GP Care is working in association with Bristol Plastic Surgery and its leading NHS Consultant Plastic/Hand Surgeons to deliver a community based hand surgery service for NHS Bristol patients. This new patient pathway offers a superb patient experience in terms of:
- Consultant delivered consultation and surgery;
- A stunning new surgical clinic at 58 Queen Square (central Bristol) complete with state of the art operating suite;
- A one-stop clinic, where appropriate, to include consultation, pre-operative assessment and surgery;
- Short waiting times with the majority of patients being offered appointments within 7 days of referral.
The Service attends to patients with the following conditions:
- Carpal Tunnel Syndrome
- Trigger Finger
- Dupuytren’s Contracture
- Ganglia
Referral Pathway
The referral pathway (once exceptional funding requirements for Carpal Tunnel, Dupuytren’s Contracture and Ganglia have been fulfilled) is for GPs to refer the patients to MATS (directly or via any Referral Service) who assess the patient and offer them options as to where they can have the surgery. Note that Trigger Finger does not currently require exceptional funding but should also be referred into MATS.
Accessing Conservative Treatment for Hand Surgery through MATS
Current Exceptional Funding criteria for Carpal Tunnel and Trigger Finger surgery require a course of conservative treatment prior to funding approval. Where GPs wish, or are required to, provide conservative treatment in advance of a referral for Hand Surgery, this can be done either:
- By the GP themselves subject to knowledge/equipment; or
- By the Bristol Musculo-Skeletal Assessment and Treatment Service (MATS) who provide a separate ultrasound guided injection service for Carpal Tunnel, De Quervain’s Tenosynovitis and Trigger Finger/Thumb as well as some splinting, temporary orthotics, and wrist and thumb spicas. This is paid for on a block contract basis by NHS Bristol.
Patients can be referred to MATS for conservative treatment by GPs through Choose and Book. For more information please contact MATS on 0117 330 2645.
Where conservative treatment does not solve the patient issues then GPs will be able to apply for exceptional funding where required.
Exceptional Funding Requirements
Referral criteria for this Service are consistent with existing NHS Bristol protocols which require Exceptional Funding Panel approval (with the exception of Trigger Finger). These are set out below:
Carpal Tunnel Syndrome
Patients should have one or more of the following referral criteria:
- Symptoms persist despite 3 months of conservative therapy with either local corticosteroid injection and/or nocturnal splinting; or
- There is neurological deficit, e.g. sensory blunting, muscle wasting or weakness of thenar abduction; or
- The patient is experiencing severe symptoms that interfere with activities of daily living; and
- PCT Exceptional Funding Panel approved treatment.
(The Service does not offer patients nerve conduction studies which may need to be carried out prior to consultation and surgery.)
Trigger Finger
Patients should have:
- Failed to respond to steroid injection and have symptoms that interfere with activities of daily living.
Dupuytren's Contracture
Patients should have the following referral criteria:
- The patient has a 30° fixed flexion deformity at either the metacarpophalangeal joint or proximal interphalangeal joint such that the patient cannot flatten their fingers or palm on a table; and
- There has been rapid progression over a few months; and
- PCT Exceptional Funding Panel approved treatment.
Ganglia
Patients should have:
- PCT Exceptional Funding Panel approved treatment.
Other Information
In keeping with GP Care’s other NHS services, a discharge report will be generated and faxed to the referring GP together with a patient management plan on the same day.
The Service represents a significant improvement in the Patient Pathway and delivers a substantial saving to the NHS.
If you have any queries regarding this Service please contact the Hand Surgery Service Lead, on 0845 625 2107 or alternatively email us at info@gpcare.org.uk.
Other Information
Please note that we are not able to provide child minding services for children accompanying patients.
If you are not satisfied with any aspect of our service, please discuss this directly with the clinician or contact the Hand Surgery Service Lead by post at GP Care UK Limited, Christchurch Medical Centre, North Street, Downend, Bristol, BS16 5SG. Alternatively call us on 0845 625 2107 or email us at info@gpcare.org.uk.
