Have you just found out you are pregnant?
You can self-refer to the hospital here, there is no need to see a GP first

You can also find out lots of useful information, including how to calculate your estimated delivery date and how to keep well in pregnancy by visiting the NHS: Your Pregnancy and Baby Guide

To minimise the risk of complications of asthma, it is advisable to have regular reviews. You will be invited to complete our online questionnaire when your review is due to see if you need to come in.  

Why it's worth going to your asthma review
An asthma review is a great opportunity to make sure you're getting the right treatment for your asthma. It could help you keep free of symptoms.

This is your chance to ask questions about anything that's worrying you. For example, you can ask about any triggers or symptoms you're noticing. And you can check that you're using your inhaler correctly.

Even if you're feeling well with your asthma go to your review. It's a chance to make sure your asthma stays well, so you can carry on with doing the things you enjoy.  It could be that you'll be able to cut down your asthma medicines.

At your asthma review you can:

• review your asthma medicines to make sure they're still working well for you
• have tests like spirometry and peak flow to see how well your lungs are working 
• talk through any symptoms bothering you or triggers you've noticed
• talk to your GP or asthma nurse about cutting down your asthma medicines (if you've had no symptoms and haven't needed your reliever inhaler for three months)
• check you're taking your inhaler in the right way so the medicine ends up in your lungs where it's needed
• update your written asthma action plan 
• ask about other things that might help your asthma such as stop smoking support and starting to exercise.

How to make the best of your asthma review
Before you go write down any questions you want to ask. For example:

• Am I on the right dose of medicine?
• Is this the best inhaler for me?
• How can I cope with triggers?
• What do I do if symptoms get worse?
• How can I get into a good routine with my asthma medicines?
• Can I get stop smoking support?
• Keep a note of any symptoms
• Every day, make a note of how you feel, and whether you've noticed any triggers.  Write down whether or not you've taken your medicines as prescribed.

You can take this record along to your appointment. It will help your GP or asthma nurse get a clearer idea of how your asthma's been. 

Write down anything you think might be a symptom, even if you're not sure. You'll be able to talk about whether it's anything to do with your asthma or not, and what you can do about it. 

Try recording symptoms on your phone
When you have symptoms, take a video of yourself on your phone. Or you could ask someone else to film you.  If you don't have symptoms on the day of your appointment, having a video can help.  Showing your GP or nurse a video tells them what your symptoms have been like straight away. It means you don't have to try describing them.  

Take along all your inhalers and spacers
Your GP or asthma nurse can check your inhaler technique. Even a small tweak to the way you take your inhalers can make a big difference to how much asthma medicine is getting to your lungs. 

At your appointment
Be open about anything that could be making your asthma worse. For example, if you keep forgetting to take your inhaler, or don't take it because you're worried about side effects, talk about it to your GP or asthma nurse. They can find ways to support you. 

It helps your GP to know if you smoke, so be honest.  Smoking can make your asthma worse, and stop your asthma medicines working so well. 

Ask your GP or asthma nurse how you can make some changes to help your health. They can help you with quitting smoking. They can also give you advice about weight loss.  It's also good to be open about any complementary therapies you've tried. Sometimes complementary medicines can interfere with your asthma treatment, so it's really useful for your GP or asthma nurse to know about it.

Ask questions
This is your chance to get information about your asthma and the best way to look after it, so ask as many questions as you need to.

Don't be afraid to ask your GP or asthma nurse to repeat anything you don't understand.

Are you happy with your inhaler technique?
If you are not, did you know there is an online demonstration on the Asthma UK website or you will have the opportunity to go over this at your annual review.

If your symptoms are deteriorating or you have any concerns before your annual review is due, please contact us.

You can find information and guidance on the Asthma UK website. Some further information about why it’s important to have your annual review and how to make the most of this appointment is taken from their website

Make sure you see your GP or Asthma nurse about your Asthma:

• Within 24 hours if asthma symptoms have been getting worse, you need to use your reliever inhaler three or more times a week, or you've had an asthma attack
• Within two working days if you've had to go to hospital with an asthma attack
• Within four to eight weeks if your prescription has changed
• After 12 weeks if you've had no symptoms. You should be on the lowest dose of medicine needed to keep you free of symptoms. Depending on your triggers and the pattern of your symptoms, you and your GP or asthma nurse can talk about keeping you on the same dose of medicines or reducing your dose
• If you have seasonal triggers like hay fever. Go the month before your hay fever usually starts. Managing hay fever symptoms is an important way of managing your asthma. Your GP or asthma nurse may also increase your asthma treatment beforehand to provide extra protection
• If you want to talk about having a flu jab in the autumn

If you are concerned about your hearing, we can offer hearing tests in the afternoons with one of our healthcare assistants 

Baby Reviews

• 8 weeks in the baby clinic. This is run by our nursing team who are trained in developmental checks.
• 11-12 month developmental review with the HV team.
• 27 Month ASQ developmental Review with the HV team.

