New Medical Examiner Death Certification Process Steps

There is a new statutory requirement for all deaths to be reviewed by a Medical Examiner before a death certificate (otherwise known as a Medical Certificate of Cause of Death or MCCD) is written.

This means that a GP has to complete an extra form, submit it to the Medical Examiner and await their response before the GP can complete a death certificate. The Medical Examiner aims for a 24 hour turn around once the submission is made. There may then need to be further discussions between the GP and the Medical Examiner.

Please bear with us as this means completion of death certificates by the GP will take longer than before.

New Service for Musculoskeletal Problems

Please see our main Musculoskeletal Problems Page for more information on this exciting new service for Havering and North East London Patients or see below for a summary and click on the photo or links below to access the service.

NHS North East London – BHR MSK app is now available to all patients. It’s a FREE, easy-to-use tool helping you to self-manage your muscle, bone, and joint (MSK) injuries and conditions.

  • No need to wait for an appointment
  • Instant access to a personalised plan
  • Safe and effective
  • What is getUBetter?

getUBetter is an app helping you self-manage at home, work, and on the move. It can be accessed on a Smartphone or via the Web.

It covers a range of MSK injuries and condition, like back pain and ankle pain, and is designed to help you recover, understand when and where to seek help, and prevent further injuries.?

Who is getUBetter for?

  • Anyone over 18
  • Anyone who’s been advised or chose to self-manage
  • Anyone waiting for treatment

What will I get?

  • A personalised recovery plan
  • Step-by-step guidance
  • Exercises based on your condition
  • Advice to seek help, if needed.
  • Referral to your local healthcare providers, treatments, and services, if needed.

Wound Care

We do not provide post-operative wound care. In Havering post operative wound care including dressings, suture removal etc is provided by Havering Health

Book here: https://app.10to8.com/book/swchavering/

All patients in Havering can book appointments for the following two sites:

The simple wound care service manages acute wounds (cuts), post-surgical sutures or clips removal, routine dressings, superficial skin ulcers and first degree superficial burns

Petersfield Surgery70 Petersfield AveRomfordRM3 9PD

(appointment times Monday & Thursday 8:30am – 6:30pm)

Rosewood Medical Centre 30 Astra CloseHornchurchRM12 5NJ

(appointment times Tuesday, Wednesday & Friday 8:30am – 6:30pm)

If you think the wound is infected, leaking or opening please go to your local Urgent Treatment Centre (UTC) or call 111

Why WLMC no longer prescribes Benzodiazepines for Flight Anxiety

Updated 01/09/2022

Skip to Fear of Flying Treatments / Courses

WLMC has reviewed it’s benzodiazepine prescribing at a practice meeting 30/08/2022 and established this new policy not to prescribe benzodiazepines or sedatives (such as diazepam) to patients for fear of flying. Many other GP practices have a similar policy. 

People often come to us requesting that we prescribe diazepam for fear of flying or to assist with sleep during flights.

Initially in the 1960s benzodiazepines including Diazepam (also known as ‘Valium’) were hailed as a wonder drug. However, it became increasingly clear that, as well as having short term deleterious effects on memory, co-ordination, concentration and reaction times, they were also addictive, with withdrawal leading to fits, hallucinations, agitation and confusion.  Furthermore, they were found to have long-term effects on cognition and balance. Unfortunately, benzodiazepines have also become a widely used drug of abuse since they first came on the market. Because of these reasons the use of benzodiazepines has been a lot more controlled around the world since the 1980-90s; especially in the UK. Diazepam in the UK is a Class C/Schedule IV controlled drug. The following short guide outlines the issues surrounding its use with regards to flying and why the surgery no longer prescribes such medications for this purpose.

There are a number of very good reasons why prescribing this drug is not recommended.

