We offer the following clinics:

Asthma

Asthma monitoring is carried out by 2 of our nurses who are all fully trained in asthma care. Alison Studd, and Lisa Bell work in both surgeries. We write to our asthmatic patients inviting them to attend for an annual check. If you wish to book an appointment, Alison or Lisa will be pleased to see you during one of their normal surgeries. Please mention that you require an asthma check when booking and bring all your inhalers, devices, and peak flow charts with you.

Blood Pressure

A nurse or a health care assistant can take blood pressures. They use electronic blood pressure meters and work strictly to protocols or GP instruction. You do not need to be referred for this service, please make an appointment at reception.

Blood Tests

If your doctor recommends you have a blood test, you can either go to a hospital out patient phlebotomy clinic or make an appointment with one of our four phlebotomists.

Our phlebotomists are: Trish Rogers, Wedad Cox, Lena Rooker and Lesley Holt.

We are dependant on the hospital collection service for transporting the samples to the laboratory for testing, therefore blood test appointments are only available weekdays between 8.30am and 11.30am. Blood testing is not available at the surgery on a Saturday or during routine nurse clinics except at the request of a GP. Please note we do not do tests on young babies.

The hospital drop-in phlebotomy services are as follows:

Broomfield Hospital Monday – Friday 8.00am – 4.45pm
St John’s Hospital Monday – Friday 8.00am – 4.00pm
St Michael’s Hospital Monday – Friday 9.00am – 4.00pm
St Peter’s Hospital Monday – Friday 9.30am – 1.00pm

Cervical Smears

The health authority sends reminders to patients when they are due to have a cervical smear test. Female patients aged between 25 and 50 are called every 3 years and patients aged between 50 and 65 every 5 years. These tests are performed by one of our nurses. A 10-minute appointment is required and you should be mid-cycle at the time of testing.

Child Health Checks

Gps carry out a child health check on babies at approximately 8 weeks of age.  This is usually done at the same time as the Mother's post natal check prior to the first immunisations.

Child Health Clinics

These are walk in clinics and are manned by the health visiting team.

They run as follows:

Little Waltham Patients
Every 2nd and 4th Friday of every month between 1.30pm and 3.00pm in the memorial hall opposite the surgery
The Health visitors can be contacted on 01245 458863.

Great Notley Patients
One Stop Shop Self Weighing is available at Seesaw Children's Centre tel: 01376 555260 or Carousel Children's Centre, tel: 01376 556863.  Please phone for additional clinic information.

Coils

Patients requiring a coil fitting will need a 10 minute appointment for a swab to be taken. This can be done by a nurse and can be done at any time except during a menstrual period. Once the swab results have been returned to the surgery a 20 minute appointment will be needed with Nurse Lisa. Coils can only be fitted within the first 5 – 7 days of the menstrual cycle. If you require a coil change it is necessary to abstain from sexual intercourse or use a condom for 7 days prior to the change.

Counsellor

Amanda Hollingworth currently works 2 sessions per week for our surgery. Unfortunately her time with us is very limited and so you will therefore need a referral from a GP before you can be seen. Please note that there is a 6 month waiting list.

Ear Syringing

All our nurses are trained on ear syringing. If you would like your ears checked for this please make an appointment with a nurse. Please note that for successful ear syringing it is recommended that you soften the ear wax with olive oil for a week prior to your appointment

ECG

This is a tracing of the rhythm of your heart and can be carried out by a nurse or a health care assistant. You will need a referral from a GP before this can be done. Please book an appointment at reception

Family Planning

Advice can be sought from both the doctors and nurses.  We provide the following services:

• emergency contraception
• combined contraceptive pill
• progesterone only pill (mini)
• IUCD and IUS (coils)
• depot contraception (depo-provera)
• diaphrams
• condoms
• general advice

Immunisations

For full details see our practice information page 'Immunisations'.

