Our Services

Our practice nurses run our annual health check clinics for patients who have

• Chronic kidney disease

• Heart disease

• High blood pressure

• Long-term blood-thinning treatment

• Stroke or TIA

• Type 2 diabetes

• Vascular disease

If you have more than one of these conditions, they will normally be reviewed together. The review usually involves:

1. a phlebotomist appointment for blood tests - you may be asked to bring an early morning urine sample which you prepare in advance on the morning of your appointment

2. a practice nurse appointment which may include questions about your health, medication and lifestyle and review of your blood pressure and test results. You might be asked to see our friendly computer called Pod before your appointment.

There are also annual review clinics for patients with an existing diagnosis of

• Asthma and/or COPD

• Coeliac disease

We will normally invite eligible patients for annual health check by text message around the time of your birthday - you are also welcome to book an appointment at any time of the year if your review is overdue.

Our practice nurses run our respiratory review clinic for patients with an existing diagnosis of asthma or COPD. This is an annual assessment of your symptoms, inhalers and other factors affecting your breathing.

We invite our patients with asthma to attend for review on an annual basis, but you should also book in

• if your shortness of breath or wheezing has been less well controlled recently (if you have asthma this could mean needing your salbutamol inhaler more than three times every week)

• if your review is overdue

• or if we have asked you to book a review appointment

Cervical screening (formerly called a smear test) is offered to women, trans men and non-binary people who have a cervix. The routine schedule is every 5 years between ages 25-64 (see NHS inform for more information including special circumstances). You will be invited by letter from NHS Scotland and you are then welcome to book your appointment with the practice nurse.

You will be automatically be sent an appointment letter when your child is due for an immunisation on the routine vaccination schedule. The immunisations clinic for babies and pre-school children is run by a dedicated team who can be contacted if necessary on 0131 454 2301 or 2300. 

Our clinical pharmacists are medication specialists who advise patients about medicines and prescriptions and advise GPs on special medication situations. They are also in charge of updating the GP prescriptions after a hospital admission. You cannot directly book an appointment with them but they may contact you if there is a query or a need to discuss your medications.

Our community link worker is a social prescriber who advises you on non-medical areas of your life which impact your health and wellbeing.

These can include:

• accessing social support

• navigating major life changes

• getting involved in your community

• local groups and services

• improving your emotional wellbeing

• unemployment and getting into work

• problems with your housing situation

• advice on accessing support for money worries and benefits

Appointments with the community link worker are by referral from the GPs and other clinicians at the surgery.

Our practice nurses run our annual health check clinic for patients with an existing diagnosis of type 2 diabetes or pre-diabetes. If you have other long-term conditions such as hypertension or heart disease, your annual health check also includes a review of these conditions.

You will usually be asked to attend for blood and urine tests in advance of your nurse appointment so that the results are available for your review. We might also ask you to see our computer called Pod, who doesn't have much personality but is good at asking simple questions and checking your blood pressure.

Patients with type 1 (insulin-dependent) diabetes, type 2 diabetes on insulin and type 2 diabetes with more difficult control are also referred to the diabetes specialists at Leith Community Treatment Centre who are in charge of making your medication decisions with you.

Contraception appointments: If you would like to consider starting or restarting an effective method of contraception, or you want to discuss your options, please book an appointment with one of the practice nurses. It is normally helpful to come with an idea of what methods you might like to consider (see NHS Inform).

Annual contraception reviews: Patients using the combined oral contraceptive pill, progesterone only pill, Evra patch or Nuvaring need to book in annually for a "pill check" appointment with the practice nurse.

Coils and implants: If you already know that you want a Nexplanon, Mirena or copper coil fitted, removed or replaced then please tell the receptionist exactly what you need so that you can go ahead and book in for the procedure with the right staff and device available.

Young people under 16: If you are under the age of 16 we would encourage you to come with a parent/guardian, but if you don't want to we will still be happy to offer you contraception if we think it is safe for you and you are able to fully understand the information we give you. 

