on the NHS, but we do have a supply to start people off with. You can buy them from chemists or obtain them free from family planning clinics.

Coil fitting - We are fitting more and more intra-uterine devices these days, especially Mirena, the progesterone-releasing coil. Please make an appointment to discuss the coil. If you decide to have one fitted, you will need a coil fitting appointment with Dr. Kroll or Dr. Lucas and a nurse, at the appropriate time in your cycle.

Cap fitting - We can fit you with a contraceptive diaphragm, or 'cap', and teach you how to use it.

Nuva ring and Evra - we can also offer the new vaginal ring which is the equivalent of the combined pill and the contraceptive patch if other methods don't suit.

Injectable contraception - We offer three-monthly progesterone injections, which provide very reliable contraception. They are particularly suitable for people with high blood pressure, people who are likely to forget the pill, and people who don't want a coil.

Contraceptive implant - Dr Kroll offers Nexplanon progesterone implants, which provide very reliable contraception. They are particularly suitable for people with high blood pressure, people who are likely to forget the pill, and people who don't want a coil. They last 3 years.

Useful links
Family Planning Association
Marie Stopes sexual health charity

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Smear Testing

The Health Authority runs a recall system and our nurses do most of the routine smears. We are now using the new and more accurate liquid based sampling technique.

The cells at the neck of the womb, or cervix, are vulnerable to a common sexually-transmitted virus called Human Papilloma Virus. This is also known as HPV, or 'wart virus'. This virus may alter the cells so that they become pre-cancerous, or even cancerous. This process usually takes many years, and so testing the cells by taking a sample, from the neck of the womb, allows early changes to be detected and treated before cancer develops.

The NHS offers smear tests every three years for women aged between twenty-five and fifty, and five yearly till sixty-five. The health authority sends invitations to all eligible women. If a previous smear has been abnormal, you may be recalled for your next smear after a shorter interval, for instance, six months or one year.

When you have a smear, the nurse or doctor will ask you to lie on the examination couch and will insert an instrument called a speculum into the vagina. This is opened to allow a view of the cervix at the top of the vagina. The smear is then taken by sweeping a special brush over the surface of the cervix, taking off a few sample cells with it.

The sample is then put into a pot of preservative liquid and sent to St. George's Hospital for analysis. You will get a letter from the hospital after about three weeks with a coded indication of your result. The codes used are:

  1. Your smear is normal and you should have the next one in three years.
     
  2. Your smear is unsatisfactory in some way and you should ring and speak to the practice nurse for further information.
     
  3. Your smear is technically unsatisfactory, and needs to be repeated. This may happen if too few cells are obtained, but the new liquid technology should overcome this problem.

If there are changes in the cells which might be pre-cancerous, you may be invited to a further examination by a hospital gynaecologist. This is called a colposcopy, and is like a smear test except that the doctor uses a microscope to see your cervix under higher magnification and may take a small biopsy.

Useful links
Women's Health

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Maternity Care

Our Doctors offer pre-conception counselling, ante-natal care and post-natal care, shared with local midwives. We will support requests for home births, but do not claim to be experts at conducting deliveries ourselves.

We also offer help with the diagnosis of sub-fertility, and suggest that you consult if you have not achieved a pregnancy after six to nine months of trying.

When you have discovered that you are pregnant, we suggest you consult early to give you the best choice of local providers of maternity care. (See link below). Our most local hospital is St. George's in SW17, whose district midwives work in several clinics in Battersea. We usually share antenatal care with these midwives, and offer the six-week post-natal appointment. There are two other hospitals nearby which also offer maternity care to our patients: St. Thomas' and The Chelsea & Westminster. Both these hospitals restrict the number of deliveries they offer and as we are not in their main health district, you have to book early to avoid disappointment.

All the hospitals offer ultrasound scanning in early pregnancy if you are bleeding, suggesting a possible miscarriage, and all offer nuchal scanning at twelve weeks to screen for Down's Syndrome.

If you are interested in a home birth, you should be referred to your local community midwife team, which is likely to be connected to St. George's.

Useful links
Netdoctor: Pregnancy & Parenting
Dr. Foster: Good Birth Guide

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Child Health Surveillance

We work together with our health visitors to do eight-week checks. You should have your baby weighed and measured at Stormont clinic on the tuesday afternoon before the check. You should then come by appointment to our baby clinic when your baby is 8 weeks old. These checks are to make sure that your baby is developing normally. At the eight-week check we offer the first primary immunisations against diphtheria, tetanus, polio, whooping cough, haemophilus influenzae and meningitis C. At eight months our health visitors will arrange for your baby to have a developmental check.