Ischaemic Heart Disease

Sharron Murphy and Frances Tierney currently hold annual reviews for patients with ischaemic heart disease. All diabetic patients will have this check up incorporated into their diabetic check. If you have not had a recent check up with your GP you will be asked to attend a 20 minute appointment with Sharron or Frances. At least 2 weeks prior to this you will be asked to have a blood test (fasting glucose and lipids, renal and liver function tests).

INR

Both surgeries offer a same day INR service – this is carried out by our health care assistants and nurses who work under close supervision of the doctors. Alternatively patients are able to attend the anticoagulation clinic at Broomfield Hospital.

Minor Surgery

The practice offers regular minor surgery clinics at Great Notley Surgery covering procedures such as removal of sebaceous cysts, suspicious moles and ingrowing toenails.  Unfortunatley we are unable to carry out what may be considered cosmetic surgery, such as the removal of skin tags, except in special circumstances.

Maternity Care

Maternity care is supported either by St. Johns Hospital or the William Julien Courtauld Hospital. We have midwives who attend our surgery. We encourage all ladies to book a 20 minute first antenatal appointment at approximately 8-9 weeks of pregnancy with a GP. At this stage a referral will be made to a midwife who will then contact you to arrange your first midwife appointment. You will receive an appointment in the post for your first antenatal scan at approximately 13-14 weeks of pregnancy.

We prefer patients at our practice to have shared care with the midwives, which means that you should alternate all antenatal appointments between your GP and the midwives.

Midwife Clinics (by appointment)
Little Waltham Surgery – Thursday – from 2pm
Great Notley Surgery – Midwife clinics are held at William Julian Courtauld Hospital - tel: 01376 308586

For more information see Community Midwives

Nurse Practitioner

Our nurse practitioner has a background of practice nursing with the addition of extended training for diagnosis and treatment of illnesses such as earache, sore throats, conjunctivitis, upper respiratory tract infections, gastro-enteritis, cystitis and urinary tract infections and minor injuries. She works closely alongside our GPs and is available to give telephone advice.

Physiotherapy

Jill Baylis currently works on behalf of the practice to provide 2 surgeries per week as described below. Unfortunately due to the demand on her time she can only offer a very limited number of appointments per person so that she may do an assessment and take people through and advise them on treatment. She has no capacity for more long term chronic care – this will need to be arranged through our local hospital unit. You will need to be referred to her by a doctor or a nurse.

Physiotherapy appointments
Tuesday 16.00 – 19.00 (Little Waltham Surgery)
Thursday 13.00 – 16.30 (Great Notley Surgery)

Smoking Cessation

We have a number of nurses trained to give smoking cessation advise Please contact reception for an appointment. Alternatively your local Primary Care Trust offers both group and individual therapy. Please see a GP or nurse if you would like to be referred to this.

Spirometry

Lisa Bell and Alison Studd are our trained spirometry nurses. Spirometry is a test to assess breathing difficulties and is used in the diagnosis of Chronic Obstructive Airways Disease (COPD). The test takes about 40 minutes to carry out and you will need to be referred by your GP.

How is it done?

You breathe in fully and then seal your lips around the mouthpiece of the spirometer. You then blow out as fast and as far as you can until your lungs are completely empty. This can take several seconds. You may also be asked to breathe in fully and then breathe out slowly as far as you can.

A clip may be put onto your nose to make sure that no air escapes from your nose. The above routine may be done two or three times to check that the readings are much the same each time you blow into the machine.

Prior to testing you should avoid the following:

• Smoking for 24 hours
• Wearing restrictive clothing
• Vigorous exercise for 30 minutes
• Eating large meals for 2 hours
• Taking short-acting bronchodilators (inhalers) for 4 hours
• Taking long-acting B2-agonists for more than 12 hours
• Taking Anticholinergics for 6 hours or long acting anticholinergics for 24 hours
• Taking sustained release Theophylline for 24 hours

Patients must be clinically stable for 4 – 6 weeks prior to testing.

Wart Clinic

This clinic runs every three weeks and is run by Nurse Sharron at Great Notley surgery. You will need to be referred to this clinic by a nurse or a doctor. Patients are seen by appointment only.

