You may find yourself being asked at your next blood test appointment if you would like a HIV test as part of the bloods you are having. In case you are wondering why, this is part of a nationwide campaign to raise awareness for everyone of their own HIV status, it is not designed to target one specific group of patients, everyone is being invited to have one.

For more information on HIV awareness and testing please view the links below:

https://www.england.nhs.uk/blog/a-routine-blood-test-not-only-changed-annes-life-but-saved-it

https://www.nhs.uk/conditions/hiv-and-aids

https://www.unitysexualhealth.co.uk/hiv-information-services-support-testing-treatments/hiv-risk-tests-treatments/

Cervical screening tests for human papillomavirus (HPV).

HPV is very common. Most people will get the virus at some point in their life. It is spread through close skin to skin contact during any type of sexual contact. There are many different types of HPV, some types can cause abnormal cell changes, but only some types can lead to cancer, these types do not cause any symptoms. In most cases, your immune system can get rid of the virus without you ever knowing you had it.

Sometimes HPV can stay in the body for many years at undetectable levels without causing any problems. This is called ‘dormant’ HPV. Dormant HPV can become active and is then found at screening. This means the HPV infection can become active again years after you have it. HPV can cause abnormal cell changes in your cervix.

Your cervix is the lowest part of your uterus (or womb), and it is found at the top of your vagina.

Diagram showing the female reproductive system.

Your body can usually get rid of the abnormal cells and your cervix returns to normal. But sometimes this doesn’t happen, and the abnormal cells can go on to develop into cancer. This is usually a slow process taking over 10 years.

Going for cervical screening when invited is the best way to protect yourself against cervical cancer. It is your choice whether to have a cervical screening test or not. Please read the leaflet about cervical screening available at: Cervical screening: leaflet for women considering screening – GOV.UK (www.gov.uk). This leaflet will help you decide whether to have the test and provide more information about HPV and cervical cancer.

You will get an invitation for cervical screening through the post if:

• your contact details are up to date
• you are between 25 and 64 years old
• you are registered as female on your NHS records*

In some areas, you may be able to arrange your appointment at a sexual health clinic instead of your GP practice.

If you are not registered at a GP practice and would like to have screening at a GP practice, you will need to register first; more information about registering is available at: How to register with a GP surgery – NHS (www.nhs.uk)

In some areas, local sexual health clinics may also offer screening. More information about finding a sexual health clinic local to you is available at: Find a sexual health clinic – NHS (www.nhs.uk).

If you are not sure if you are due for cervical screening, you can ask your GP or health professional.

*If you have a cervix but are not registered as female with your GP you will need to ask for a cervical screening appointment. You can talk about this with your GP, practice nurse, at a sexual health clinic or transgender health clinic. More information is available at: NHS population screening: information for trans and non-binary people

Booking your appointment

Before you book your appointment, it might help to think about what would make screening easier for you. You might already know what can help or you may want to discuss this with a nurse or health professional who can make some suggestions. Here are some tips that might help:

• If you get anxious sitting in waiting rooms, let the receptionist know. You can ask to book the first appointment of the day, so that you do not have to wait long.
• If you would prefer to be seen by a woman, ask for a female health professional.
• Tell the receptionist if you would like a chaperone. This is a usually another health professional. You might also want a friend, relative or carer present.
• You may feel you need more time for your cervical screening appointment. Ask the receptionist if you can book a longer appointment to give you more time during and after.

You may also wish to consider asking for an appointment just to talk about what happens during the screening first (you do not have to have the test at this appointment).

If you find screening painful a doctor may be able to prescribe creams or medications to help you feel more relaxed.

Before your appointment

You may find it helpful to:

• plan your journey
• listen to music or watch something on your phone to help you relax, or bring something to read
• consider what to wear to your appointment; if you feel more comfortable wearing a skirt, dress or long top, it may help you feel more covered (you can keep these clothes on during your test and only take off your underwear)
• speak to the health professional beforehand to discuss your concerns if you think the test may be uncomfortable as they can offer support
• ask someone you trust to go with you, such as a friend, relative or carer/mental health worker, who can also be with you after your appointment

Questions to ask the health professional

It might be helpful to think of any questions you want to ask the health professional before your appointment.