The health visitors have a drop-in session on Tuesday and Wednesday afternoons,1-3pm, at Stormont Road Clinic, for weighing and general advice about caring for your baby. Immunisations can be booked with our nurse.

We advise parents to have children immunised against measles, mumps and rubella with the MMR vaccine. If you want more information about MMR, visit www.imunisation.nhs.uk.

The Health Visitors organise two-year and three-and-a-half-year checks. They offer practical support where needed for families with children up to five years old, and run post-natal groups in the surgery.

When the health visitor comes to see you at around 10 days after the birth of your child, she will give you a 'red book' giving information about child care, immunisations and routine check-ups. Please bring this book to all baby clinics and to consultations with doctors during the baby's first year of life: it may be helpful to refer to it.

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Immunisations

Routine children's immunisations are done in our baby clinic and routine adult immunisations are by appointment with our nurses. For information about all immunisations, you can visit immunisation.nhs.uk, an evidence-based site.

The current routine schedule is as follows:

2 months:
Diphtheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenzae type b (Hib, a bacterial infection that can cause severe pneumonia or meningitis in young children) given as a 5-in-1 single jab known as DTaP/IPV/Hib
Pneumococcal infection

3 months:
5-in-1, second dose (DTaP/IPV/Hib)
Meningitis C

4 months:
5-in-1, third dose (DTaP/IPV/Hib)
Pneumococcal infection, second dose
Meningitis C, second dose

Between 12 and 13 months:
Meningitis C, third dose
Hib, fourth dose (Hib/MenC given as a single jab)
MMR (measles, mumps and rubella), given as a single jab
Pneumococcal infection, third dose

3 years and 4 months, or soon after:
MMR second jab
Diphtheria, tetanus, pertussis and polio (DtaP/IPV), given as a 4-in-1 pre-school booster

Around 12-13 years:
Cervical cancer (HPV) vaccine, which protects against cervical cancer (girls only): three jabs given within six months

Around 13-18 years:
Diphtheria, tetanus and polio booster (Td/IPV), given as a single jab

65 and over:
Flu (every year)
Pneumococcal

We also offer immunizations for certain groups at particular risk of infection, including Hepatitis B, Flu, Pneumococcal and advise about TB inoculation with BCG.

We offer a full range of travel vaccinations, including yellow fever. Please speak to a nurse at least six weeks before setting off, as you may need a course of injections. Some of these vaccines are not given on the NHS, and have to be paid for privately.

To find out what travel immunisations you need, go to the Fit for Travel website.

Useful links
Fit for Travel
Center for Disease Control
www.immunisation.nhs.uk

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Travel Clinic

Our nurses will offer appointments for travel immunisations and advice. They give travel advice in person, not via email or on the phone.

Try to plan ahead and come six weeks before travel to allow vaccines to work. We offer a full range of vaccinations, including yellow fever.

Do bring some cash (not a cheque) as the NHS does not support all travel immunisations.

Malaria prophyllaxis: Travellers to areas where malaria is prevalent are advised to take preventive measures. This may include simply covering up bare skin with clothing, sleeping under mosquito nets and using insect repellant. However, anti-malarial tablets are recommended for many areas. Chloroquine and paludrine must be bought from chemist, but doxycycline needs a private prescription. Malarone can be given on private prescription, which works out cheaper if you are travelling for more than 14 days, or some chemists can sell it directly. You are advised to see what local chemists offer.

Be prepared to pay in cash for the vaccines not covered by the NHS.

Current Charges per vaccine:
Yellow Fever £60
Meningitis A+C £45
Rabies x 3  £50 each   RABIES VACCINE IS CURRENTLY UNAVAILABLE (10/2012)
Hepatitis B x 3 £40 each
Polio £30
Charge for Private Immunisation Course £30

Charge for private prescription for travel drugs £15

Useful links
Fit for Travel
Center for Disease Control

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Tests in the Surgery

Self measured Blood Pressure and Weight, ECGs, 24 hour Blood Pressure, Spirometry and Doppler ultrasound testing can be done here. We also run an HCA led Warfarin monitoring service with our INR checking machine. Most Blood Tests are done by our Healthcare assistants.

Blood tests - Your doctor may order a blood test and do it during a consultation. Alternatively, you may be asked to make an appointment with our phlebotomist for a blood test on another occasion. The samples are delivered to St. George's Hospital and the results are usually available on the practice computer system within five working days. Some samples take longer than this. Your doctor will plan how you are to receive your results. You may be asked to ring the surgery for your results. The receptionist will be able to tell you if the results are normal or tell you what you should do to have the results explained to you.