It's easy to take your health for granted.
By following a healthy lifestyle you can reduce the risk of getting seriously ill. You will feel better and it will help improve your immune system.

ALCOHOL
In small quantities, alcohol can actually be beneficial to health. In large quantities, on a regular basis, it can have a very serious negative effect on health. At one extreme it can kill. CIRRHOSIS of the liver, for instance, is killing an increasing number of people, as are drivers who are over the limit.

• An accepted safe limit is 28 units a week for men and 21 units for women, a unit being approximately a glass of wine, half a pint of beer or a single measure of spirit
• This recommended maximum presumes that the consumption is spread throughout the week and not consumed all at once in a 'binge'
  

SMOKING

• Over 100,000 people die each year in the UK from smoking-related diseases
• Every cigarette you smoke can shorten your life by an average of five and a half minutes
• Babies of smokers are, on average, 200 grammes smaller than those of non smokers
• Smokers smell!

HOW TO GIVE UP
Stopping smoking is all about motivation. Without the real desire to give up you are unable to succeed. You must want to give up rather than feel you should give up.

• Set a date a week or so in the future when you intend to stop
• Tell all your friends, relations and work colleagues that you're giving up on that day and ask for their support and encouragement. If at all possible, find someone to give up with you
• When the big day comes, plan it carefully with plenty to keep you occupied. Avoid situations where the desire to smoke will be strongest such as whilst drinking
• Finally, carefully put the money you would have spent on cigarettes on one side, each day, to save up for some special treat as a reward
  If you've tried everything and failed but are still keen to give up, seek help from our trained smoking cessation nurses.

DIET
If your diet is lacking, your body has ways of letting you know, for example, you may be overweight or underweight or you may have a spotty complexion or constipation. Ultimately, a bad diet can lead to serious problems such as heart disease.

• A good diet helps fight off disease and makes you look and feel good

EIGHT WAYS TO KEEP HEALTHY

BLOOD PRESSURE
Has yours been checked in the past five years?

OVERWEIGHT
Some people are overweight - others are "undertall". Chances are you weigh more than you should.

SMOKING
More and more people are giving up smoking. There are various programmes available to help you give up.

EXERCISE
Regular exercise has both physical and mental benefits.

RELAXATION
Tension and anxiety can be helped by a psychologist or counsellor.

ALCOHOL
Can make a good servant but a bad master.

CERVICAL SMEARS
We recommend women should have regular three yearly cervical smears.

TETANUS PREVENTION
We will check if you are immune and bring your cover up to date.
MUSCLE AND JOINT PAIN
Pain in muscles and joints are common and seldom need to be treated by a doctor.

WHAT TO LOOK FOR

• Stiffness and pain especially with movement

CAUSES

• Strain due to overexertion
• Injury
• Inflammation
• Wear and tear
  

TREATMENT AT HOME FOR MUSCLE PAIN

• Massage affected part and keep it warm
• Rest
• Take painkillers such as paracetamol or ibuprofen
  

TREATMENT AT HOME FOR JOINT PAIN

• Rest the sore joint
• Take painkillers as for muscle pain
  

STRAINS AND SPRAINS
RICE -

Rest the injured part
Ice wrapped in a cloth - or a bag of frozen peas - can be used to reduce the swelling. But do not apply for longer than 15 minutes at a time.
Compress the injury gently with a bandage
Elevate the injured part

WHEN TO SEE YOUR DOCTOR

• If the pain in the joint or muscle does not improve after three days
• If the joint looks deformed
• If mobility is badly affected

• Back Pain
• Meningitis
• Chicken Pox, Measles, Mumps
• Managing Children’s Temperatures
• Preparing For Pregnancy
• First Aid Kit

Back Pain

Back pain causes 13 million working days to be lost in Britain each year. The spine, being made up of 24 fragile bones and associated cartilage and tendons, supports the whole weight of the upper body, and therefore it is understandable that it sometimes goes wrong. Because of the complex nature of the spine it is advisable to consult your doctor if back pain persists for more than a few days. If, as is usual, the pain has been caused by abuse, i.e. lifting too heavy weights etc., be sensible and take things easy. Take care to sit as upright as possible with a support for the small of the back. Take aspirin or paracetamol, which will not only relieve the pain, but will help to relieve inflammation. Your doctor may well prescribe stronger drugs, heat treatment, gentle exercise or physiotherapy.

