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Noticeboard

Sickness Certificates

The first 7 days of sickness do not require a certificate from your GP. If your employer insists on a sickness form, complete a Self-Certification form, which can be found here


We do NOT do sick notes for suspected Coronavirus

Sick Notes do NOT need to be SIGNED. We will text them to you, as we do not want you to come to surgery to pick them up. You can print them or email them to your employer.

We are not allowed to write letters telling your employer that you should be allowed to work from home. That's your HR department's decision, based on what medical conditions you declare to them. If they don't believe you, we can write a letter confirming your medical problems for £30 in advance. We have been overwhelmed with such requests, understandably, and we cannot deal with them all.

Keep Your Details up to Date
Please do update your contact details ("Your Contact Details" box at the bottom of screen) with home & mobile & email. You will receive appointment reminders and occasional requests for information by text.

 

Budgets
Patients are quite rightly getting more and more frustrated at not getting what they want, when they want it! Please be assured that we are your advocates and we act in your best interests. But we do have to prescribe cost-effectively, and refer for medical reasons when we can't manage your problem, not simply for your peace of mind. You will not find a GP practice these days which will oblige your every wish without discussion!

 

Photo ID

You may be asked for a photo for our records. This reduces problems where patients are mistaken for each other when they consult another GP within the practice. PHONE CALLS may be recorded for your protection.

 

 

CORONAVIRUS

general advice  don't ring 111, but use the website. 111 will be very busy organising admissions to hospital for those very sick people.

AVOID catching it! if you touch anything with snot/mucus on it, then touch your face, you will catch it. Wash hands with soap: if your not near a sink, then use disinfectants.  Stay out of the way from people who are coughing, especially in confined places (like surgery waiting rooms!). Keep drinking fluids, especially warm ones: viruses are more likely to be absorbed by cold, dry throats.

AVOID spreading it! You'll be infectious 5days before you know you have Coronavirus. If you have to cough/sneeze, then cough into a 
paper tissue and dispose of responsibly. Masks only really limit spreading of viruses from sneezing & coughing. Wash your hands frequently in order to reduce spread to others who are unwise enough to be touching their faces!
There is NO cure for Coronavirus & people will NOT be tested unless they are critically ill and need admission. Private tests.

See below for how to manage your illness & for what to Vital Signs to monitor, which will alert you that you may contact the doctor.

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please read below about symptoms before ringing GP with vague 'suffering' symptoms of a cold, so we can make as best an assessment on the phone.

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ADULTS WITH  FEVER/COUGH

These can be Upper (throat, sinuses, ears, laryngitis) or Lower (lungs, bronchitis/pneumonia/chest infection). Each can be caused by Virus or Bacteria.

 

The usual attacking germ is a virus. This causes irritability of the airways. The body responds by producing excess catarrh to clean out the germ from the air tubes, and also cough (to clear infected mucus). The germ also causes a temperature.  All these things are the normal way that a body deals with attacking germs, infection.

 

In people with Asthma or COPD (chronic bronchitis/emphysema), these viruses can trigger narrowing of the airways with potentially serious consequences! Refer to your Personal Care Plans we printed for you on how to manage such exacerbations/attacks.

 

When we examine you (assess you), we need information on symptoms, not just ‘coughing, can’t sleep, feel terrible, feel hot’. Everyone gets these symptoms. We need specific information which will help us assess your severity, the need medicines and even the need for hospital. This information you will find below.

We will also examine you: we have experience in examining chests and throats for many years, so you can trust that we get it right. But things Can change, and what can seem to us a virus one day, can turn in to a secondary bacterial pneumonia or even meningitis the next day. Which is why it’s important to record key information and come back for reassessment as necessary.

The overall symptoms and examination will help us decide if antibiotics are necessary to help your immune system fight what might be Bacterial infections. Antibiotics are no use whatsoever against viruses.

People’s immune systems vary: some have medical condition or take tablets which suppress their ability to fight infections. Some people just don’t look after their health and are weakened (balanced diet, fruit veg, top ups of Vitamin D before each winter, exercise).

