Diagnostics
Diagnostics is an ever-changing field of medicine and research, challenged with combining several different scientific disciplines into one for the sake of diagnosis and treatment of human disease.
Pathology
Vaginal discharge is normal – most women and girls get it. It's a fluid or mucus that keeps the vagina clean and moist, and protects it from infection. If the discharge changes – for example, in smell, colour or texture – it might be a sign of an infection. There’s more information on the NHS website. Referral information for GPs is here.
Faecal calprotectin testing is recommended by NICE as an option to help doctors distinguish between inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, and non-inflammatory bowel diseases, such as irritable bowel syndrome. You can find out more in this patient leaflet. More information for GPs is here and here.
Diarrhoea and vomiting are common in adults, children and babies. You can have them together or on their own. They're usually caused by a stomach bug and should pass in a few days. However, you may be highly infectious. There’s more information on the NHS website. Referral information for GPs is here.
GPs should click here for information, compiled by York Teaching Hospital NHS Foundation Trust.
The menopause can be diagnosed in women who have not had a period for at least 12 months and are not using hormonal contraception. There’s more information for GPs, here.
Clinicians should click here for guidance on selecting the right test in the right bottle.
UTIs can affect different parts of your urinary tract, including your bladder (cystitis), urethra (urethritis) or kidneys (kidney infection). Most UTIs can be easily treated with antibiotics. There’s more information on the NHS website. Referral information for GPs is here.
A leg ulcer is a long-lasting (chronic) sore that takes more than four to six weeks to heal. They usually develop on the inside of the leg, just above the ankle. The symptoms of a venous leg ulcer include pain, itching and swelling in the affected leg. There may also be discoloured or hardened skin around the ulcer, and the sore may produce a foul-smelling discharge. There’s more information about venous leg ulcers on the NHS website. Referral information for GPs is here (see also surgical pathway).
Radiology
GPs should click here for the General Commissioning Policy for the investigation of acute back pain with potentially serious (red flag) features.
GPs should click here for the General Commissioning Policy for the investigation of acute back pain without potentially serious features.
GPs should click here for the General Commissioning Policy for the investigation of chronic lumbar back pain with no clinical or serological indicators of infection or neoplasia.
There is new RSS guidance for patients with suspected groin hernia. The CCG and local surgeons do not want patients to be referred for ultrasound first, but instead they should be referred to the surgeons for an opinion.
This might seem contrary to a desire to do more in primary care, however, experience has shown that USS are a poor diagnostic indicator of doubtful hernia, unless done by experienced ultrasonographers and many get referred to the surgeons anyway, where often scans have to be repeated or other investigations done.
The new guidance has been written by CCG GPs, radiologists and general surgeons. From now GPs should not use direct access to ultrasound scan requests for groin hernias. It is thought that there are approximately 500 scans requested for this by GPs across Scarborough and Ryedale and Vale of York and the hospital are confident on a significant reduction of scans if the guidance is adopted.
This will contribute to reducing the radiology waiting list and also the number of scans undertaken by Yorkshire Health Solutions (YHS) at additional cost (outside of the current York Teaching Hospital NHS Foundation Trust contract).
GPs should click here for the General Commissioning Policy for the investigation of chronic headaches.
GPs should click here for the General Commissioning Policy for the investigation of severe, sudden onset headache, subarachnoid haemorrhage.
GPs should click here for the General Commissioning Policy for the investigation of knee pain with locking.
GPs should click here for the General Commissioning Policy for the investigation of knee pain without trauma, locking or restriction of movement.
GPs should click here for the General Commissioning Policy for the investigation of non traumatic hip pain including suspected avascular necrosis.
For guidance on the imaging and management of back pain, please click here.
GPs should click here for the General Commissioning Policy for the investigation of thoracic spine pain without trauma; degenerative disease.