Surgery clinics

Bowel cancer is a term used to describe cancer in the colon, rectum or the small bowel.

The symptoms of bowel cancer can include:

• Bleeding from the back passage (rectum) or blood in your stools
• A change in normal bowel habits to diarrhoea or looser stools, lasting longer than 4 to 6 weeks
• A lump that your doctor can feel in your back passage or abdomen (more commonly on the right side)
• A feeling of needing to strain in your back passage (as if you needed to pass a bowel motion)
• Losing weight
• Pain in your abdomen or back passage
• A lower than normal level of red blood cells (anaemia)

Because bowel tumours can bleed, cancer of the bowel often causes a shortage of red blood cells. This is called anaemia and may cause tiredness and sometimes breathlessness.

How do I get a screening kit?

If you are aged 60 to 69 years, you will be sent your screening invitation automatically through the post. All you need to do is make sure that your GP has your correct address.

‘People aged 70 years and over or under the age of 60, who wish to be screened, should request a kit. Simply telephone the free helpline on 0800 707 60 60.’

The National Breast Screening Programme was introduced in 1988 as an early detection service for breast cancer. It states that all women who are aged between 50 to 70 years of age will be routinely invited for free breast screening every three years. The programme is very successful and currently saves around 1,400 lives per year.

Breast screening aims to find breast cancer at an early stage, often before there are any symptoms. To do this, an x-ray is taken of each breast (mammogram). Early detection may often mean simpler and more successful treatment. When women are invited for their mammogram depends on which GP they are registered with, not when their birthday is.

The screening office runs a rolling programme which invites women by area. The requirement is that all women will receive their first invitation before their 53rd birthday, but ideally when they are 50. If you are under 50 and concerned about any aspect of breast care, please contact the surgery to make an appointment with your GP.

Useful links:

• West London breast screening

We offer a range of clinics and services here at Stanmore Medical Centre to help with cancer screening.

Macmillan Cancer Support

Have questions about cancer? Visit www.macmillan.org.uk or call 0808 808 000 free (Monday to Friday 9am to 8pm).

Cervical screening, or smear test, is a method of detecting abnormal (pre-cancerous) cells in the cervix in order to prevent cervical cancer. The cervix is the entrance to the womb from the vagina. Cervical screening is recommended every three years for women aged 25 to 49 and every five years for women aged 50 to 64 or more frequently if smear results indicates abnormal changes.

Cervical screening is not a test for cancer; it is a test to check the health of the cells of the cervix. Most women’s test results show that everything is normal, but for 1 in 20 women the test will show some abnormal changes in the cells of the cervix.

Most of these changes will not lead to cervical cancer and the cells may go back to normal on their own. However, in some cases, the abnormal cells need to be treated to prevent them becoming cancerous.

Our nurses are qualified to carry out cervical screening and tests in the form of cervical smears. In order to have a cervical smear the patient must have received a letter requesting that they have a cervical smear and the appointment must please be made for when the patient is not menstruating.

These appointments typically take around 15 minutes. For any further information or to book an appointment, please call the surgery.

Useful links

• NHS Choices – cervical screening
• Jo’s cervical cancer trust

While it is commonly believed that depression only effects adults, around 10% of children in Great Britain aged between 5 and 16 have a recognisable mental disorder; with about 4% of children suffering from an emotional disorder such as anxiety or depression.

The problem for many is that depression is difficult to spot and often regarded as teenage mood swings. However, if your child is appearing to have an extreme emotional response to a life event or has lost interest in activities which previously interested them they may be suffering from an emotional disorder.

If you are worried about your child’s mental health please visit your GP, who will be able to offer a range of support to help both you and your child. There are a range of talking therapies which are highly effective in dealing with both short term and long term depression, for more information on these therapies please view the NHS Talking Therapy Guide.