You can also have blood tests done locally at St John's Clinic on weekdays 8am-1pm, 2pm-4pm without an appointment.

ECGs - The surgery has its own electrocardiograph (ECG) machine, which is used to measure the electrical activity of your heart. An ECG can show changes in various diseases of the heart. You will be asked to make an appointment in the late morning with a nurse, and the doctor will arrange a follow-up appointment to discuss the results.

Blood Pressure - The surgery has a blood pressure machine in the waiting room for you to test your own BP at any time. Hand the printout to reception to get the reading put into your notes. We also have a 24 hour BP monitoring machine that can be fitted and worn for 24 hours. This allows us to see what is happening to your blood pressure when you are relaxed and asleep as well as active or anxious! It allows us to see if you have sustained high blood pressure that may need treatment.

Weight - The surgery has a weighing machine in the waiting room for you to check your weight whenever you like. You can hand the printout to a receptionist to update your record.

Doppler Ultrasound - The surgery has Doppler ultrasound equipment, which can detect the heartbeat of a baby in the womb. This is very helpful for ante-natal checkups. We can also assess the circulation in the legs and you might find our nurses offer to do this especially if you develop leg ulcers that need compression bandaging.

Warfarin Monitoring - The surgery has an INR testing machine, and Tina our HCA runs a weekly anticoagulation clinic.

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Well Person Checks

We offer routine checkups for all new patients. These include a lifestyle history, medical history, measurement of height, weight and blood pressure and a simple urine analysis. Patients who have not been seen for some time may make a routine appointment with our nurses for a checkup to make sure their blood pressure is normal, etc. The nurses can also look for evidence of diabetes and test for blood cholesterol.

This may lead to further appointments with a doctor to follow up any abnormalities, or lifestyle advice from our nurses or dietician. Men may want to consider screening for prostate cancer with the PSA blood test, but we recommend a consultation with a doctor first to discuss the pros and cons of this imperfect test.

Women between the ages of 50 and 65 will be recalled for breast screening every three years. This involves an X-ray (called a mammogram), and any abnormality will be followed up either by St. George's Hospital if you live in Wandsworth, or King's College Hospital if you live in Lambeth.

There are groups for exercise and healthy eating advice. Ask to be referred to Footsteps.

Useful links
NHS Direct (Healthy Living)

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Diabetes Care

The practice offers organised routine checkups for diabetic patients either attending the surgery alone, or sharing care with local hospitals. We have a visiting diabetes nurse specialist  to help nurse Anjana, who leads on diabetes.

We will make sure that you are called up for your checkups regularly and our nurses will arrange to do your blood tests before your appointment with the doctor.

If we have just diagnosed diabetes, we will offer you dietary advice and treatment. We may refer you to either St. George's or St. Thomas' Hospital diabetic clinics for more help if we are not happy with your progress.

For most diabetic patients we offer follow-up in our surgery along with an annual eye check up at the hospital. For diabetics who attend a hospital clinic, we will also provide an appointment so that you are seen six monthly. For insulin-dependent diabetics, the hospital will follow you up more often, but we can also provide checkups between hospital appointments. All diabetic patients will be called for annual retinal photography at St Johns or St George's. There are education sessions at St John's clinic to learn how to live with Diabetes, called the Desmond programme.

All diabetic patients are eligible for free NHS prescriptions for any medicine.

Useful links
Diabetes UK

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Chest Disease Monitoring

Our nurses and community respiratory nurse specialist, offer checkups for asthma and COPD patients and help with inhaled treatments. They have nebulisers available for asthmatic emergencies. If you have asthma, it can be helpful to monitor your peak flow with a special meter which can be prescribed. Our nurses can supply peak flow diaries for you to monitor the success of your treatment, and alert you to potential problems.

You can be shown how to get the best out of your inhaled asthma treatment, and referred to a doctor if the treatment is not working. The nurses can teach you how to vary your treatment so that you can keep control of your asthma in most circumstances.

For chronic obstructive airways disease, known as COPD, we offer spirometry to check lung function every year. This involves breathing out as fast as you can through a measuring device. You can come after taking your inhalers and we will see if you do any better after a dose of inhaler.

Many people who have been smoking for at least 20 years develop a "smokers cough" or get bronchitis in the winter and these may be this early signs of COPD. We use the spirometry test to diagnose it, so we can advise and treat you properly. Needless to say the most important advice is to stop smoking!