Baby Clinics

There are a number of Well Baby and breastfeeding support drop in clinics in the area. Please remember to bring your red book (parent held record).

Kingston

Address: Kingston Town Children’s Centre, 40 Villiers Road, Kingston upon Thames, KT1 3AR

• Wednesday, 09:30-11:00
• Breastfeeding Support, Wednesday 10:30-12:00.

Address: North Kingston Children’s Centre, Latchmere Road, Kingston upon Thames, KT2 5TT

• Monday, 13:00-14:30

Surbiton

Address: Tolworth Children’s Centre, School Lane, Surbiton, KT6 7SA

• Wednesday, 13:15-14:45.
• Thursday, 09:30-11:00 (by appointment only, please call 020 8274 7718).
• Breastfeeding Support, Friday, 09:30-11:00.

New Malden/Old Malden

Address: New Malden Children’s Centre, Burlington Road, New Malden, KT3 4LR

• Wednesday, 009:15-10:45.
• Breastfeeding Support, Wednesday, 10:30-12:00.

Address: Old Malden Children’s Centre, Malden Manor Primary School, Lawrence Avenue, KT3 5NB

• Friday, 09:30-11:00.

Recommended Weighing
Every 1-2 weeks for the first 4-6 weeks.

Monthly up to 3 months unless requested otherwise by a health professional. Then at 6 months, one year, and yearly thereafter unless requested otherwise by a health professional.

You can come in to the Kingston branch at any time during our opening hours to weight your baby.

Recommended Length Measure
At birth, 6 weeks, 1 year, and yearly thereafter.

For most blood tests you do not need to do anything specific prior to coming in.  Drinking two large glasses of water will make it easier to have the test.

Instructions for Fasting Lipid/Glucose Blood Tests

• NO alcohol to be consumed 24 hours before the test
• NO smoking 12 hours before the test
• NO food, tea, coffee or fruit drinks to be consumed 12 hours before the test – i.e. your last meal should be eaten by 8.30pm the night before

You may drink as much plain water as you like, we suggest two glasses before the test in the morning.

Please take your usual medication, unless you have diabetes.  If diabetic, please delay your diabetic medication until after your blood test then continue as normal.

The test may have to be postponed if these instructions are not followed.

Children under 7
Blood tests for children under 7 years of age at Kingston Hospital are by appointment only - to book an appointment, please call 020 8546 7711 ext. 6403

All children under the age of 16yrs attending the Phlebotomy should be accompanied by an adult.

Our nursing team carries out cervical screening.  

All women aged 25-64 are eligible for a smear test as part of the national screening programme.  Cervical screening is offered because it can detect abormal cell changes in the cervix that could potentially develop in to cancer.  If significant abnormalities are detected at an early stage there is the option of having treatment to remove them before they have a chance to become cancerous.  

You can watch a video about what to expect during your smear test on the NHS website

How do you book an appointment?
As soon as you have received your invitation letter in the post from the national screening programme you can either book online or contact reception to make an appointment.  It is not possible to carry out a smear before it is next due, so you do need to wait for your recall letter, but if you have any worries please request an appointment to see of one of the GPs. You can see our nurses at any time to have your cervical screening, including Thursday evenings.

Find out more about other screening services on the NHS website

Our practice nurses carry these appointments and will be happy to discuss your child’s vaccines with you.  If you have any questions or concerns, they will be happy to talk to you about this.

To minimise the risks of COPD it is advisable to have regular reviews. 

You can find out more information about how you can manage your COPD on the Asthma and Lung UK website

C Are you CHESTY?

• Are you more breathless, feeling unwell?
• Are you coughing up more phlegm or has your phlegm turned yellow or green? 

Yes = Take your “emergency medicines” given to you to have at home by your doctor.  If, after 72hrs, you do not feel better then contact your GP or Out of Hours Doctor service on 111.

O ORDER your medicines

• Make sure you have your inhalers and tablets.  If you use your emergency medicines, do not forget to let your G.P. know and order a fresh supply. 

P PLAN your care. 

