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Referral forms

Please click on the appropriate links below to download referral forms.

Radiology

General X-Ray request form (updated)

Additional Guidance Letter Letter to accompany new x-ray request form regarding bowel cleansing preparations (updated)

Open Access Ultrasound request form  (updated)

Request for Ultrasound Scan in Pregnancy

TVS Open Access Gynae request form

Attendance information - Open Access (plain film imaging)

Attendance information - Open Access Ultrasound

Attendance Information - TVS Open Access Gynae Scan March 2012

Referral guidelines can be found in the Radiology section of this website, accessed through our clinical services.

Endoscopy (to be returned by post)

Short term closure of UHB for routine endoscopies which are eligible for other providers.

UHBristol is entering a period of reduced endoscopy capacity.  The Trusts have approached Bristol, South Gloucestershire and North Somerset CCGs to request that eligible routine scopes be referred to other providers, and are not referred to UHB for a short period.

This is a short term issue to ensure that capacity continues to be available to scope urgent and 2WW patients quickly over the next 3 months.

BNSSG CCGs have contacted other endoscopy providers, and have confirmed that capacity is available.  GPs are asked to support UHB Endoscopy departments during this time by referring suitable patients to other providers.

There are several options available to patients who need endoscopy and the information below provides the latest information on referral choices.

Please note that this does not change referral routes for 2 week wait referrals, urgent referrals or patients who do not meet the eligibility criteria for endoscopy at an alternative provider.

Routine Endoscopy Referral, options for BNSSG Practices

  • All endoscopy referrals (other than 2WW referrals) should be submitted on one of the forms via eReferral.
  • EGTC and PRIME also offer a duodenal biopsy service for patients with suspected coeliac disease. These forms are based on the Care UK referral form and are accepted by Emerson's Green, PRIME or Nuffield so that patients referred using this form will have a choice of provider.

Referral options are:

  • Emerson's Green NHS Treatment Centre via eReferral - fast access to upper and lower GI endoscopy but you must complete the referral form in order to access this service. This form can also be faxed directly to the provider.
  • Prime Endoscopy (Westbury-On-Trym) via eReferral- Prime will accept referrals on a Care UK referral form (preferred option) or on their own referral form or a dictated letter with all relevant details.
  • Nuffield Hospital, Bristol - via eReferral. Ideally also using one of the forms below.

The South Gloucestershire GP Referral Tool will be updated to reflect this temporary change.

Governance

Please be assured this has been agreed with all Providers named herein, in a number of forums where CCG staff are members and present, these include:

  • NBT Access and Performance Group
  • UHBristol Access and Performance Group
  • BNSSG RTT Programme Board
  • BNSSG Partnership

Care UK Lower Gastrointestinal Endoscopy Referral Form

Care UK Routine Gastroscopy Referral Form

UH Bristol Colorectal request form

UH Bristol Gastroscopy request form

University of Bristol Dental Hospital referrals

Please see here for the dental hospital's referral forms.

Request of sinus Xray/CT sinuses