Our dermatology team can treat a wide range of skin condition, below are those which are excluded from referral: - Suspected skin cancers (which should be referred directly to secondary care using the 2 Week Wait pathway in ERS and the Pan London referral form - Patients requiring phototherapy e.g. PUVA/B - Contact allergy testing - Wounds/leg ulcers to be referred to the tissue viability service. -Cosmetic skin tags and warts -Laser service -Dermatology emergencies -Surgical procedures considered as plastic surgery/ or surgery under the remit of local minor surgery services In line with NEL ICB Procedure of Limited Clinical Effectiveness (POLCE) guidance the following common, clinically benign skin lesions can be referred for Non- cosmetic reasons only (if symptomatic): - Skin tags including Anal skin tags - Viral Warts - Pityriasis versicolor - Early male pattern baldness - Androgenic alopecia in females - Physiological hirsuitism - Melasma/Chloasma

Please note that only the following symptoms can be treated in our service. Diagnosis of Ischaemic Heart Disease (Non-Acute Chest Pain) A clinical assessment will be made, investigations arranged in line with NICE guidance CG95, medication initiated and patients referred back to GP with a clear treatment plan. Please ensure there is a BP & weight recorded. Investigation and Assessment of Arrhythmia (Non AF) (Haemodynamic stable and asymptomatic patient) A clinical assessment will be made, appropriate investigations completed to reach a diagnosis of the arrhythmia type. Patients will then be discussed by the GPwSI / consultant and appropriate referral onto a medical cardiology or ablation clinic made. Please attach patient ECG report Heart Failure A clinical assessment will be made, investigations arranged in line with NICE guidance, medication initiated and patient referred back to GP with clear treatment plan. Please ensure there is a recent BNP results Suspected Valvular Disease A clinical assessment will be made, and an echo done. If no further treatment is required then the patient will be referred back to the GP. If surgical intervention is required the patient will be discussed by the GPwSI with the consultant to identify appropriate secondary care escalation. Hypertension – LVH, Suspected Cardiac Dysfunction A clinical assessment will be made, an echo done, medication initiated / optimised and the patient referred back to GP with a clear management plan. If further referral is required then the GPwSI will discuss the case with the consultant and refer on

Our dermatology team can treat a wide range of skin condition, below are those which are excluded from referral: - Large Lipomas - Carpal Tunnel Injections - Large Sebaceous cysts with history of infections - Removal of ganglion & aspirations and injections - Head and neck subcutaneous lesions - Rigid sigmoidoscopy and injections of piles - Excisions of extra digits - Sebaceous cyst with history of infections - Removal of ingrowing toe nail Articular injections In line with NEL ICB Procedure of Limited Clinical Effectiveness (POLCE) guidance, the following common, clinically benign skin lesions can be referred for Non- cosmetic reasons only (if symptomatic): - Skin tags including Anal skin tags - Seborrhoeic keratosis - Hand or foot viral warts in adults (subject to your Practice being exempted from providing Cryotherapy treatment) - Corn/callouses - Small Lipomas - Molluscum contagiosum - Sebaceous (epidermoid or pilar) cysts - Neurofibromata - Angioma Keratoma and Benign Naevi

Please see below for condition that can be referred: - Menorrhagia - Prolapse minor for Ring Pessary - Polycystic Ovarian Syndrome (PCOS) (Within POLCV guidelines only) - Genital Pruritus - Primary and Secondary Amenorrhoea - Ovarian Cyst Hirsutism (within POLCV guidelines only) - Dysmenorrhoea - Cervical Polyp removal - Menopausal Symptoms - Menstrual Disorders Please note referrals will not be accepted into this service for the criteria below ​ - Under 18 - Suspected Cancer - Infertility - Family Planning - Urinary Incontinence

- Haemorrhoidal diseases - PR bleeding with or without symptoms - Chronic Constipation - Rectal prolapse - Anal/faecal Incontinence - Anal pain & itching - Anal Fissure - Irritable bowel syndrome - Constipation