  • The use of any sort of benzodiazepines causes longer reaction times & slowed thinking, which during a flight will put the passenger at significant risk of not being able to act in a manner which could save their life, or that of a loved one or co-passenger, in the event of a safety critical incident. Incapacitation from benzodiazepines is a risk to the lives of all on board the aircraft in the event of an emergency requiring evacuation.
  • The use of such sedative drugs can make you fall asleep, however when you do sleep it is an unnatural non-REM sleep. This means you won’t move around as much as during natural sleep. This can cause you to be at an increased risk of developing a blood clot (Deep Vein Thrombosis – DVT) in the leg or even the lungs. Blood clots are very dangerous and can even prove fatal. This risk is even greater if your flight is greater than 4 hours
  • Whilst most people find benzodiazepines like diazepam sedating, a small number have paradoxical agitation and in aggression. They can also cause disinhibition and lead you to behave in a way that you would not normally. This could impact on your safety as well as that of other passengers and could also get you into trouble with the law.
  • Benzodiazepine use added to alcohol consumption causes an increase in the risk posed by the points above
  • According to the prescribing guidelines doctors follow (British National Formulary) diazepam is contraindicated (not allowed) in treating phobic states.[i] It also states that “the use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate.[ii] Your doctor would be taking a significant legal risk by prescribing against these guidelines. (They are only licensed short term for a crisis in generalised anxiety. If this is the case, you should be getting proper care and support for your mental health and not going on a flight; benzodiazepine doses used for flying previously are not likely control an acute crisis in generalised anxiety disorder.)
  • NICE guidelines suggest that medication should not be used for mild and self-limiting mental health disorders[iii]In more significant anxiety related states, benzodiazepines, sedating antihistamines or antipsychotics should not be prescribed
  • In some countries it is illegal to import these drugs, e.g. in the Middle East, and so the passenger will need to use a different strategy for the homeward bound journey and / or any subsequent legs of the journey; they may be confiscated or you may find yourself in trouble with the police. The passenger may also need to use a different strategy for the homeward bound journey and/or other legs of the journey.
  • Diazepam stays in your system for quite a while. If your job requires you to submit to random drug testingyou may fail this having taken diazepam.
  • Benzodiazepines have been linked to the onset of dementia
  • A study published in 1997 from the Stanford University School of Medicine (iv) showed that there is evidence use of benzodiazepines stops the normal adjustment response that would gradually lessen anxiety over time and therefore perpetuates and may increase anxiety in the long term, especially if used repeatedly. In an article in Clinical Psychiatry News, Shanna Treworgy, Psy.D., of the Dartmouth Geisel Medical School, said that though there may be reduced anxiety in the moment, benzodiazepines cause increased long-term anxiety reactions.

Given the above we will no longer be providing Diazepam for flight anxiety and instead suggest the below aviation industry recommended flight anxiety courses which are easily accessible for those who wish to fly & conquer their fear of flying, eg:

  1. Easy Jet www.fearlessflyer.easyjet.com Tel 0203 8131644
  2. British Airways www.flyingwithconfidence.com  Tel 01252 793250
  3. Virgin www.flyingwithoutfear.co.uk  Tel 01423 714900
  4. https://thefearofflying.com/programs/fly-and-be-calm/
  • Flight anxiety does not come under the remit of General Medical Services as defined in the GP contract and so we are not obliged to prescribe for this. 
  • Patients who still wish to take benzodiazepines for flight anxiety are advised to consult with a private GP or travel clinic. 
  • It is important to declare all medical conditions and medications you take to your travel insurer. If not, there is a risk of nullifying any insurance policy you may have.

For further information/References:

[i] British National Formulary; Diazepam – https://bnf.nice.org.uk/drug/diazepam.html

[ii] British National Formulary; Hypnotics and anxiolytics – https://bnf.nice.org.uk/treatment-summary/hypnotics-and-anxiolytics.html

[iii] Generalised anxiety disorder and panic disorder in adults: management. NICE Clinical guideline [CG113] Published date: January 2011 Last updated: July 2019 https://www.nice.org.uk/guidance/cg113

[iv] Acute and delayed effects of Alprazolam on flight phobics during exposure. Behav Res Ther. 1997 Sep;35(9):831-41

[v] Travel Health Pro; Medicines and Travel; Carrying medication abroad and advice regarding falsified medication – https://travelhealthpro.org.uk/factsheet/43/medicines-abroad

Manage Your Diabetes Online

Follow this link to access FREE service that helps you manage your diabetes, and improve your quality of life.

MyWay Diabetes gives instant access to:

1. Register (or login) for

a) Secure access to your personal diabetes health records displayed via easy-to-understand dashboards, and linked to information and advice to help you decide on priorities for your health.

b) NHS accredited eLearning courses that you can complete in your own time, covering type 1, type 2, gestational diabetes, those at risk of developing type 2 diabetes, and a range of other useful topics.

Please Book with the Right Clinician – We provide Over 47,000 Appointments Per Year

We recognise there is very high demand for appointments at the moment. By making the most of our services we can work together to make sure they provide the most for all our patients.

PLEASE EXPLAIN WHAT YOUR PROBLEM IS AND ASK OUR CARE-NAVIGATORS / RECEPTIONISTS WHO IS BEST TO SEE. MOST NEEDS CAN BE MET BY OUR EXTENDED CLINICAL TEAM AND DON’T NEED YOU TO WAIT FOR A GP APPOINTMENT

Who to Book WithWhat For?
Check our Self Referral & Self Help Page first Click Here
Ask your PharmacistCold sores
Colds
Conjunctivitis
Hay fever
Lice
Medication Queries & Side Effects
Constipation
Nappy Rash
Worms
Warts/Verrucas
Other Minor Ailments
Health Care AssistantChronic Disease checks
Prevention eg cholesterol, BP
Health checks
Ear checks
Nurses & Nurse PrescribersMinor ailments
Chronic Disease Management
Advanced Clinical PractitionerMost problems that a GP can deal with except very young children
Clinical PharmacistMost problems that a GP can deal with except very young children
Medication problems
Chronic Disease Management
Minor ailments
PCN PhysiotherapistMusculo-skeletal problem Experts
PCN Mental Health Professional (imminent)Mental Health problems
Health Coaches, Care Navigators, Social PrsecribersWeight loss
Benefits advice
Low Level Anxiety / depression

We provide an average of 930 consultations per week which = 96 for every 1000 of our population per week, or enough per year (over 47000) for nearly 5 appointments for every member of the population per year.  So each person would, on average, be able to have an appointment almost once every 2 months.