MOST BACK PAIN IS CAUSED BY

• Stiffness or spasm of the muscles caused by sleeping in an uncomfortable position
• Doing activities you are not used to

• Being overweight
• Pregnancy
• Incorrect lifting techniques
• A disc between the base of the spine moving out of position or pressing on a nerve

• Pain of the upper or lower back
• Pain spreading from the back of the thigh to the ankle (sciatica)

• Keeping active
• Keeping to a healthy weight
• Sleeping on a firm mattress
• Lifting heavy weights correctly - crouch down, straighten knees and keep your back straight

• Stay in bed, but no longer than one or two days
• Massage the painful area; apply heat
• Take painkillers
• Exercise gently
  

Meningitis

This is a rare illness that is most common in babies, children under four years and teenagers, and requires urgent attention. It is important to be aware of the symptoms, which we have listed below.
Signs and symptoms in BABIES and VERY YOUNG CHILDREN are:

• Difficulty waking
• A high pitched cry that is different from a normal cry
• Repeated vomiting
• Refusing feeds
• Pale or blotchy skin, especially with red or blue/black bruises that don't go white when you press on them
• Tight or bulging soft spot on the top of your baby's head
  If you are in any doubt contact your doctor immediately.

• A high temperature
• A constant headache
• Vomiting
• Drowsiness or confusion
• Dislike of bright lights
• Stiffness of the neck (moving their chin to the chest will be particularly painful)
• A rash of red/blue spots or bruises that don't go white when pressed with a tumbler
  

If you are in any doubt contact your doctor immediately. 
  

Chicken Pox, Measles, Mumps

CHICKENPOX
On the first day a rash appears as small red patches about 3-4mm across and a slight temperature may develop. Within a few hours, small blisters appear in the centre of these patches. During the next three or four days further patches will appear and the earlier ones will turn 'crusty' and fall off.

• Calamine lotion may be applied to soothe the often severe itching
• Cool baths may also help
• The most infectious period is from two or three days before the rash appears and up to five days after this date. Children may return to school as soon as the last 'crusts' have dropped off

• It is infectious from two days before the rash appears, until the rash disappears in about four or five days from that date
• The only danger is to unborn babies and, therefore, it is important that all contacts are informed in order that anyone who may be pregnant can contact their doctor
• Immunisation can prevent this disease

MEASLES
This usually causes high temperature, cough and sore eyes, before the typical rash appears. The rash is red, blotchy and occurs on the face and trunk around the fourth day of illness. It is contagious from two or three days before the rash apears until 10 days after the rash began. Severe illness is unusual, but complications can occur, so consult your doctor.
o Immunisation can prevent this disease

MUMPS
Symptoms are: Swelling of the gland in front of one ear often followed, after a couple of days by swelling in front of the other ear. It is infectious from two or three days before the swelling appears until eight to ten days after that date If the pain is severe you should consult your doctor.
o Immunisation can prevent this disease