Other ways: You can also access family planning services via the Lothian Sexual Health Service (Chalmers). 

Free condoms: We are a c:card point. Ask at reception. You don't need an appointment and you don't even need to give us any personal details.

Emergency contraception: If you need emergency contraception please consult the Lothian Sexual Health Service or visit a local pharmacy and tell them that you need a confidential consultation with the pharmacist.

Unplanned pregnancy: if you need to discuss your options you should consult the Lothian Sexual Health Service.

Sometimes medical problems require time off work. This might be because the medical condition stops you from doing your job, or because doing the job would make the medical condition worse.

If we consider that you need to be off work for more than 7 calendar days in a row we can issue you with a fitness for work statement - this is a standardised paper certificate which you can give to your employer. We can also issue recommendations that you are fit for work with amended hours, duties or adaptations.

How to get a fit note

We will normally issue a fit note on our own recommendation as a result of a medical consultation. You can consult us even if the only reason is needing to be off work - please let the receptionist and the clinician know that you are contacting us mainly to ask for a fit note. We take this type of request by way of you phoning reception between 8-9am.

If we already have access to medical notes which make it clear that you need to be off work, then you may not need a consultation - speak to reception about your request.

Important points about fit notes

• The government sets rules about how fit notes can be provided

• A fit note is our recommendation to you, the patient, about your fitness to work. We are not obliged to interact with your employer or provide this information directly to them.

• Fit notes are not issued as an NHS service for absences from work of seven days or less, even if you have been off work for periods of time in the past.

• All fit notes include a reason, a start date and an end date. Fit notes cannot start in the future and can only be backdated if we have access to a valid previous assessment of your fitness for work.

• There is no need for a new certificate to say that you can return to work - no certificate exists for this.

• We will not issue fit notes to patients who are abroad; healthcare when you are not in your home area is accessed via the local services.

Our advanced physiotherapy practitioner (GPAPP) is a specialist offering assessment and treatment advice for musculoskeletal problems. If you have a problem which you think is due to your bones, joints, muscles or spine you can book in for a GPAPP appointment.

Routine GP appointments

Please ask for the doctor who you normally see as they will be the best placed to offer you continuity of care and help you make decisions about your health. The main way to consult your GP on a non-emergency health matter is by pre-booked face-to-face appointment. We also offer pre-booked telephone appointments if this is more convenient for you but please consider whether you would benefit more from seeing the GP in person.

Urgent medical advice

We usually consider a problem to be urgent if a very prompt decision needs to be made about your health. For urgent medical problems please phone us between 8-9am and give the receptionist specific information about the advice which you need. You can also phone us at other times of day if your problem cannot wait until the next morning. Often the emergency doctor will respond to your request by phoning you back or sending you a message, so please ensure you have given us the phone number best to contact you on and keep your phone available. It will usually not be possible to speak with your usual GP and in fairness to other patients also awaiting urgent advice we will focus only on problems which doctors consider to be medically urgent.

GP registrars

Our GP registrars (also known as GP specialty trainees) are fully qualified doctors who have chosen a career in general practice and are working towards completing their postgraduate training through the national training programme for new GPs. They share all aspects of medical care with the GPs and you can consult them in the same way as you would consult a GP. Sometimes, for training purposes, patients are requested to allow their consultation to be recorded for educational purposes only; your permission will always be requested beforehand.

Medical students

As we are a teaching practice, we host medical students from the University of Edinburgh and other academic institutions. The medical students gain valuable experience both by observing our staff and by taking their own appointments. If we are proposing that one of the medical students take the lead on your consultation, we will always ask your permission. Medical students are not qualified doctors and any medical plan that they make with you will be supervised or checked with one of the doctors. Medical students are bound by the same strict duties of confidentiality as all of our staff.