Useful links

• Barnardo’s mental health support for children and adolescents
• Mind- mental health charity
• Sane – mental health support
• Rethink mental illness
• Kooth (11 – 18 year olds)

Childhood immunisations

One of the most important things that a parent can do for their child is to make sure that they have all their routine childhood vaccinations. It’s the most effective way of keeping them protected against infectious diseases.

Ideally, children should have their jabs at the right age to protect them as early as possible and minimise the risk of infection.

Find out which jabs your child needs, when they need them, and what the benefits of each jab are.

Please call the surgery to make an appointment.

For more information please visit the websites below:

Useful links

• NHS choice – vaccinations for you and your family
• Childhood immunisation schedule
• National immunisation schedule

The most common symptoms of coronary heart disease (CHD) are chest pains (angina) and a heart attack.

You can also experience other symptoms, such as palpitations and unusual breathlessness. In some cases, people may not show any symptoms before they are diagnosed.

Angina

If your coronary arteries become partially blocked, it can cause chest pain (angina). This can be a mild, uncomfortable feeling similar to indigestion.

However, a severe angina attack can cause a painful feeling of heaviness or tightness, usually within the centre of the chest, which may then spread to the arms, neck, jaw, back or stomach.

Angina attacks are often triggered by physical activity or stressful situations. Although symptoms of Angina usually pass within 10 minutes, you can alleviate the symptoms by resting or using a nitrate tablet or spray.

Heart attacks

If your arteries become completely blocked, it can cause a heart attack (myocardial infarction). Heart attacks can cause permanent damage to the heart muscle and, if not treated straight away, can be fatal.

If you think you are having a heart attack, dial 999 for immediate medical assistance.

Although symptoms can vary, the discomfort or pain of a heart attack is usually similar to that of angina but often more severe. During a heart attack you may also experience the following symptoms:

• Sweating
• Light-headedness
• Nausea
• Breathlessness

The symptoms of a heart attack can be similar to indigestion. For example, they may include a feeling of heaviness in your chest, a stomach ache or heartburn. However, these symptoms can also be accompanied by a pain that affects the arms (particularly the left arm), the neck and the jaw.

A heart attack can happen at any time, including while you are resting. If heart pains last longer than 15 minutes, it may be the start of a heart attack.

Unlike angina, the symptoms of a heart attack are not usually relieved using a nitrate tablet or spray.

In some cases, you may have a heart attack without any symptoms, called a silent myocardial infarction. This is more common in people with diabetes.

Heart failure

Heart failure can also occur in people with CHD when the heart becomes too weak to pump blood around the body, which can cause fluid to build up in the lungs that makes it increasingly difficult to breathe.

Heart failure can happen suddenly (acute heart failure) or gradually over time (chronic heart failure).

Useful links

• British Heart Foundation – Angina
• British Heart Foundation – Cardiovascular Disease
• British Heart Foundation – Heart Attack

Diabetes is a long term condition caused by too much glucose, a type of sugar, in the blood. It is also known as diabetes mellitus.

There are two main types of diabetes, which are explained below:

• Type I diabetes
• Type II diabetes

Normally, the amount of sugar in the blood is controlled by a hormone called insulin, which is produced by the pancreas. The pancreas is a gland behind the stomach. When food is digested and enters your bloodstream, insulin moves any glucose out of the blood and into cells, where it is broken down to produce energy.

However, in people with diabetes, the body is unable to break down glucose into energy. This is because there is either not enough insulin to move the glucose, or because the insulin that is there does not work properly.

Our specialist diabetes team will provide you with support, regular reviews and the day to day care of your needs.

All diabetic patients are entitled to an annual review. The practice will normally contact you if yours is due. The review takes place in two parts, a data collection appointment and where appropriate, a follow up care plan appointment. If you feel you have been missed, or require a more urgent review, then please contact the practice to arrange an appointment.

At the initial data collection appointment, your blood pressure, weight, urine, feet and wellbeing will be checked. It is necessary for you to bring an early morning urine sample with you. Following your initial appointment, a care plan booklet will be sent to you and if necessary, an appointment with your GP or one of our specialist nurses will be arranged.