• Is your care plan up to date?  Are you sure you know who to contact if you feel unwell?  Do you have a copy to show to any health professional that you see? See your GP to agree your care plan. 

D DO act.  DON’T ignore how you feel.  

• There is good evidence that treating chesty type symptoms early can reduce the risk of people with COPD being admitted to hospital.

We run Diabetic Clinics on Tuesday Mornings with Karan one of our HCAs.  Karan takes some initial measurements, such as BP, BMI and will perform your foot check.  You will then have a consultation with a GP to discuss your diabetic care.  If you cannot attend this clinic, alternative appointments can be arranged.

The Diabetes UK website has lots of useful information about your condition, and how to live well with diabetes

If you have Type 2 Diabetes you can also book directly on to Diabetes Education Programmes running in South London. This includes structured education courses where you attend a group educational session, for example the DESMOND course or remote support provided completely online, such as the OVIVA project.  You can also find out more about what each course is able to offer through the link above.

Diabetic Retinopathy Screening is provided by the South West London Diabetic Eye Screening Programme. You can contact them by calling 0333 456 0223 or via their website if you need to re-arrange or book your appointment.  

More information is available on the NHS website

You need to arrive at least 30minutes before your appointment time and rest with your legs horizontal.  Please inform reception when you arrive, especially if you self-check in, so that they are able to find somewhere for you to rest with your legs up. 

This test may take 30-60 minutes to complete. 

Gel will be placed on your leg(s).  A transducer (Doppler) will be placed on your skin and moved around during the test. The nurse or HCA may apply pressure with the doppler throughout the test to compress the veins underneath.

What is ear wax?
Ear wax forms a protective antiseptic coating of the skin in the ear canal.
The amount of ear wax produced varies from person to person. Some individuals form plugs of ear wax in their ear canals which can interfere with hearing and cause tinnitus (ringing in the ears).

A doctor or nurse can look into the ear to check if an excessive amount of wax is present. 
A plug of wax is not a serious problem, but may be a nuisance if it dulls hearing.

Important Note
Never try to clean the ear canal with cotton buds, hair grips, pens etc. as this can only make the problem worse. The wax can be pushed further into the ear canal making it very difficult to remove. It may also cause an ear infection.

What happens if ear wax builds up and causes symptoms?
If the doctor or nurse thinks you may benefit from ear irrigation, they will ask you to put drops into your ear to soften the wax before the procedure is carried out

Use a small bottle with a dropper which can be obtained from a chemist. Fill this with pharmacy grade olive oil and warm to body temperature by standing in a bowl of warm water.

Then, either sitting or lying comfortably with the affected ear uppermost, pull the ear up and back, gradually drop all the oil from the dropper into the affected ear.
Allow the olive oil drops to soak into the earwax for at least 10 minutes. Then let the excess oil to drain out of the ear and wipe away with tissues.

Carry this procedure out twice a day for two weeks prior to ear irrigation.

Important Note
Don’t worry, it is not possible to “over oil” your ear!  Excess oil will simply drain back out of the ear canal. The more oil you use, the softer the wax will become and the easier it will be to remove with irrigation. 

Occasionally, you may find effective oiling reduces the need for irrigation.

Ear Irrigation After Care 
Discontinue using the olive oil following irrigation if the procedure has been successful, then keep the ear canal dry for 48hrs being especially careful when showering and also avoid swimming for the 48hours, if possible or wear swimming ear plugs. 

If this is an ongoing problem for you then to help to keep ears clear of a build of wax, it is advisable to instill pharmacy grade olive oil as done previously once a week.

If you have high blood pressure (hypertension) you may be able to be seen in our HCA-led hypertension clinics.  The aim of these clinics is to ensure you are getting the best possible advice about how you can manage your blood pressure, and to make it easier for you to obtain your repeat medications.

The clinic runs in two parts:

1. A non-fasting blood test
2. A ‘hypertension clinic’ appointment with one of our HCAs or Flora approximately one week after your blood test appointment 

Once you have seen the Health Care Assistant or nurse, and if your results are all normal, they will ask Dr Rooms to re-authorise your medication.  This will be sent to the chemist of your choice for you to collect within 48hours and you will not need to make an appointment with the doctor.  If any of your results are abnormal, your blood pressure is not well controlled or you have any concerns about your tablets that the HCAs are not able to answer they will make you an appointment with the doctor.

Your medication can then be automatically issued and sent to the pharmacy every 2 months for you to collect; you do not need to put in a repeat request either to the pharmacy or to the surgery.  This is a system called ‘repeat dispensing’.  When your repeat medication runs out, it will normally show as ‘6/6 issues’ on your repeat slip you will need to attend the hypertension clinic again.  This will usually be every 12months.