Our practice mental health nurse is a mental health specialist who offers assessment and treatment advice for mental health problems and mental illness. You can book an appointment with the practice mental health nurse by speaking to reception. This includes if you need to review or consider starting medication for mental illness - the mental health nurse can often make a provisional medication plan with you pending approval by the prescribing GP. There are now a variety of ways to access help with your mental health, depending on what your needs are.

Letters requested by a patient

The NHS provides for clinicians to make decisions with patients about their health. Your health information belongs to you and includes advice which you are given in appointments, your GP patient records and your hospital patient records. You can make a request to us to access your own GP records if you need to - reasonable requests are facilitated free of charge under the Data Protection Act.

If you want a letter or report to be written or signed off, this is a separate piece of work for the GP and is not covered by the NHS. You should make your request as specific as possible and in writing. Our reception team can advise you on the fee (they may need to check with the GP). You can usually expect a timescale of thirty days after payment has been made. 

If you are considering requesting a letter from your GP please think about the following:

• The GPs will usually only write information about your health which they already know to be true based on your medical record. If you need to provide the GP with lots of new information for the purposes of the letter, there is likely to be little value in the GP transferring this information into a letter format and the GP will not be able to claim to know that the information is true.

• GP letters will usually focus on stating facts rather than lending any opinion or support to your circumstances, even if the GP does support the premise of your endeavour. Please consider whether your letter request is likely to provide you with good value for money if you could as well provide the information yourself.

Reports and forms requested by other companies and agencies

Third parties may send us requests for us to author a report or complete a form about a patient. Typically we are asked to do this by:

• insurance companies (usually through the "iGPR" electronic system)

• private medical providers

• solicitors acting on behalf of a patient

• an individual or organisation acting in their capacity as the patient's employer

If we are asked to reply directly to the relevant third party and we are not legally obliged to share your information with them, then we will require evidence of your consent. Please tell us whether you want to view the report before we send it to the third party. The third party will usually tell us whether our fee will be paid by them or by the patient.

Reports which we do not offer include

• firearms certificates; we conscientiously object to firearms ownership.

Private medicals

Some private reports require a consultation with us involving questions and/or an examination. A combined fee is charged for the consultation and the report. We are usually able to offer this if the scope of information is within the competence of GPs, who are medical generalists.

If the private medical requires additional tests such as blood tests or x-rays to be arranged for the sole purpose of completing the report, we usually cannot offer this.

Practice nurse appointments are for

• annual health checks for review of long-term conditions 

• arranging home blood pressure monitoring for suspected high blood pressure

• cervical screening

• family planning advice and contraception reviews

• injections (bring your prescribed medication to your appointment)

• See the other sections on this page for more information.

You can book a nurse appointment by speaking to reception.

Some care which used to be delivered by practice nurses is now usually done in the CTACS clinics based in other NHS hubs including Leith Community Treatment Centre: removal of stitches, wound care and ear syringing.

Most of our blood tests are taken by our phlebotomist who is a blood-taking specialist. 

If one of the clinicians at the surgery recommends that you should have blood tests, you should book in with the phlebotomist by speaking to reception. You can book in for blood tests after we have already recommended for you to have these. 

Blood tests on the advice of a specialist

You can also book a phlebotomist appointment if a hospital specialist has written to us to recommend that you have blood tests as part of a plan which is in keeping with usual NHS care; most specialists know what blood tests can normally be offered by GPs so it is usually fine to book in following their recommendation - check with us if unsure. If the specialist gave you a blood test form, please bring this to your appointment, as this means that the result can go directly to the specialist.

When you have an active registration at the surgery, we are responsible for the general practice part of your NHS primary care, which we provide for NHS Lothian. It is important for everyone to be registered with an NHS GP. At the same time, patients are entitled to access private healthcare at their own expense. When private healthcare interacts with NHS primary care, this can create a hybrid situation in which it can be difficult for patients to know what to expect - but a general rule is that we will treat private patients without advantage or disadvantage. This section gives you general guidance but can't cover every scenario so if you are not sure what to expect then we suggest that you ask us about your particular situation before embarking on private treatment.