Taking antibiotics in the past will have weakened your immune system. Taking unnecessary antibiotics now will continue to weaken the immune system (but of course May really be necessary). Taking unnecessary antibiotics in a child who is brewing up a meningitis will mask the symptoms of an emerging meningitis, and make it difficult to diagnose.

Antibiotics are no longer recommended for ear infections, sinusitis, or throats unless we see white pus.

 

People will be concerned about Coronavirus. This is just like any other virus, the influenza virus that many patients chose not to be vaccinated against. But it has hit the headlines and has a higher complication rate than our usual influenza virus. The symptoms of coronavirus are identical to most Upper and Lower Respiratory Tract infections! So it will be impossible to tell the difference between what we see and experience on a daily basis in surgery, and what is Coronavirus which has no treatment. What we will be more concerned with is Secondary bacterial infections  which need antibiotics, and the unlikely need for Respiratory Support in hospital. There is much in the news about how to self isolate, reduce risks of spread or catching of viruses.

 

Whether the doctor feels you have a virus or a bacteria needing antibiotics, self-monitoring is very important to detect deterioration of the infection. Do fill out the table below.

Whatever the infection, virus or bacteria, you need to have adequate hydration. At least 2Litres of fluids/24hrs. If you were in hospital, the first thing they put up is a fluid drip into your veins!

Paracetamol to keep down temperature, so that you feel well enough to drink fluids. You will still feel miserable. Your body is in a battle and it will hurt: it needs rest  and it will beat the infection. Paracetamol is preferred to Ibuprofen or any other AntiInflammatory, as there is some suggestion that anti-inflammatories reduce the Immune System's capacity to fight Covid-19.
There is evidence that high dose vitamin C   3grams/day ‘berocca’ can temporarily boost your immune system and help to fight off these respiratory infections.

Steaming the airways reduces irritation and cough, and lubricates and allows sputum/catarrh to be brought up  and spat out. Putting your head over a steamy bowl of water with a towel is better than nothing, but spending 24hrs in a SteamRoom is much more powerful! A good compromise is the purchase of an electric facial steamer. The cheapest place to buy one is Argos £18   442/4266  By all means put a little Vicks in the boiling water, and mind you don’t jog the boiling water by walking into the electric cord!

Day:

 

 

 

 

 

 

 

 

 

temperature

 

 

 

 

 

 

 

 

 

RespRate

 

 

 

 

 

 

 

 

 

Pulse

 

 

 

 

 

 

 

 

 

Fluids   mls

 

 

 

 

 

 

 

 

 

Breathlessness on stairs

 

 

 

 

 

 

 

 

 

Pulse Oximeter

 

 

 

 

 

 

 

 

 

 

Monitor your symptoms, ideally 4x per day.

Write the Maximum (temperature, pulse..) in the table

 

Temperature: with thermometer. Under arm or ear. Take an average of both ears. Not forehead.

 

Respiratory Rate: how many breaths per minute  at rest, not while you’re having a coughing fit. Anything over 20/minute for adults is concerning.

 

Pulse.  If you can feel your pulse, or have someone put their head against your heart and listen, the number of beats her minute should be 70 or less at rest. If it is persistently over 90, it’s cause for concern.

 

Fluid input. This should really be 2.5L   2,500ml daily. Filling a 1.5L water bottle and pouring from it, including pouring into kettle to make tea, is a good way of measuring total daily fluid input.

 

Breathlessness.  Going up the stairs shouldn’t make you breathless. But if it begins to, then that’s a bad sign. Patients often talk about being breathless to me, but often it’s not really breathlessness, it’s just a feeling of congestion or a limitation of breathing in because of rib muscle pain (caused by spraining rib muscles from coughing).

Another useful test is the 8-second test: Take a deep breath & count to 30 in your native language. See how many seconds it takes before you need to take another breath. Normally it should be 12 seconds or more. BE CAREFUL, this test can give you false reassurance. It's only useful if you Can't achieve it!

 

Pulse Oximeter. More & more patients are buying these. About £15 on Amazon. They measure both pulse and % oxygen in blood. 96% or above is normal.  If it’s between 92-95%, try breathing deeply for a minute and waiting to see if it rises above 96%, or try another finger. I find that people often simply don’t breathe properly!. Any sustained reading below 96% is immediate cause for concern.