We want to make you feel at ease so you have the best possible experience – you can ask for extra support for any reason, including if you:

• have a mental health condition
• take medication that makes you shake
• find it hard to leave your house
• sometimes find it hard to process information
• do not like to feel exposed by removing your clothes
• are embarrassed by showing your body
• have scars
• feel like you might be judged
• feel like a burden
• are afraid it will hurt
• may start to cry or freeze up
• may pass out or faint
• may have a panic attack
• get distressed during a physical examination
• have had a negative cervical screening experience in the past
• have experienced trauma
• are a survivor of sexual violence
• are a survivor of female genital mutilation or cutting (FGM/C)
• want to be warned before the health professional touches you
• find that waiting rooms make your symptoms worse
• find that certain words, actions or positions trigger anxiety attacks or flashbacks

You may want to print out and fill in the extra support checklist to take with you to your screening test.

During your appointment

The cervical screening test takes a few minutes – here’s what to expect at your appointment:

The health professional will explain the test at the start of your appointment.

1. You will have a private space to undress from the waist down and you will have a modesty sheet to cover you – remember you can wear a long top or dress/skirt to help you feel less exposed.
2. There may be different positions that could make the test more comfortable for you, like lying on your side. Your healthcare professional will work with you to make sure you are in the most comfortable position.
3. A speculum (usually plastic) will be gently put into your vagina. It opens so the health professional can see your cervix. Speculums come in a range of sizes. Talk to your health professional to discuss the size that is most appropriate for you.
4. The health professional will use a small, soft brush to take a sample of cells from your cervix.
5. Your test could feel uncomfortable but remember, you are in control during the test. It may help to agree a word or hand signal, so the health professional knows to stop immediately if you want them to.

After the test

The sample of cells is sent to the laboratory for testing.

We will send your screening result to you by post. The nurse or doctor who does your screening test will tell you when you can expect to get your result letter, and they will also get a copy. Please make sure you tell your GP practice or healthcare professional about any changes to your address.

You may feel anxious while waiting for your results. It may help to speak with someone you trust about how you are feeling.

Cervical screening results

HPV negative

Most people get an HPV negative result. This means no further tests are needed and you will be called back for screening when your next test is due.

HPV positive, no abnormal cells

If your sample is HPV positive, we also test it for abnormal cells. If none are found, your result will say you have HPV, but no abnormal cells. We will ask you to come for screening again sooner than usual. Your result letter will explain when.

HPV positive, abnormal cells

There are several ‘grades’ of abnormal cells as some are more serious than others. Your result letter will explain what your results mean. If you have HPV and any grade of abnormal cervical cells we will refer you for colposcopy (see information below).

Further information about having a colposcopy is available at: NHS cervical screening – having a colposcopy.

Unavailable or inadequate

Occasionally a sample may be called ‘unavailable’ or ‘inadequate’. This means that we were not able to get a result from your screening sample. This sometimes happens when there are not enough cells in the sample to get a result or due to a technical problem at the laboratory.

We will send you a letter inviting you for a repeat test in 3 months. Waiting 3 months gives your body enough time to make new cells, meaning it is less likely to happen again.

Looking after your health

You will get another invitation through the post when you are due for cervical screening again.

If you have any unusual symptoms, please tell your GP as soon as possible. These might include:

• vaginal bleeding that is unusual for you; bleeding between your periods, during or after sex, after the menopause or having heavier periods than usual
• pain during sex
• changes to vaginal discharge
• pain in your lower back, between your hip bones (pelvis), or in your lower tummy (abdomen)

These symptoms are often caused by other things, but it is important to get them checked. In rare cases cervical cancer can develop in between screening tests. But if you are found to have cancer, getting it diagnosed and treated early can mean you are more likely to survive.