Key messages:

1. Choosing private healthcare for some aspects of your care does not impact your ability to consult your NHS primary care team or to access NHS emergency assessment.

2. Sometimes specialists request for the primary care team (GP team) to have some involvement in an episode of care - whether or not we can accept the request depends mostly on whether it is in keeping with our own usual care and usual treatment within the NHS, and not on whether the specialist is in the NHS or the private sector.

3. The NHS is not obliged to provide routine care or aftercare resulting from any private treatment which would not have been routinely offered on the NHS.

To find out about hybrid care for conditions and medications which require shared monitoring over time, please see "Shared care with private medical providers" below.

Private referrals

1. Referrals on our own recommendation

If we recommend a specialist referral and you decide that you want to use the private sector rather than the NHS, we can usually offer a private referral free of charge. It would then be your responsibility to find an appropriate provider and have a funding arrangement in place. We can prepare a referral letter for you to collect from the surgery and present to your medical insurance provider or the private provider of your choice. Alternatively, some of the larger providers are linked into the electronic primary care referrals system so we can make an electronic referral directly to the provider if that is preferable for you.

If we have recommended and made a specialist referral and you have chosen to go private, we will thereafter work on a basis of parity with NHS referrals, for example:

• subsequent recommendations from the private specialist will be considered by the GP team in the same way as we would treat recommendations made by NHS specialists, for example recommendations to prescribe long-term medications. As with NHS specialists, there is no guarantee that we will be able to accept their recommendation, which needs to confirm to the usual scope and guidelines applying to general practice.

• recommendations from the private specialist for further specialist assessment, further tests or specialist treatment are the responsibility of the specialist to arrange directly (the GP team does not arrange this for NHS nor private specialists).

There are, however some logistical differences in the way that we can communicate with private specialists because we do not have means of secure electronic communication with non-NHS clinicians and private providers often do not have access to your electronic hospital record to see any of your electronic test results or any previous NHS clinic letters. Therefore, if your private specialist writes to us with a request or recommendation and we need to write back to them - additional work which would not be required under NHS-only care - we will charge the patient a private letter fee.

2. Private referrals decided by you

Sometimes our patients decide themselves that they would like to access private healthcare without a recommendation from us that referral is necessary - or is yet necessary - within the NHS system.  The patient might go about this by:

• referring themself by contacting their insurance company or a private medical provider directly (who might then request us to send them a medical letter or complete a medical form)

• asking their NHS GP for a referral

We often will agree to complete such a letter or form; this does not mean that we have recommended the referral but that we recognise it is in the interests of a thorough assessment for the private provider to have additional information from primary care, or that it might be a prerequisite for accessing private health services. There is a private letter charge at the surgery for our completion of this type of private referral letter or form and any necessary follow-up letters.

If there is then a recommendation from the private provider for the GP team to have involvement with the episode of care, this cannot necessarily be handled in the same way as for referrals which we recommended ourselves, because it may not be clear to us that your care pathway has been the same as normal NHS care.

• We can only work on the basis of parity between NHS and private medical care when it is clear to us that the nature of any treatments, and the indications for those treatments, are equivalent to the care which, in the GP's opinion, would be normally offered by NHS. This means that if the NHS would not have, in our reasonable opinion, offered you the same treatment, we cannot offer related routine care or treatment resulting from this, as this would risk us providing inequitable access to NHS resources. Your choice to access private treatment, whether it would have been offered on the NHS or not, will not affect your entitlement to consult the primary care team at the surgery or to access emergency assessment with the NHS.

• However, if a private assessment has been accessed in lieu of the normal NHS process of consulting a primary care professional at the surgery, we can often accept requests for basic tests or treatment which would have been routinely offered by the GP if the patient had consulted us at the surgery as per the NHS model of care.