 

 

The point of monitoring your symptoms is to detect deterioration, and need for re-examination.

 

Some of my responsible patients even have their own stethoscope.  Even the “StJohn Ambulance” brand on Amazon is only £6. If you or your partner listen often enough, you’ll know what’s normal, and what is suddenly different. If you bring it along, I’ll always show you.

They are useful for spotting chest infections, or tracking the noise the doctor hears to make sure it disappears. Obviously, nothing substitutes for an experienced doctor’s ear, but they can be really helpful in prompting patients to come see their GP if they hear something new that they’re worried about.

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ADULTS WITH DIAGNOSED CHEST INFECTIONS ON ANTIBIOTICS

 

You’ve been diagnosed with a chest infection. Doctor can hear it in part of your lung.

 

In people with Asthma or COPD (chronic bronchitis/emphysema), these viruses can trigger narrowing of the airways with potentially serious consequences! Refer to your Personal Care Plans we printed for you on how to manage such exacerbations/attacks.

 

A bacteria has penetrated your upper respiratory airways defences and settled in your lung.

 

People’s immune systems vary: some have medical condition or take tablets which suppress their ability to fight infections. Some people just don’t look after their health and are weakened (balanced diet, fruit veg, top ups of Vitamin D before each winter, exercise).

Taking antibiotics in the past will have weakened your immune system. Smoking damage in past or present will have contributed.

 

TREATMENT is with AntiBiotics, but also the important measures listed below.

Self-monitoring is very important to detect deterioration of the infection. Do fill out the table below.

You need to have adequate hydration. At least 2Litres of fluids/24hrs. If you were in hospital, the first thing they put up is a fluid drip into your veins!

Paracetamol to keep down temperature, so that you feel well enough to drink fluids. You will still feel miserable. Your body is in a battle and it will hurt: it needs rest  and it will beat the infection.  If you are possibly infected, paracetamol is best for fever, rather than Ibuprofen. The body's 'inflammatory process' is part of it's defence, and AntiInflammatory medicines can decrease the immune system's way of dealing with pathogenic covid19.
There is evidence that high dose vitamin C   3grams/day ‘berocca’ can temporarily boost your immune system and help to fight off these respiratory infections.

Steaming the airways reduces irritation and cough, and lubricates and allows sputum/catarrh to be brought up  and spat out. Putting your head over a steamy bowl of water with a towel is better than nothing, but spending 24hrs in a SteamRoom is much more powerful! A good compromise is the purchase of an electric facial steamer. The cheapest place to buy one is Argos £18   442/4266  By all means put a little Vicks in the boiling water, and mind you don’t jog the boiling water by walking into the electric cord!

Expectoration. Having loosened the infected phlegm in that part of the lung, using steam. Ask your partner to firmly pat you on that part of the lung and lean forward to try to cough up the phlegm.

 

Day:

 

 

 

 

 

 

 

 

 

temperature

 

 

 

 

 

 

 

 

 

RespRate

 

 

 

 

 

 

 

 

 

Pulse

 

 

 

 

 

 

 

 

 

Fluids   mls

 

 

 

 

 

 

 

 

 

Breathlessness on stairs

 

 

 

 

 

 

 

 

 

Pulse Oximeter

 

 

 

 

 

 

 

 

 

 

Monitor your symptoms, ideally 4x per day.

Write the Maximum (temperature, pulse..) in the table

 

Temperature: with thermometer. Under arm or ear. Take an average of both ears. Not forehead.

 

Respiratory Rate: how many breaths per minute  at rest, not while you’re having a coughing fit. Anything over 20/minute for adults is concerning.

 

Pulse.  If you can feel your pulse, or have someone put their head against your heart and listen, the number of beats her minute should be 70 or less at rest. If it is persistently over 90, it’s cause for concern.

 

Fluid input. This should really be 2.5L   2,500ml daily. Filling a 1.5L water bottle and pouring from it, including pouring into kettle to make tea, is a good way of measuring total daily fluid input.

 

Breathlessness.  Going up the stairs shouldn’t make you breathless. But if it begins to, then that’s a bad sign. Patients often talk about being breathless to me, but often it’s not really breathlessness, it’s just a feeling of congestion or a limitation of breathing in because of rib muscle pain (caused by spraining rib muscles from coughing).