Screening is not a test for investigating symptoms. If you have any of these changes, don’t wait for your next cervical screening appointment. See your GP as soon as possible. Your GP can examine you and refer you to a gynaecology clinic if necessary.

Getting support

If you need support, you:

• can talk to a trusted friend, relative or health professional
• may find it helpful to seek spiritual support from a religious or spiritual leader
• may want to talk to someone at Jo’s Cervical Cancer Trust, The Havens, Samaritans or SANE

Jo’s Cervical Cancer Trust

Jo’s Cervical Cancer Trust is a national charity dedicated to eliminating cervical cancer that has information and support about cervical screening, cell changes (abnormal cells) and cervical cancer – no question too big or small.

More information about their Helpline (0808 802 8000) and online services can be found at Get Support – Jo’s Cervical Cancer Trust

The Havens

The Havens are specialist centres in London for people who have been raped or sexually abused. Telephone 020 3299 6900 for urgent advice or an appointment.

My Body Back (London and Glasgow)

My Body Back offers support to people to reclaim control of their body after sexual violence. It runs specialist clinics offering cervical screening and sexually transmitted infection (STI) testing in London and Glasgow for women, transgender and non-binary people who have experienced sexual violence.

Email: info@mybodybackproject.com

Samaritans

Samaritans is available round the clock, every single day of the year. You can talk to them any time you like, in your own way, about whatever’s getting to you.

Call free, any time: 116 123

Email: jo@samaritans.org

SANE

SANE is a national mental health helpline offering specialist emotional support to anyone affected by mental illness.

SANEline: 0300 304 7000 (every day, 4.30 to 10pm).

Support for victims of sexual violence and abuse

Advice and support for those who are experiencing or feel at risk of sexual violence and abuse is available at: Support for victims of sexual violence and abuse – GOV.UK (www.gov.uk)

National FGM Support Clinics

National FGM Support Clinics (NFGMSCs) are community-based clinics that offer a range of support services for women with female genital mutilation (FGM)

More information and clinic locations can be found at: National FGM Support Clinics – NHS – NHS (www.nhs.uk)

Acknowledgement

This information is adapted from a leaflet developed by Dr Frederique Lamontagne-Godwin, which was based on research with users of mental health services and was supported by:

• Jo’s Cervical Cancer Trust
• NHS Dorset Healthcare University Foundation Trust
• University of Surrey
• University of West London
• West London NHS Trust

We are grateful to all the patients, service user groups, professionals and frontline staff who helped in the making of that leaflet.

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Information for Trans Patients – Or those wishing to change their name, title and / or gender on their NHS records
​
We are proud to have you as our patient.
 
We support all patient groups and are committed to accessibility and inclusion, but we also know we may not always get things right. If there is anything you think we can improve or change to make accessing our services easier for you, please email bnssg.pilningsurgery@nhs.net

Confidentiality

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We hold your medical records in the strictest confidence, regardless of whether they are electronic or paper. We take all reasonable precautions to prevent unauthorised access to your records. Access to medical records is audited. Your NHS records are only shared with our Practice team and other organisations directly involved in your care that have a genuine need for it e.g. community health services, hospitals, mental health services, social care, NHS 111. We will not share your information with any other third party without your permission unless it is an exceptional situation (e.g. life or death situation) or where the law tells us to. For more information on how your data is shared and stored by the NHS, including opting out of sharing data, please see here
 