• Referrals by one specialist to another is always done directly and never by inviting the GP to be an intermediary, regardless of whether care is in the NHS or the private sector.

The NHS model for assessing all routine health matters is to consult the primary care team - that is, the healthcare professionals at the GP surgery and the other services which take self-referrals from patients.

Referral to NHS secondary care (hospitals and specialist clinics) is an option available to GPs and other primary care clinicians when they deem that this is necessary.

If we advise that a referral is necessary, we will tell you whether the referral involves

1. a direct referral from us to the specialist (in which case you await contact from the clinic - most often by letter), or

2. a self-referral whereby you need to contact the relevant department yourself and/or give them a form or letter.

Most referrals to hospital are described as "routine", even though most medical problems requiring hospital clinics are problematic or severe. You can find out about current waiting times on the NHS Lothian website. The surgery does not receive updates about where individual referrals are in the queue and we usually cannot look into it for you, but it is possible for you to contact the waiting list office yourself using the contact details below.

Once you receive your clinic letter in the post, this gives you the direct contact details of the relevant hospital department. Keep this for your reference, even after your appointment, in case you need to contact the department with any questions or problems. If you need to get in touch with secondary care before you have your letter, phone the relevant place: 

• Western General Hospital: 0131 537 1000

• Royal Infirmary of Edinburgh and Lauriston Building: 0131 536 1000

• Leith Community Treatment Centre: 0131 536 6225

Private referrals

The NHS model of care does allow NHS patients to pay for some aspects of their medical care privately without favour or prejudice - please see "Private healthcare while you are registered at the surgery".

Some conditions require assessment by clinicians, for example hospital doctors, who are not part of the GP surgery. When they ask the GP to share parts of the assessment and/or management of a long-term condition, we call this shared care. A shared care agreement is a document which sets out the roles of each doctor in managing that condition.

NHS Lothian uses standardised shared care agreements for a variety of conditions and medications to make sure all the clinicians working in Lothian provide the care of those conditions in a standardised way.

Shared care prescribing often involves checks and/or tests at certain intervals - this should be discussed with the patient by the team recommending the treatment - then it is the patient's responsibility to arrange blood tests and attend the necessary appointments at the surgery.

Usually, there is no need to provide explicit consent for shared care when the condition is managed entirely within NHS Lothian.

When a private (non-NHS) medical provider asks NHS GPs to take part in shared care for a patient, there are many complexities.

We can't provide guidance for every scenario, but we can provide some general guiding principles to help you.

General principles of shared care with a private provider

• Shared care is for long-term conditions that require checks and/or blood tests at intervals. These could be done at the surgery for the patient’s convenience.

• The private clinician(s) should be suitably qualified and experienced and be working in the UK. They must be an independent prescriber and registered with a UK regulatory body such as the GMC. This is usually clear from the documentation provided by the private clinic.

• The patient must agree with shared care. If you give us a shared care agreement or clinic letter or ask us for tests or treatment which have been recommended by a private provider, we will take this to imply your consent.

• We will usually take part in shared care when:
  1. the proposed treatment(s) and
  2. the GP role in providing assessment, tests and prescribing medication are similar to the care provided when the same condition is managed within NHS Scotland
  or the specialist team is taking a larger share of responsibility than would be usual within the NHS.

• Adequate follow-up arrangement must be in place with the private provider and the patient must engage with the shared care.

Shared care blood tests

Blood tests can usually be offered if they are tests that can be requested by GPs. Once blood tests are done, it is the responsibility of the patient to give the results to the private doctor and the private doctor needs to give advice on the results. Blood tests are usually not possible in primary care if they need to be done very frequently, eg less than three months apart.

Shared care prescribing

• All prescribed medications in the UK are “licensed” for certain approved uses. If your private doctor is recommending an “unlicensed” medication then we will usually require documentation that this aspect has been discussed with you by them.