For more information please visit the websites below:

Useful links

• Diabetes UK

Hypertension relates to high blood pressure.

High blood pressure often causes no symptoms, or immediate problems, but it is a major risk factor for developing a serious cardiovascular disease (conditions that affect the functioning of the heart and the circulation of blood around the body), such as a stroke or heart disease.

Useful links

• NHS Choices – High Blood Pressure Explained
• Blood Pressure Association
• British Heart Foundation
• British Hypertension Society

Our respiratory clinics are primarily intended for patients with asthma and COPD.

Asthma is caused by inflammation of the airways. These are the small tubes, called bronchi, which carry air in and out of the lungs. If you have asthma, the bronchi will be inflamed and more sensitive than normal. Our practice nurses have specialist asthma qualifications. During their clinics they monitor your overall condition, offer advice, answer any queries and ensure your treatment is effective.

Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease. People with COPD have trouble breathing in and out. This is referred to as airflow obstruction. Breathing difficulties are caused by long-term damage to the lungs, usually because of smoking.

Asthma and COPD clinics

We hold clinics to diagnose and to help patients to manage their asthma or COPD.

We like to see all our patients who have been diagnosed with these conditions at least once a year, depending on the severity of your condition, we may invite you to come to the clinic more often in order to ensure we give you the care you require.

Useful links

• NHS Choices – Asthma
• The British Lung Foundation
• Asthma UK
• NHS Choices – COPD

Male pattern baldness is the most common type of hair loss, affecting 6.5 million men in the UK.

It generally starts with a little thinning of the hair, followed by wider hair loss, allowing more of the scalp to become visible.

For a few men, this process starts as early as the late teens. By the age of 60, most men have some degree of hair loss.

Some men aren’t troubled by this at all. Others, however, suffer great emotional distress associated with a lack of self esteem and, in some cases, depression.

Useful links

• NHS Choices – Hair Loss Treatments

Prostate cancer is the most common cancer in men in the UK, with over 40,000 new cases diagnosed every year.

Prostate cancer usually develops slowly, so there may be no signs you have it for many years.

Symptoms often only become apparent when your prostate is large enough to affect the urethra (the tube that carries urine from the bladder to the penis).

When this happens, you may notice things like an increased need to urinate, straining while urinating and a feeling your bladder has not fully emptied.

However, these signs do not mean you have prostate cancer. It is more likely they are caused by something else, such as benign prostatic hyperplasia (also known as BPH or prostate enlargement).

What is the prostate?

The prostate is a small gland in the pelvis found only in men. About the size of a satsuma, it is located between the penis and the bladder. It surrounds the urethra, the tube that carries urine from the bladder to the penis.

The main function of the prostate is to help in the production of semen. It produces a thick white fluid that is mixed with the sperm produced by the testicles, to create semen.

Although still rare compared to other cancers, testicular cancer is the most common cancer in men aged between 15 to 45 years with around 2,200 to 2,300 men being diagnosed each year. It is more common in Caucasian males.

If found at an early stage a cure rate of 98% is usually possible and even when testicular cancer has spread to other areas of the body cure can still be achieved. In fact according to recent research overall 96% of men diagnosed with any stage testicular cancer will be alive 10 years after treatment.

It is important to visit your GP as soon as you notice any lump or swelling on your testicle. Your GP will examine your testicles to help determine whether or not the lump is cancerous.

Symptoms

The earliest warning signs of testicular cancer usually include the following:

• A change in size or shape of a testicle.
• Swelling or thickening of a testicle.
• A firm, smooth, initially painless, slow-growing lump or hardness in a testicle.
• A feeling of testicular heaviness.

Useful links

• Orchid – Fighting Male Cancer
• Your Privates – Testicular Cancer Awareness
• NHS Choices – Testicular Cancer

Certain small surgical operations can be performed at the surgery. With minor surgery the recovery time is usually short and you will be back to your usual activities fairly quickly (depending on your procedure).