Below is information about the new hypertension clinics and about the repeat dispensing service.  If you have any questions about this process, please do contact our Reception Manager, Hayley or Senior Administrator, Julia who will be able to help.

To manage high blood pressure and high cholesterol is very important for your health, and your lifestyle can play an important role in this.  As such we want to ensure you are getting the best possible advice on what you can do to improve your health with lifestyle changes. Our HCAs and nurses are specially trained to offer this advice to you. You will be seen in the clinic once every 12 months. You do not need to see a GP as well regarding your blood pressure or high cholesterol unless the HCA or nurse advises you to do so, or you have specific concerns with your medication or symptoms that the HCA or nurse cannot address.

We recognise that recording your blood pressure in the GP surgery can cause anxiety for some patients (the ‘white coat syndrome’!). If you tend to get high readings at the surgery you may wish to consider purchasing a machine to check your blood pressure at home. These can be bought quite cheaply from a pharmacy or online but please ensure you get a good quality machine that measures on the upper arm not the wrist, as these are not so accurate. If you do have a machine at home please consider bringing in up to a week of twice daily readings to your clinic appointment so we can record this on your records. We will also be looking at installing a machine in the surgery waiting room so you can check your blood pressure when it is convenient to you.

What will happen at the clinic:

• Last issue of medication (issue 6/6 on your prescription repeat order form) – recognise that your review is due.
• Book an appointment at the surgery for your blood test (not fasting unless told otherwise).
• At least one week later book an appointment for the hypertension clinic.
• During the appointment the HCA will check your blood pressure, height, weight and ask you about your lifestyle. They will discuss healthy lifestyle advice with you and answer any questions you have.
• They will record your ‘QRISK2’ which is calculation of your estimated risk of heart disease in the next 10 years. If this is raised and it has not previously been discussed with a doctor they will advise you see a GP routinely to do so.
• They will ask if you have any problems with your medication or symptoms that could be related to your blood pressure e.g. headaches, chest pains, dizzy spells. You may be advised to discuss these issues with a GP.
• If your blood pressure is normal your medication will be reauthorized for another 12 months, when you should attend the hypertension clinic again. Your medication will be sent to your pharmacy via the repeat dispensing service, so you can collect each set from the pharmacy directly when you need it, without having to request it from the surgery.
• If your blood pressure is high the HCA will advise you what to do next.
• If you have seen a GP in the interim for another reason and had a normal blood pressure recorded and the appropriate blood tests done then you can been seen in the hypertension clinic 12 months after that time.

If you are aged between 40-74 and do not have any pre-existing medical conditions we would like to invite you to attend a FREE NHS Health Check here at practice with one of our Health Care Assistants.

The NHS Health Check programme runs across the whole country, and aims to provide you with a personal assessment of your risks of developing conditions such as;

• heart disease
• stroke
• kidney disease
• diabetes 

If there are any warning signs of these conditions, then together we can do something about it.  By taking early action, evidence shows that you can improve your health and prevent the onset of these conditions.

The check should take about 20-30 minutes.  We will ask you some straight forward questions and measurements such as:

• family history
• height
• weight
• blood pressure.

We will also take a sample of your blood to measure your cholesterol level. 

Following the check, you will receive personalised advice from our health care professionals to let you know what you can do to stay healthy.

You can find out more about the NHS Health Checks programme and how it can benefit you on the NHS website

Postnatal appointments can be booked with the doctor at any time. You should have a postnatal check about six weeks after giving birth to check in on how you are feeling and make sure you are recovering well.   

If you would like more information on the postnatal check you can view information on the NHS website

You will be asked how you are feeling as part of a general discussion about your mental health and wellbeing. It is important to look after your emotional well-being at any time, but during pregnancy and after the birth of your baby you will be more vulnerable to some of the common mental health problems that can impact on you and your baby.

These problems are treatable so if you think that you are experiencing any of these, please talk to the GP, health visitors or contact iCope

Kingston ICope offers treatment for a range of psychological problems and is for all adults registered with a Kingston GP. You can self-refer to this service by completing the self-referral form on their website, by telephone on 0203 317 7850 or find their email address on their website. Your GP can also refer you should you wish to discuss any concerns with them first.

The practice has a team of secretaries who send off all referrals generated by the GPs and nurses at the practice. Routine referrals are prepared within 5 working days and urgent referrals within one working day.