Managing Children’s Temperatures

A child will develop a fever because of an infection. Usually the child will get over such an infection without the need for antibiotics. Viruses cause most childhood infections and these do not respond to antibiotics. The following advice will help to bring your child's temperature down and make them feel better.
1. Always keep a supply of paracetamol syrup (Calpol, Disprol) at home. If you wait until you need it, there will be none close at hand.
2. If your child feels hot or appears unwell:-
a) Give the maximum dose of paracetamol stated for a child of that age.
b) Dress your child in cool clothes. A lot of heat is lost through a child's head, so leave it uncovered. Cool down the room by opening doors and windows.
c) Give your child plenty of cool drinks, as fluid is lost with a fever. If they are reluctant to drink, encourage small amounts from a favourite cup.
d) Sponging your child down with a tepid flannel will make them feel better as well as bringing their temperature down. Using tepid water is more effective than using cold water.
e) Repeat the dose of paracetamol every four hours as necessary, up to the maximum daily dose stated.
f) A child with a fever is likely to be restless at night. Offer cool drinks and sponge them down if they wake.
g) If your child does not improve after giving paracetamol and sponging, or appears particularly ill, call the doctor.
3. Very rarely, a child under five years will have a convulsion with a high temperature. They will shake all over and become very still. It usually subsides in less than five minutes. Lie the child on their side and stay with them while it lasts. If there is another adult in the house, ask them to phone a doctor. If not, call when the convulsion has passed.

Preparing For Pregnancy

If you are planning to start a family you must, of course, cease contraception. If you are taking the pill you should change to a barrier method for a period of at least three months. This is to allow for the normal hormone levels and egg production cycle to re-establish itself.
If you smoke, both you and your partner should stop. A woman who smokes during pregnancy stands a 30% greater risk of miscarrying or losing the baby at birth due to a variety of complications.
You should also ensure that your alcohol consumption is kept to an absolute minimum if you are unable to abstain totally.
Both partners should give attention to their diet with particular regard to choosing fresh unrefined foods.
Ask your doctor to check if you are immune from rubella (German measles). If not, he will arrange immunisation. In such a case you should continue with a barrier method of birth control for a period of at least two months whilst the vaccine takes effect.
Unless you've had one during recent months it is advisable to arrange for a smear test to ensure you have a healthy cervix prior to becoming pregnant.

PROBLEMS CONCEIVING
One in ten couples experience some degree of difficulty in conceiving. This difficulty may equally be caused by a problem concerning either partner. The causes of infertility are wide and varied but most can be helped with treatment. Good pre-conceptual care will lessen the need for such treatment.

Family First Aid Kit

Here is a list of useful medicines and dressings with a description of their uses. All are quite cheap and worth stocking at home in readiness for minor illnesses.
Keep them in a box or cupboard with a lock - or store them well out of the reach of children.

Soluble Aspirin Tablets
Good for headaches, colds, sore throats (gargle with the solution), and pains in general. Aspirin should NOT be given to children under 16.

Paracetamol Mixture
For relief of pain or fever in young children

Sedative Cough Linctus
For dry or painful coughs - but not coughs caused by common colds.

Menthol Crystals
Add to hot water to make steam inhalations for treating catarrh and dry or painful coughs.

Vapour Rub
Again, for steam inhalations. Also useful for children with stuffy noses or dry coughs. Rub on the chest and nose.

Ephedrine Nose Drops
For runny noses in children over one year old. Use before meals and at night but not for more than four days.

Antiseptic Solution
One teaspoon diluted in warm water for cleaning cuts and grazes.

Antiseptic Cream
For treating septic spots, sores in the nose amd grazes.

Calamine Lotion
For dabbing (not rubbing) on insect bites, stings and sunburn.

Dressing Strips
For minor cuts.

3" Wide Crepe Bandage
To keep dressings in place. To support sprained or bruised joints.

Cotton Wool
For cleaning cuts and grazes.

Thermometer
For fevers.

Tweezers
For removing splinters.

Remember that your local chemist can give you advice about medicines

If you require any vaccinations relating to foreign travel you need to make an appointment with the practice nurse to discuss your travel arrangements.  This will include which countries and areas within countries that you are visiting to determine what vaccinations are required.

Information about countries and vaccinations required can be found on the links below:

Europe & Russia	North America
Central America	South America
Carribean	Africa
Middle East	Central Asia
East Asia	Australasia and Pacific

It is important to make an appointment as early as possible  - at least 6 weeks before you travel.

Most travel vaccines are ordered on a private prescription and these incur a charge over and above the normal prescription charge.  This is because travel vaccination is not included in the services provided by the NHS and therefore is a chargeable service.