Before attending for minor surgery you will need to see a doctor for the diagnosis and then you will be given an appointment to attend for your procedure.

Please note we do not offer minor surgery for cosmetic purposes.

Everyone is at risk of developing heart disease, stroke, diabetes, kidney disease and some forms of dementia. The good news is that these conditions can often be prevented – even if you have a history of them in your family. Have your free NHS health check and you will be better prepared for the future and be able to take steps to maintain or improve your health.

Visit NHS Choices – Health Checks for further information.

Why do I need an NHS health check?

We know that your risk of developing heart disease, stroke, type 2 diabetes, kidney disease and dementia increases with age. There are also certain things that will put you at even greater risk. These are:

• being overweight
• being physically inactive
• not eating healthily
• smoking
• drinking too much alcohol
• high blood pressure
• high cholesterol

Both men and women can develop these conditions, and having once could increase your risk of developing another in the future.

• In the brain a blocked artery or a bleed can cause a stroke.
• In the heart a blocked artery can cause a heart attack or angina.
• The kidneys can be damaged by high blood pressure or diabetes, causing chronic kidney disease and increasing your risk of having a heart attack.
• Being overweight and physically inactive can lead to type 2 diabetes.
• If unrecognised or unmanaged, type 2 diabetes could increase your risk of further health problems, including heart disease, kidney disease and stroke.

What happens at the check?

• This check is to assess your risk of developing heart disease, type 2 diabetes, kidney disease, and stroke.
• The check will take about 20 to 30 minutes.
• You’ll be asked some simple questions. For example, about your family history and choices which may put your health at risk
• We’ll record your height, weight, age, sex, and ethnicity.
• We’ll take your blood pressure.
• We’ll do a simple blood test to check your cholesterol level.

What happens after the check?

• We will discuss how you can reduce your risk and stay healthy.
• You’ll be taken through your results and told what they mean. Some people may be asked to return at a later date for their results.
• You’ll be given personalised advice on how to lower your risk and maintain a healthy lifestyle.
• Some people with raised blood pressure will have their kidneys checked through a blood test.
• Some people may need to have another blood test to check for type 2 diabetes. Your health professional will be able to tell you more.
• Treatment or medication may be prescribed to help you maintain your health.

What happens after the check?

Why do I need this check? I feel fine!

The NHS health check helps to identify potential risks early. By having this check and following the advice of your health professional, you improve your chances of living a healthier life.

But don’t these conditions run in the family?

If you have a history of heart disease, stroke, type 2 diabetes, or kidney disease in your family then you may be more at risk. Taking action now can help you to prevent the onset of these conditions.

I know what I’m doing wrong. How can the doctor help me?

If you would like help, we will work with you to find ways to eat healthily, reach your healthy weight, be more active, cut down your drinking, or stop smoking.

If I am assessed as being at ‘low risk’, does this mean I won’t develop these conditions?

It is impossible to say that someone will or won’t go on to develop one of these conditions. But taking action now can help you lower your potential risk.

Will everyone has this check?

This check is part of a national scheme to help prevent the onset of these health problems. Everyone between the ages of 40 and 74 who has not been diagnosed with the conditions mentioned will be invited for a check once every five years. If you are outside the age range and concerned about your health, you should contact your GP.

Antenatal care is the care and help you receive from health professionals during the course of your pregnancy. It is important you take good care of your own health and that of your unborn baby during pregnancy.

As soon as you find out you are pregnant, you should get in touch with us to find out more information on the services and support that are available to you.

Useful links

• The Pregnancy Care Planner
• NHS Choices – Antenatal Care

If you’ve forgotten to take your pill, your condom split or you’ve had unprotected sex in the last 72 hours then you may need emergency contraception, and the sooner you take it the better.

Emergency contraception is available free from contraception and sexual health services, some GPs (family doctors) and most pharmacies (chemists), even if you’re under 16.