Useful links
National Asthma Campaign
BTS on Chronic Bronchitis

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Minor Surgery

Dr. Kroll and Dr. Lucas offer Minor Surgery. If you have a mole or small skin lump that may need removing, please see either Dr. Kroll or Dr. Lucas. We do not offer cosmetic surgery, but we will remove lumps that are rubbing on clothing, skin cysts and moles that show any signs of possible malignancy. Some possibly malignant skin lesions we ask our dermatology colleagues to deal with.

We use local anaesthetic and you may have stitches, which will need to be removed by our nurses five to ten days later. We use an electrocautery machine called a Hyfrecator, which can be used to remove some of the superficial skin lesions like tags and keratoses.

We also treat warts and superficial skin lesions with liquid nitrogen, called 'cryotherapy'. The freezing spray destroys the surface layer of cells. It may take several appointments at two-week intervals to destroy any particular wart or lesion.

Useful links
Bandolier: Wart cryotherapy

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Joint Injections

Arthritic joints can be swollen, stiff and painful. These joints can be injected with a mixture of anaesthetic and steroid to reduce pain and inflammation. This effect may last for months and give worthwhile relief. Joints particularly suited to this treatment include shoulders, knees and thumb joints. Injections can also relieve Carpal Tunnel Syndrome. Dr Kroll offers all of these injections. Dr Zuberi and Dr Gray can offer shoulder joint injections.

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Physiotherapy

We have a visiting physiotherapist who visits the practice on Tuesdays and Fridays all day. You can be referred by any of the doctors, and you will be called with an appointment.

The physiotherapist can offer treatment for acute injuries or chronic painful musculoskeletal conditions in adults. They perform manipulation, acupuncture, and ultrasound treatment and teach rehabilitation exercises.

Manipulation - Many people suffer from back and neck pain with stiffness in the facet joints of the spine. Manipulation is designed to increase movement at these stiff joints and ease pain and spasm in the overlying muscles.

Ultrasound treatment - Ultrasound treatment consists of high frequency sound wave energy applied to the tissues, that causes them to heat up. This helps relax stiff muscles and promotes healing where there has been local injury.

Rehabilitation exercises - Once stiff joints have been mobilised, it is important that the muscles are strengthened so that a good and comfortable posture can be maintained. The physiotherapist can teach exercises designed to strengthen the relevant muscle groups.

Useful links
Chartered Society of Physiotherapists

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Dietician

We have a visiting dietician who can help patients with all of the common dietary problems, referred by our doctors or nurses. These include obesity, diabetes, dietary deficiency and food intolerance.

A good way to check whether you are overweight or underweight is to calculate your body mass index. The calculation is based on your weight and height.

BMI Calculator

Useful links
NHS Choices Healthy eating tools

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Psychological Therapies

We have the Wandsworth Psychological Therapies and Wellbeing Service to help if you are suffering from depression or anxiety. They can offer a mixture of telephone and online help and can refer you on for one to one counselling.

Denise Clarke-Campbell is our attached counsellor and Rachael Orr our cognitive behaviour therapist. They and their trainees see patients with a variety of psychological problems for a maximum of twelve one-hour sessions each. We wish we had much more of their time!

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Addiction Counselling

Simon Paton, our visiting addiction counsellor, can see patients with addictions to street drugs and prescribed painkillers, alcohol and sedatives. He is available for one session a week.

For alcohol problems, there is also a local community alcohol team at St. John's Clinic. For mild to moderate alcohol problem drinking ring the new Fresh Start clinic on 0844 477 3306 which is at Bridge Lane Healthcentre nearby.

Smokers who are ready to stop are encouraged to see Tina and Victoria our smoking counsellors. We can prescribe all forms of smoking cessation prescriptions that you may need to help you quit.

Useful links
Wandsworth Stop Smoking Website
Drugs Advice Line (Talk to Frank)
Fresh Start Clinic

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Private Services

Most of our work is on the NHS. We can refer patients to private specialists but the cost of private work will have to be covered by insurance or self payment, not the NHS. We do some private work that the NHS does not fund but allows us to provide for our patients.

Examples are:
• Insurance and employment reports and medicals
• Certificates of fitness for various purposes
• Travel cancellation certificates
• Driving license signature
• Provident Association claim forms
• Travel vaccination
• Private consultation for overseas visitors

We do not countersign Passport applications.

We can accept cash but not cards or cheques in payment.

See the practice information page for our current charges.

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