Each day we release many more appointments which are reserved until 48 hours before; and emergency on the day appointments.

Many of our appointments are with nurses and clinical pharmacists, as well as GPs.  Our whole team is qualified to help with your medical needs and can call upon a GP for advice or to come and review your case during your consultation. 

If you only want to consult with a GP and do not want to use E consultation then the wait for routine, pre-bookable, unrestricted appointments is longer, due to demand, at the moment. So we encourage you to use our whole clinical team and the support they have.  Many such appointments are going unused.

Demand is extremely high at the moment.  After the past year of lock down there is a backlog of health problems and concerns.  Lock down has provoked a great number of concerns for everyone.  Many appointments are booked because people are unhappy with hospital Covid delays but unfortunately, we cannot resolve this.  Many are booked for problems which can be resolved with self-care, self-referral options or by your pharmacist:  Please see our website for details: https://www.woodlanemedicalcentre.co.uk/self-help-self-referral/

Booking online is easier and available on our website as are our E-consultations and many other services:

Appointments are also available at our local GP Hubs.  You can call 02037701888 to access these: Booking lines are open 2pm-9pm Monday to Friday and 9am-5pm Weekends.  Appointments are available Monday to Friday and Weekends.

Our Appointment and Access Data:

Please see this useful video on accessing your care and general practice

WLMC

POLITE Notice to Patients

NHS staff at GP surgeries are facing unprecedented abuse and aggression from patients.  A recent poll by the body representing GP surgery staff across the UK found that 75% of them face abuse every day, including assaults, threats, racism and sexism. Comments in the national press include “Perhaps most distressing of all is a real surge in the number of patients who feel it is appropriate to shout at, swear at and insult not just our non-clinical staff but clinical staff as well. We have one member of staff reduced to tears every single day.” https://www.theguardian.com/society/2021/may/28/staff-at-uk-gp-surgeries-facing-abuse-and-tsunami-of-demand?CMP=Share_iOSApp_Other

Regrettably experiences at WLMC are in keeping with the national trend and this video from the Institute of General practice management https://www.youtube.com/watch?v=hAM3fSDq9kA. It is not reasonable to expect our team to suffer this day to day.  Our whole team has continued, and still continues, to do the best they can to help all our patients through and despite the great challenges the country, world and NHS is and has been going through.  

We understand that waiting times have been longer than normal for responses and appointments.  This is due to: 

  1. national and local unprecedented increased demand for general practice services
  2. the backlog and access problems in hospitals
  3. the volume of calls we have been receiving regards the covid-vaccine & staff we have had to second to the vaccine programme 

We are doing the best we can.  Our doors have always been open and we have continued to provide services for all our patients in line with the guidance. We have now completed our covid-vaccination campaign; which has received national accolade. Disruption to NHS care, unprecedented demand and access problems are not the fault of our staff and they are only doing what they can to help you.

The GP Partners and Management would like to advise patients of the surgery that under no circumstances will any kind of verbal abuse, raising of voices, derogatory comments, or any kind of threatening behaviour be tolerated towards any member of staff.

Any patient who continues to be abusive, threatening or generally unpleasant towards our staff – who are trying to help you under extremely challenging circumstances – will be spoken to by the management with a view to taking further action which may result in removal from our patient list.

The GP Partners

E-Consultations

We endeavour to respond to online consultations within two working days. Please be patient and bear with us if it takes 2-3 days longer. There is a tremendously high demand on general practice nationally currently. Please do not duplicate E-Consultations/appointments as this blocks access to appointments/consultations.

Please Select your problem/symptom rather than use general enquiries so the system can best help you. Please be accurate with your information and follow the advice the system gives you, particularly if that suggests you should seek more urgent attention.

Please focus on one problem in your E-Consultation: Both our clinicians and the E-Consultation system will struggle to help you satisfactorily regards multiple different problems or concerns in a E-Consultation.

If your condition deteriorates and you need more urgent help please seek it in the interim. But if there is no severe deterioration then please be patient and bear with us so we can help you the best we can.

This is particularly important over bank holidays.

In many instances the system will show you ways to help yourself which we would greatly encourage. Please also see our self help area on our website.