If you’ve had unprotected sex or your condom failed, it is also really important to consider your risk for sexually transmitted infections and to think about your long-term contraception needs. Please phone the surgery to book an emergency appointment.

Our family planning clinics offer free, confidential advice and information about contraception and sexual health.

We provide a range of services including:

• Confidential advice about contraception
• The combined oral contraceptive pill
• The progestogen-only pill
• Progestogen injections
• Limited supplies of free condoms
• Free emergency contraception
• Confidential advice about STIs
• Cervical screening
• Unplanned pregnancy advice
• Free pregnancy tests
• Pre-conception advice and fertility awareness information
• Fitting and checking of caps, diaphragms, and coils (intrauterine devices, or IUDs)

Please book an appointment (through reception or via our online services) with your GP to discuss any of the above in more detail.

We also run the Caryl Thomas Clinic in Wealdon, full information can be found here.

For more information please visit the websites below:

Useful links

• NHS Choices – Planning a Pregnancy
• NHS Choices – The Facts about Contraception

Some new born babies are released from hospital without a detailed examination. If this is the case, please contact the surgery.

Postnatal care extends for between 6 to 8 weeks after the birth of your baby. During this period, routine checks are carried out by the health visitor and you and your baby’s recovery is monitored.

During your postnatal care you will find out about feeding, potty training, illnesses, safety and more. You will be able to ask your health visitor questions and request advice.

Useful links

• NHS Choices – Birth to 5 years old guide
• NHS – Breastfeeding Guide
• Netmums – Information and support

If you are planning to have a baby or you need to know more information about how to look after yourself and your unborn baby, please book an appointment with your GP.

We can provide you with all the information you need to know to have a happy and healthy pregnancy.

Useful links

• NHS Choices – Before you try to get pregnant
• NHS Choices – Pregnancy Care Planner
• NHS Choices – See how your baby will develop
• NHS Choices Tool – Work out your due date

Please review our list of Non NHS work that we offer at the practice, which attract a fee. This includes certificates, forms, medical examinations and various travel vaccinations.

Certificates and forms fee

• Private letter / TWIMC
• Private sick certificate
  
• Private prescription for travel
  
• Freedom from infection certificate
  
• Sickness / accident insurance form
  
• Lighter life forms
  
• Housing letter (payable in advance)
  
• Children letter for ballet / stage etc
  
• Fitness to fly letter
  
• Cancellation holiday form / letter
  
• Fitness to exercise certificate
  
• Overseas pension form
  
• Power of attorney form
  
• Power of attorney form (home visit)
  
• School health report
  
• School health report (Ofsted)
  
• Letter for taking meds on plane
  
• Passport form / photograph
  
• Firearms / shotgun licence

Medical examinations and reports

• HGV
  
• All taxi medicals and bus medicals
  
• Pre-employment medical
  (Including elderly driver fitness to drive)

Travel vaccinations fees

• Hepatitis B
  
• Yellow Fever
  
• Polio certificate
  
• Rabies (three injections)
  
• Japanese Encephalitis (adult – two injections)
  
• Japanese Encephalitis (child – two injections)
  
• Tickbourne Encephalitis (adult – two injections, 1 year cover)
  
• Tickbourne Encephalitis (child – three injections, 1 Year cover)
  
• Meningitis
  
• MMR (over 16s)

NHS advice on drinking recommends that men should not regularly drink more than 3 to 4 units of alcohol a day and women should not regularly drink more than 2 to 3 units a day, “regularly” means drinking every day or most days of the week.

Useful links

• NHS Choices – Alcohol Misuse
• NHS Choices – Where to find alcohol support
• Drinkaware
• Change Grow Live

A range of sexual health services are offered at the surgery including:

• Contraception and contraception advice
• Emergency contraception and emergency contraception advice
• Testing and treatment for sexually transmitted infections (STIs), such as chlamydia, syphilis, gonorrhoea and genital warts
• Testing and counselling for HIV and AIDS

If you need advice and support with a sexual health matter or you think you have a problem you would like to discuss, please make an appointment with your GP.