Take a deep breath & count to 30 in your native language. See how many seconds it takes before you need to take another breath. 12 seconds or more is normal. 8 seconds is very concerning! One needs to practice, after steaming, because sometimes it's an irritating cough that forces you to stop for breath, or an irritation in the airways on breathing in.  BE CAREFUL, this test can give you false reassurance. It's only useful if you Can't achieve it!

 

Pulse Oximeter. More & more patients are buying these. About £15 on Amazon. They measure both pulse and % oxygen in blood. 96% or above is normal.  If it’s between 92-95%, try breathing deeply for a minute and waiting to see if it rises above 96%, or try another finger. I find that people often simply don’t breathe properly!. Any sustained reading below 96% is immediate cause for concern.

 

 

The point of monitoring your symptoms is to detect deterioration, and need for re-examination.

 

Some of my responsible patients even have their own stethoscope.  Even the “StJohn Ambulance” brand on Amazon is only £6. If you or your partner listen often enough, you’ll know what’s normal, and what is suddenly different. If you bring it along, I’ll always show you.

They are useful for spotting chest infections, or tracking the noise the doctor hears to make sure it disappears. Obviously, nothing substitutes for an experienced doctor’s ear, but they can be really helpful in prompting patients to come see their GP if they hear something new that they’re worried about.

 

If everything settles, you’re healed. Try to think about prevention in future, by building up your Immune System.

 

If you ever smoked, the doctor will need to listen to your lungs to make sure the noise of infection has totally disappeared in 10days: sometimes a second course of antibiotics is necessary, or even an Xray to rule out Lung cancer.

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CHILDREN (over 1yr) WITH  TEMPERATURE/COUGH

These can be Upper (throat, sinuses, ears, laryngitis) or Lower (lungs, bronchitis/pneumonia/chest infection). Each can be caused by Virus or Bacteria.

 

The usual attacking germ is a virus. This causes irritability of the airways. The body responds by producing excess catarrh to clean out the germ from the air tubes, and also cough (to clear infected mucus). The germ also causes a temperature.  All these things are the normal way that a body deals with attacking germs, infection.

 

In children with Asthma , these viruses can trigger narrowing of the airways with potentially serious consequences! Refer to your Asthma Personal Care Plans we printed for you on how to manage such exacerbations/attacks.

 

When we examine your child (assessment), we need information on symptoms, not just ‘my child couldn’t sleep for coughing, and is hot, and hasn’t eaten anything’. Most parents report these symptoms, and some even add ‘projectile vomiting’. Of course, we all want your child to FEEL better, so it’s understandable that these symptoms will worry you foremost. But we need specific information which will help us with a probable diagnosis, assess the severity of the disease, the need medicines and even the need for hospital. This information you will find below.

We will also examine your child: we have experience in examining chests, throats & ears for many years, so you can trust that we get it right. But things Can change quickly in children, and what can seem to us a virus one day, can turn in to a secondary bacterial pneumonia or even meningitis the next day. Which is why it’s important to record key information and come back for reassessment as necessary.

The overall symptoms and examination will help us decide if antibiotics are necessary to help your immune system fight what might be Bacterial infections. Antibiotics are no use whatsoever against viruses.

Children’s immune systems vary: some won’t eat a balanced diet, fruit veg, top ups of Vitamin D before each winter. Some will have parents who pressured the doctor to give unnecessary antibiotics in the past, and worse, not finished the course of antibiotics. Hopefully, breathing secondhand smoke is now a thing of the past.

Taking unnecessary antibiotics now will continue to weaken the immune system (but of course May really be necessary). Taking unnecessary antibiotics in a child who is brewing up a meningitis will mask the symptoms of an emerging meningitis, and make it difficult to diagnose.

Antibiotics are no longer recommended for ear infections or throats unless we see white pus.

