Referral pathway / services

Non-painful swelling or long-standing cysts do not require emergency attention and can be referred to the GOPD for further evaluation.

Should be seen in GTA if it appears suitable for I&D or Word Catheter insertion, or if the patient is systemically unwell or septic (e.g., may need IV antibiotics). However, if the abscess is firm or non-fluctuant, it will not be amenable to drainage. In such cases, recommend a 1-week course of oral antibiotics (confirm current local micro guideline) and offer a follow-up in 1 week unless the abscess spontaneously bursts (which can happen). Ask the patient to cancel the follow-up if the abscess discharges before the planned review.

If you receive calls about patients referred by other specialties, where imaging suggests pelvic malignancy or a gynaecology referral is recommended, and you're unsure about the next steps, consult with a member of the Gynae Oncology team. The Gynae Oncology nurse specialists—Lorraine Chitambo, Amanda Killin, and Louise Falconer—are also available and can provide helpful advice when available.

For stable patients, the Choices Clinic has a designated nurse who can be contacted via mobile at 07765 395887 for advice between 08:30 and 16:30.

You may receive calls requesting non-urgent advice on HRT, menopause management, or STI follow-up. If you're able to assist, that's fine, but if it's outside your scope, you can suggest the caller contact the Chalmers advice line.

EFREC patients may present OOH with acute symptoms, such as post-operative pain or OHSS.

Keep ovarian torsion in mind, especially if the patient has recently undergone ovarian stimulation, as this can lead to enlarged ovaries and acute pain!

If the patient exhibits symptoms of OHSS that require admission, follow the guideline available on the intranet (Directory -> Edinburgh Fertility Centre -> Edinburgh Fertility Centre Documents -> Documents for Ward 210).

If the patient is stable, EFREC can be notified in the morning for a review.

If a patient contacts Ward 210 regarding issues with their IVF injections, spare medications are available on the ward. Since the timing of injections is crucial, avoid instructing patients to wait until the morning to contact EFREC if there's a chance they may miss their medication!

For urgent overnight advice, including issues related to injections, there is a dedicated EFREC Consultant on-call. They can be reached through the switchboard for assistance.

You may receive phone calls regarding early pregnancy pain or bleeding.

During daytime hours (08:30 – 17:00) direct calls to PSC (Pregnancy Support Centre) (ext. 22438), as they prefer to triage them directly.

For out-of-hours calls, stable patients can be referred to PSC for follow-up during daytime hours.

If a patient in A&E appears potentially unstable (e.g. suspected ruptured ectopic pregnancy), they should be reviewed in A&E and may need to go straight to theatre from there.

Pessary changes or difficulties can often be referred to Urogynaecology Specialist nurse Andrea Jones (Andrea.Jones@nhslothian.scot.nhs.uk) so these patients may not need to attend GTA solely for pessary change.

Pessaries falling out are not considered emergencies. Patients can be seen at the next available pessary clinic appointment or by the Consultant who inserted the pessary.

The only pessary-related emergency occurs if a patient is at risk of urinary retention due to obstruction. Pessaries causing acute symptoms (e.g., pain or urinary retention) after insertion should be reviewed in GTA. However, if you are already seeing a patient for another issue and they need a pessary change, please address it during your review to help reduce the workload in GOPD.

Unless the patient is actively haemorrhaging, ask the GP to request an urgent out-patient TVUS and refer via the PMB pathway. If the patient is on Tamoxifen, they should be directly referred for an out-patient hysteroscopy.

Ask the referrer to request an urgent in-patient TVUS and to call you with the result. Unless there is heavy or active bleeding, it is better to wait for the endometrial thickness (ET) before seeing the patient, as this will help plan whether a pipelle biopsy is needed and determine the best setting for the review.

Some GPs may contact you about patients who have already been referred to GOPD. Given the long waiting lists, if the original issue has developed into an acute emergency, the GTA is the appropriate place for the patient to be seen.

For certain situations, it may be appropriate to ask the GP to escalate the urgency of the referral for outpatient review. GPs may also inquire about the status of appointments, results, or surgery dates. If this information is not available through TRAK correspondence or appointment lists, kindly suggest they contact the relevant Consultant's secretary (contact details are listed on the GTA wall).

You may receive calls from other specialties (e.g., general surgery) referring patients with pain and imaging showing an ovarian cyst smaller than 3cm. Take a thorough history from the referrer and, if any important details are missing, request that they gather the relevant information from the patient.

If there are no red flags in the history or indications for further gynaecological review, you can reassure them that this is likely an ovarian follicle.