Sexual health services are freely available for everyone.

For more information please visit the websites below:

Useful links

• Family Planning Association: Sexual Health Advice
• British Pregnancy Advisory Service
• Sexual Advice Association
• NHS Choices – Sexual Health Topics

If you’re trying to give up smoking, we can help. Studies show that your chances of success will be greatly improved if you get advice and support from health care professionals to help you stop smoking and if you don’t pay for your prescriptions then giving up is free.

• The services we offer from the practice can:
• Boost your willpower to stop smoking
• Concentrate your efforts by getting advice from someone who knows your medical background
• Help you feel that you’re not doing it alone
• Help you to cope when you are tempted to smoke
• Monitor improvements to your health so that you can see the benefits

Please contact the surgery for further guidance.

Useful links

• Gosmokefree
• NHS Choices – Smoking Cessation

If you would like to know more about weight and diet advice, please contact us for advice on how to lose weight and stay healthy.

A range of options are available to support people with weight loss. To understand which of them may be the best fit for you please arrange an appointment with your GP who will be happy to discuss them with you.

Many doctors now believe that when it comes to your health, your waist measurement is important.

While knowing your body mass index (BMI) is a good way to decide if you’re overweight, it doesn’t tell the whole story.

BMI is a measure of how healthy your weight is for your height. You can work out what your BMI is by using the NHS choices BMI healthy weight calculator.

If you have a high BMI, you’re likely to be carrying extra fat. But your health could be at greater risk depending on where you store that fat.

Having a large amount of tummy fat (compared to fat around your bottom or thighs) makes you more likely to develop diabetes and heart problems.

A healthy waist circumference for men is less than 94cm (37 inches), and for women it’s less than 80cm (32 inches).

Losing weight and keeping it off isn’t easy, but it has many benefits. You may only need to make small changes to your lifestyle to maintain a healthy weight.

If you’d like to find out more about how you can lose weight in a healthy way please book an appointment with one of our nurses.

For more general information about weight loss, please see the websites below:

Useful links

• NHS Choices – Check your BMI
• NHS Choices – 8 tips for healthy eating

One of the most important things that a parent can do for their child is to make sure that they have all their routine childhood vaccinations. It’s the most effective way of keeping them protected against infectious diseases.

Ideally, children should have their jabs at the right age to protect them as early as possible and minimise the risk of infection.

Find out which jabs your child needs, when they need them, and what the benefits of each jab are.

Please call the surgery to make an appointment.

For more information please visit the websites below:

Useful links

• NHS Choice – Vaccinations for you and your family
• Childhood Immunisation Schedule
• National Immunisation Schedule

Seasonal flu is a highly infectious illness caused by a flu virus.

The virus infects your lungs and upper airways, causing a sudden high temperature and general aches and pains.

You could also lose your appetite, feel nauseous and have a dry cough. Symptoms can last for up to a week.

We offer ‘at risk’ groups the flu vaccine at a certain time each year to protect you against the flu virus.

You may be invited for a flu jab if you are:

• over 65 years of age
• pregnant

or have:

• a serious heart or chest complaint, including asthma
• serious kidney disease
• diabetes
• lowered immunity due to disease or treatment such as steroid medication or cancer treatment
• if you have ever had a stroke
• If you have any queries please contact the surgery.

For more information please visit the websites below:

Useful links

• NHS Choices – Flu and the Flu Vaccine

Stanmore Medical Centre will no longer prescribe sedatives like diazepam for fear of flying

We have several reasons why we have taken this decision.