Did you know you can self-refer to some services? 
Please check our self-care section. Referrals to hospital outpatient clinics are sent via e-referral, the NHS national electronic referral service. Through e-referral you are able to choose the place, time and date of youebsr first outpatient appointment.  

Want to book or change your outpatient appointment? 
Log in to the e-referral service. You will need your Booking Reference Number (UBRN), your password and your date of birth. You can find this information on the letter you received from the surgery. 

Community Services
Referrals to community or selfservices are booked in a different way. For these types of appointments it is not possible to change the location of your appointment, and you will hear directly from the service. You can view Community Services that are available here

Two week rule referrals
If your GP discussed referring you under the ‘Two Week Rule’ you will hear from the hospital within 2 weeks.  It is very important we have your correct address and telephone number, if you think this might be wrong please contact the practice to update your details.  

These appointments are with our healthcare assistants or pharmacists who are able to offer advice and support on quitting.  

Your first appointment will be 30 minutes long and they will discuss with you the range of support measures available to you. 

You can also visit NHS: Smoke Free to find out how you can get free help today.  

Mrs Harriet Mpanga – Social Prescriber
Many of our patients face issues of a non-medical nature which nonetheless affect their health and well-being.  The social prescribing service supports patients in addressing these needs.  We may refer patients to relevant community resources or we might provide advice and advocacy where this is possible.  We work with patients in tackling issues including but not restricted to: housing, welfare benefits, supportive care, loneliness, parenting, financial strain, employment, mobility, caring roles, bereavement and post-discharge care.  We also address the social needs of patients living with autism, ADHD, dementia and post-treatment cancer.  

Single spirometry testing
You will have a single spirometry test as part of a COPD annual review or as part of your ongoing respiratory monitoring.

Please use your salbutamol (blue) inhaler 30minutes before your spirometry test.

If you are unsure please contact the surgery as if you do not follow these instructions you may have to re-book your test.

Reversible spirometry testing
A reversible spirometry is a breathing test which allows the GP or Nurse to establish the efficiency of your lungs at present.   In order to obtain an accurate reading it is essential that you avoid certain things prior to this test. This includes:

1. Using your Salbutamol/Terbutaline for at least 4 hours prior to the test.
2. Using your Salmeterol/Formoterol for at least 12 hours prior to the test.
3. Taking either Theophylline or Tiotropium in the 24 hours before the test.
4. Smoking for 24 hours prior to the test.
5. Consuming alcohol for at least 4 hours prior to the test.
6. Vigorous exercise for at least 30 minutes prior to the test.
7. Wearing tight clothes that might restrict your ability to breathe in or out deeply with ease.
8. Eating a substantial meal for at least 2 hours prior to the test.

Recommendations of British Thoracic Society and the Association for Respiratory Technology and Physiology

Test results will normally be available around 7-10days after you have had your test at the surgery.  Some results, such as MRIs, take longer to arrive back at the practice.

You will usually be contacted once your results have been reviewed to advise you on next steps.  We do ask patients to get in touch if you have not heard three weeks after your test. 

Please note if you had a test at the request of a consultant or other health professional not based at the practice, we will not be able to give you this result or chase it up for you.  You will need to contact the consultant or health care professional who asked you to have the test

Our practice nurses carry out travel vaccine appointments. In order to make an appointment for these you will need to:

1. Complete an administration form with your dates and destination of travel
2. We will be in touch to arrange your appointment once your form has been reviewed

Please try to contact us at least two months prior to departure to allow time for your vaccinations to take effect.  

Not all vaccinations are free on the NHS, below is a pricing list for the vaccines we are able to offer:

Fees For Travel Vaccines (costs per vaccine)

• Hepatitis B(course of 3) - £35.00 (1 dose, complete course £105)
• Meningitis ACWY - £48.00
• Rabies - £60.00 (1 dose, complete course £180)
• Yellow Fever (including certificate) – Registered patients £61.00
• Yellow Fever (including certificate) – Private patients £76.00

Other Vaccinations

• Polio - Free
• Tetanus - Free
• Typhoid - Free
• Hepatitis A (1st and 2nd injection) - Free

Travelling within the next month
If you are travelling within the next 2 weeks, you will need to attend a travel clinic as we will not be able to see you at the practice.  This is because you need to be seen as soon as possible to give the maximum amount of time for your vaccines to take effect and the nursing team will not have time to check your vaccination history.  

The practice will be able to give you a computer printout of your vaccination history free of charge, alternatively you can log in to your online access account and view it there.