Referral Out of Area in the NHS

I get a lot of enquiries from patients who are wishing to transfer care from their local area.

The previous government set up a system called Patient Choice and as part of this set out a series of rights for patients within the NHS in England - Scotland and Wales are separate from this.

As part of Patient Choice (more details on the NHS website) every NHS patient is entitled to be referred by their GP to a consultant of their choice.  This can be anywhere in England and your GP should not restrict you to just your local area.

In practice most GPs are entirely aware of the entitlements so as long as you are clear in what you would like to do this is not really a problem.

I encourage patients to be referred by their GP as this will allow for safe and efficient transfer of information - in particular past medical history, blood tests and other investigation results.

For patients from out of area we operate a very efficient service where I will endeavour to see you, undertake all tests the same day and then you simply come back for surgery - a 2 stop service!

Bucksendocrine - Thyroid and Minimal Access Parathyroid Surgery

Thyroid Surgery by a UK specialist surgeon

Calcium Levels and Diagnosing Parathyroid Disease

Calcium levels in the blood are controlled in a very tight range - in the UK levels are given on blood tests such that the normal range is between 2.2 and 2.55 mmol/l.  This varies between laboratories and hospitals but not by much.

Key Point 1 - A high calcium is never normal

Calcium levels are controlled by the parathyroid glands which make parathyroid hormone (PTH).  The 4 parathyroid glands have a really big blood supply and can monitor calcium levels really effectively.  Contol of calicum is in a very narrow range.


Key Point 2 - Calcium levels will fluctuate on a day to day basis

So calcium levels if checked and are just outside normal can be rechecked and may a few days later be in the normal range.  Some patients with parathyroid disease who have calcium levels that are marginally elevated will therefore dip into normal from time to time - this can make the diagnosis difficult.


Key Point 3 - What to do if calcium is high

Calcium levels should be rechecked along with a PTH level.  If the calcium is high PTH levels should be almost zero because like your boiler their internal thermostat (measuring calcium not temperature) should have switched them off.

If PTH levels are in the 'normal' range and calcium is high you almost certainly have parathyroid disease as the calcium levels are inappropriately elevated as they should be near zero.


Key Point 4 - Symptoms are not linked to calcium level

Many patients will have marginally elevated calcium levels and yet have terrible symptoms.  Some will have very high calcium and no symptoms.  The absolute numbers are of no great relevance.  All patients with parathyroid disease should have a discussion about treatment with someone who understands the disease.


More information on:

Parathyroid Surgery

Parathyroid and Minimal Access Thyroid Surgery

Minimal Access Parathyroid Surgery Video

Mr McLaren performing minimal access parathyroid surgery.  Note the small incision size and 2.5cm adenoma being removed.

This operation is available as a daycase procedure to NHS and private patients and most do not require any painkillers after the surgery.




Video of Minimal Access Parathyroid Surgery


More information on the service provided is available on:

http://www.bucksendocrine.com/

http://www.thyroidsurgeon.org.uk/