Initially in the 1960s benzodiazepines including Diazepam (also known as ‘Valium’) were hailed as a wonder drug. However, it became increasingly clear that, as well as having short term deleterious effects on memory, coordination, concentration and reaction times, they were also addictive, with withdrawal leading to fits, hallucinations, agitation and confusion, and increase your risk of developing dementia.  Furthermore, they were found to have long term effects on cognition and balance. Unfortunately, benzodiazepines have also become a widely used drug of abuse since they first came on the market. Because of these reasons the use of benzodiazepines has been a lot more control around the world since the 1980-90s; especially in the UK. Diazepam in the UK is a Class C/Schedule IV controlled drug.

The following short guide outlines the issues surrounding its use with regards to flying and why the surgery no longer prescribes such medications for this purpose.

People often come to us requesting the doctor or nurse to prescribe diazepam for fear of flying or assist with sleep during flights. Diazepam is a sedative, which means it makes you sleepy and more relaxed. There are a number of very good reasons why prescribing this drug is not recommended.

1. According to the prescribing guidelines doctors follow (British National Formulary) diazepam is contraindicated (not allowed) for treating phobias (fears). It also states that “the use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate.” Your doctor would be taking a significant legal risk by prescribing against these guidelines. They are only licensed short term for a crisis in generalised anxiety. If this is the case, you should be getting proper care and support for your mental health and not going on a flight. Fear of flying in isolation is not a generalised anxiety disorder.
2. Although plane emergencies are a rare occurrence there are concerns about reduced awareness and reaction times for patients taking Diazepam which could pose a significant risk to themselves and others due to not being able to react in a manner which could save their life in the event of an emergency on board necessitating evacuation.
3. The use of such sedative drugs can make you fall asleep, however when you do sleep it is an unnatural non-REM sleep. This means you won’t move around as much as during natural sleep. This can cause you to be at an increased risk of developing a blood clot (Deep Vein Thrombosis – DVT) in the leg or even the lungs. Blood clots are very dangerous and can even prove fatal. This risk is even greater if your flight is greater than 4 hours, the amount of time which has been shown to increase the risk of developing DVT whether in an aeroplane or elsewhere.
4. Whilst most people find Diazepam sedating, a small number have paradoxical agitation and aggression. They can also cause disinhibition and lead you to behave in a way that you would not normally which can pose a risk on the plane. This could impact on your safety as well as that of other passengers and could also get you into trouble with the law. A similar effect can be seen with alcohol, which has led to people being removed from flights.
5. Diazepam and similar controlled drugs are illegal in a number of countries. They may be confiscated or you may find yourself in trouble with the police. The passenger may also need to use a different strategy for the homeward bound journey and/or other legs of the journey
6. It is important to declare all medical conditions and medications you take to your travel insurer. If not, there is a risk of nullifying any insurance policy you may have.
7. Flight anxiety does not come under the remit of general medical services as defined in the GP contract and so we are not obliged to prescribe for this. Patients who still wish to take benzodiazepines for flight anxiety are advised to consult with a private GP.

We appreciate that fear of flying is very real and very frightening. A much better approach is to tackle this properly with a Fear of Flying course run by the airlines and we have listed a number of these below:

For further information:

Fly and be calm

Fearless flyer

Flying with confidence

Flying without fear

The pneumococcal vaccine (or ‘pneumo jab’ or pneumonia vaccine as it’s also known) protects against pneumococcal infections.

Pneumococcal infections are caused by the bacterium Streptococcus pneumoniae and can lead to pneumonia, septicaemia (a kind of blood poisoning) and meningitis.

Read more about why the pneumococcal vaccination is needed.

Who should have the pneumococcal vaccine?

A pneumococcal infection can affect anyone. However, some people need the pneumococcal vaccination because they are at higher risk of complications. These include:

• all children under the age of two
• adults aged 65 or over
• children and adults with certain long term health conditions, such as a serious heart or kidney condition

Read more about who should have the pneumo jab.

How often is the pneumococcal vaccine given?

Babies receive the pneumococcal vaccine as three separate injections, at 2 months, 4 months and 12 to13 months.

People over-65 only need a single pneumococcal vaccination which will protect for life. It is not given annually like the flu jab.