 

People will be concerned about Coronavirus. Thankfully the risk of children getting serious complications from this is uncommon, compared to older patients. This is just like any other virus, the influenza virus that many parents chose not to vaccinate their children against. But it has hit the headlines and has a higher complication rate than our usual influenza virus. The symptoms of coronavirus are identical to most Upper and Lower Respiratory Tract infections! So it will be impossible to tell the difference between what we see and experience on a daily basis in surgery, and what is Coronavirus which has no treatment. What we will be more concerned with is Secondary bacterial infections  which need antibiotics, and the unlikely need for Respiratory Support in hospital. There is much in the news about how to self isolate, reduce risks of spread or catching of viruses.

Children are much more likely just to Spread the virus than to become seriously ill.

 

Whether the doctor feels you have a virus or a bacteria needing antibiotics, self-monitoring is very important to detect deterioration of the infection. Do fill out the table below.

Whatever the infection, virus or bacteria, you need to have adequate hydration. At least 1Litres of fluids/24hrs.

Paracetamol (preferable to Ibuprofen!) to keep down temperature, so that they feel well enough to drink fluids. Ice lolly if the throat hurts, so that it will numb the throat so that child will drink more fluids. They will still feel miserable and look poorly. Their body is in a battle and it will hurt: it needs rest  and it will beat the infection.  If your child is  possibly infected, paracetamol is best for fever, rather than Ibuprofen. The body's 'inflammatory process' is part of it's defence, and AntiInflammatory medicines can decrease the immune system's way of dealing with pathogenic covid19.


Steaming the airways reduces irritation and cough, and lubricates and allows sputum/catarrh to be brought up  and spat out. Putting their head over a steamy bowl of water with a towel is better than nothing, but spending 24hrs in a SteamRoom is much more powerful! A good compromise is the purchase of an electric facial steamer. The cheapest place to buy one is Argos £18   442/4266  By all means put a little Vicks in the boiling water, and they need to be supervised at ALL times, minding you don’t jog the boiling water by walking into the electric cord! Some children have been scolded this way!

Day:

 

 

 

 

 

 

 

 

 

temperature

 

 

 

 

 

 

 

 

 

RespRate

 

 

 

 

 

 

 

 

 

Pulse

 

 

 

 

 

 

 

 

 

Fluids   mls

 

 

 

 

 

 

 

 

 

Breathlessness on stairs

 

 

 

 

 

 

 

 

 

 

Monitor your symptoms, ideally 4x per day.

Write the Maximum (temperature, pulse..) in the table

 

Temperature: with thermometer. Under arm or ear. Take an average of both ears. Not forehead.

 

Respiratory Rate: how many breaths per minute  at rest, not while you’re having a coughing fit. Anything over 25/minute for children is concerning.

 

Pulse.   put your head against their heart and listen, the number of beats her minute should be 80 or less at rest. If it is persistently over 100, it’s cause for concern.

 

Fluid input. This should really be 1.5L   1,500ml daily. Filling a 1.5L water bottle and pouring from it, is a good way of measuring total daily fluid input.

 

Breathlessness.  Going up the stairs shouldn’t make them breathless. But if it begins to, then that’s a bad sign. Patients often talk about their kids being breathless to me, but often it’s not really breathlessness, it’s just a feeling of congestion or a limitation of breathing in because of rib muscle pain (caused by spraining rib muscles from coughing). In younger children, if they are struggling with breathing, you’ll notice the skin dip in between their ribs, as their muscles try hard to breath.
Another pointer can be to see how far they can count on one breath: they should be able to count for at least 12 seconds. BE CAREFUL, this test can give you false reassurance. It's only useful if your child Can't manage to do it!

 

 

The point of monitoring your child’s symptoms is to detect deterioration, and need for re-examination.

 

Some of my responsible parents even have their own stethoscope.  Even the “StJohn Ambulance” brand on Amazon is only £6. If you listen often enough, you’ll know what’s normal for your child, and what is suddenly different. If you bring it along, I’ll always show you.

They are useful for spotting chest infections, or tracking the noise the doctor hears to make sure it disappears. Obviously, nothing substitutes for an experienced doctor’s ear, but they can be really helpful in prompting patients to come see their GP if they hear something new that they’re worried about.

RASH  a rash is a game-changer! The rash of meningitis normally starts on the buttocks and down the back of the thighs. It will not blanch: that is, pressing a glass against the rash will not make it fade! Call for help immediately.

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INFANTS UNDER  1 YEAR    WITH  FEVER/COUGH



 
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