• We will only prescribe medications which we feel can safely be prescribed by GPs. 

• Medication titration: Some medications require monitoring in the early stages and the dose adjusted. During this "titration phase" of treatment, we expect the specialist to provide the prescription.

• There is usually no role for shared care for prescriptions which are expected to be short-term or time-limited.

Shared care agreements

If you ask GPs to review and sign a shared agreement (which would not be required for NHS care), or if the GP finds it necessary as part of your treatment to write to your private specialist, this is not an NHS service and therefore a letter fee is chargeable to the patient.

Certain tests are available to your primary care clinician to organise for you if the result will make a medically relevant difference to your treatment.

Tests arranged by us:  After tests are arranged by the team at the surgery, the results are reported and then sent back to us for our review.
Tests arranged in secondary care: Conversely, when tests are arranged by a clinic or hospital specialist, the result is sent to that specialist and not to the surgery - the specialist then decides on how to communicate the result to you and whether any further action is required. It is not usually possible to get this type of result from the GP.

Waiting for results

After a test has been done, it takes time for the relevant hospital department to analyse the test and send us the result. We typically wait:

• biochemistry and haematology blood tests: 2-3 working days

• antibody blood tests and other complex blood tests: several days to several weeks

• bacteria culture and antibiotic sensitivities: 3-4 days

• fungal clippings and scrapings: 2-4 weeks

• x-rays, scans and other tests requiring a professional in another department to interpret the result: at least one week

Getting your results for tests which have been arranged by the surgery

To phone us for your results, avoid our extremely busy phone lines first thing in the morning and phone us between 11.00-12.00 or 14.00-15.00.

When your test result has been reviewed by your clinician, they will sign off on the result and state whether additional action is required;

• If there is no action required, we usually will not contact you. This includes both normal results and results not requiring any change in your medical treatment. Please keep any existing plan which you have made with your clinician. You are welcome to phone reception to find out your results after allowing enough time. If you have had multiple tests, the results might return to us in stages and it might not be obvious whether all of your results are back - please ensure your contact details are up to date so we can contact you about abnormalities.

• If some further action is required, we will take this forward. If we have already asked you to attend a follow-up appointment or to contact us again depending on your progress, please stick to the plan; let us know if you have any unexpected problems. If we haven't already asked you to book a follow-up appointment, we will usually send you a message to:

  • • • ask you to book in for a further test

      • give you information about the result

      • ask you to book a follow-up appointment (usually this should be a routine appointment with the clinician who asked you to have the test)

Giving your results to a specialist

Sometimes blood tests or tests on other samples are arranged by the surgery on behalf of a specialist - in this case the specialist might not automatically get a copy of the result and might have asked you to provide them with the results - you can request a printout with reception.

X-ray department contact details

When we refer you for an x-ray, you also need to phone the x-ray department yourself to arrange an appointment date and time after we have made your electronic referral.

Most of our patients go to Leith Community Treatment Centre: 0131 536 6400

The x-ray departments can only help you after they have received our referral (often this takes us a day or so). The departments are open Monday to Friday only and you might need to try phoning again if their lines are busy.
Lauriston Building 8.30 am - 4.00 pm 0131 536 2942
Leith Community Treatment Centre 8.30 am - 4.00 pm 0131 536 6400
Midlothian Community Hospital 9.15 am - 12.30 pm 0131 454 1045
Roodlands Hospital 8.30 am - 4.00 pm 0131 536 8387
Royal Hospital for Sick Children (For 13 and under ONLY) 9.00 am - 5.00 pm 0131 536 0255
Royal Infirmary Edinburgh 9.00 am - 4.30 pm 0131 242 3700
St John's Hospital 8.00 am - 5.00 pm 01506 524 339
Western General Hospital (Main X-ray Dept) 8.00 am - 5.00 pm 0131 537 2054.