People with a long term health condition may need just a single one off pneumococcal vaccination or five-yearly vaccination depending on their underlying health problem.

In order to assist us to make a full assessment of the potential risks to your health from your planned travel, we would ask that you make a travel clinic appointment with our practice nurse. Ideally, this appointment should be made around the time of booking your holiday, at least 6 weeks before you travel.

At your appointment we may ask the following questions to help us plan for your trip:

• When are you departing and for how long?
• Where are you going, including the destinations within a country?
• Where are you staying, e.g. backpacking, camping, hotels?
• Are you planning to undertake any high risk activities?
• Have you taken out travel insurance and have you informed the company of any existing medical condition?
• If female and of child bearing age, is there any possibility you could be pregnant, or are you planning a pregnancy?
• Do you have any medical conditions, or a history of significant medical illness? (these can influence the choice of malaria tablets we recommend)

It would help us greatly if you had some awareness of the travel problems that you may be at risk from on your trip before you come for your appointment.

Useful links

• Fit for Travel
• Travel Health Pro
• National Travel Health Network and Centre

Warfarin is a drug which can prevent life threatening conditions. However, it can be dangerous if people taking it are not monitored regularly and advised which dose to take. Recent changes have been made to the way we prescribe it.

When a patient requests a prescription for anti-coagulation, the doctor must check that the necessary monitoring has been carried out. We can no longer prescribe a anti-coagulation drug “as directed” and the specific dose must be stated on the prescription.

The National Breast Screening Programme was introduced in 1988 as an early detection service for breast cancer. It states that all women who are aged between 50 to 70 years of age will be routinely invited for free breast screening every three years. The programme is very successful and currently saves around 1,400 lives per year.

Breast screening aims to find breast cancer at an early stage, often before there are any symptoms. To do this, an x-ray is taken of each breast (mammogram). Early detection may often mean simpler and more successful treatment. When women are invited for their mammogram depends on which GP they are registered with, not when their birthday is.

The screening office runs a rolling programme which invites women by area. The requirement is that all women will receive their first invitation before their 53rd birthday, but ideally when they are 50. If you are under 50 and concerned about any aspect of breast care, please contact the surgery to make an appointment with your GP.

Useful links

West London Breast Screening

Cervical screening, or smear test, is a method of detecting abnormal (pre-cancerous) cells in the cervix in order to prevent cervical cancer. The cervix is the entrance to the womb from the vagina. Cervical screening is recommended every three years for women aged 25 to 49 and every five years for women aged 50 to 64 or more frequently if smear results indicates abnormal changes.

Cervical screening is not a test for cancer; it is a test to check the health of the cells of the cervix. Most women’s test results show that everything is normal, but for 1 in 20 women the test will show some abnormal changes in the cells of the cervix.

Most of these changes will not lead to cervical cancer and the cells may go back to normal on their own. However, in some cases, the abnormal cells need to be treated to prevent them becoming cancerous.

Our nurses are qualified to carry out cervical screening and tests in the form of cervical smears. In order to have a cervical smear the patient must have received a letter requesting that they have a cervical smear and the appointment must please be made for when the patient is not menstruating.

These appointments typically take around 15 minutes. For any further information or to book an appointment, please call the surgery.

Useful links

• NHS Choices – Cervical Screening
• Jo’s Cervical Cancer Trust

If you’ve forgotten to take your pill, your condom split or you’ve had unprotected sex in the last 72 hours then you may need emergency contraception, and the sooner you take it the better.

Emergency contraception is available free from contraception and sexual health services, some GPs (family doctors) and most pharmacies (chemists), even if you’re under 16.

If you’ve had unprotected sex or your condom failed, it is also really important to consider your risk for sexually transmitted infections and to think about your long-term contraception needs. Please phone the surgery to book an emergency appointment.

If you miss the 72 hours it is still possible to have an emergency coil fitted up to 5 days after unprotected sex. You can have an emergency coil fitted for free at your local sexual health clinic.