• Changing your name on your NHS records – Please fill out a change of name form available here or at reception. Please hand the form into reception or email to us bnssg.pilningsurgery@nhs.net No proof of ID is needed. This name will be used by staff, on the automated call-in screen, and communications from the Practice e.g. SMS, letters, email. You can request to change it at any time.
• Changing your title on your NHS records – you can change your title on your NHS records to any of Mr/Mx/Miss/Mrs/Ms without changing your gender or name. No proof of ID is needed. Just ask any member of staff or email us at bnssg.pilningsurgery@nhs.net. The NHS computer system is currently binary and the only titles it currently accepts with a male gender marker are Mr or Mx. The only titles the computer system accepts with a female gender marker are Mx/Miss/Mrs/Ms. This computer system and titles available are set nationally and are out of our hand. If you wish to choose another title, we can add an alert to your notes, so we as a Practice know your gender identity, please discuss with any staff member
• Changing your gender marker on your NHS records to male or female– you can do this at any time, please book an appointment (ideally face to face) with a GP to discuss this. No proof of ID is needed. You do not need to have undergone any form of gender affirmation treatment, have been referred to a gender identity clinic or have any official documentation. Changing your gender will mean you will be allocated a new NHS number, and your pre-existing NHS number will no longer be accessible. Your previous notes will be merged to your new notes, minus any previous identity information. Any subsequent changes to gender would involve a further NHS number.

How long will the process take?

A new NHS number can take over 4 weeks to come through to us, once we notify PCSE . Once we receive your new NHS number, we will create a new registration for you at the practice within 5 days and will aim to merge your old records to your new records (excluding any information related to your previous identity) in a timely manner to ensure minimal disruption to your care. We suggest you order 2 months’ supply of your medication beforehand. You should be informed of your new NHS number by PCSE. If you do not receive this, please contact us and we can give it to you. You may need to inform any hospitals you are under (e.g., waiting for an appointment, surgery or treatment) of your new NHS number so they can update your records.

Cancer screening tests

Unfortunately, currently national cancer screening test invitations are sent out based on the gender marker on your NHS records. This system is currently very binary and only accepts a male or female gender marker on NHS medical notes. This is a national decision and out of our hands. If you wish to choose non-binary or another gender identity, we can add an alert to your notes, so we as a Practice know your gender identity, please discuss with a GP (see below).
Importantly patients who have changed their gender marker on their NHS records may not be invited to some of these cancer screenings, meaning there is a risk of missing cancer. Please see NHS screening Guidance for Trans Patients for more information. Please discuss with your named GP to make discuss this further.
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Cervical cancer screening in trans men and non-binary people with a cervix
We welcome you to have your cervical screening at the GP surgery by highly trained staff. Please book a telephone appointment with a GP or nurse who performs cervical screening to discuss this.
 
Please see this NHS video on cervical screening in trans men here
 
We can also offer adaptions e.g.

• an appointment at the beginning or end of the clinic
• bring a friend/partner, bring your own blanket to cover the lower half of your body
• choose to have the door locked or unlocked
• chaperone in the room
• bring a phone/tablet and headphones to play music or watch a video
• different sizes of medical equipment – you can take one home with you to practice with beforehand if this is helpful
• At your appointment, other people in the waiting room will be waiting for a range of different appointments and will not be aware you are there for cervical screening
• Medication and lubricant to make the procedure more comfortable

You can also contact a specialist NHS clinic to have your cervical screening there (nearest is London):

• 56T at 56 Dean Street in London >
• The Butterfly Clinic in Liverpool >
• Clinic T in Brighton >
• CliniQ in London >
• My Body Back in London >
• My Body Back in Glasgow >

 
Discussion with named GP Once we receive your gender marker change form, we will book you a GP appointment to discuss cancer screening tests and merging your old and new notes.

Referral to an NHS Gender Identity Clinic

Please book a GP appointment to discuss referral – you do not need to have socially transitioned, have counselling or psychotherapy or any tests for the referral. We will send the referral as soon as you request it. You can choose which GIC to be referred to see here. Hormone therapy can reduce your fertility, please let your GP know if would like to be referred to discuss egg or sperm storage whilst waiting for your appointment at the gender clinic. Your GP can also discuss other ways to support you whilst awaiting your appointment e.g., medications to stop periods and ensuring your physical health is optimised ready for hormone treatment.

Private Providers – Gender Identity Clinics

In the UK there are a number of private gender identity services, ranging from those mirroring the NHS offer – led by a team of clinicians (including doctors, psychologists) who also work at NHS gender clinics. Other clinics do not offer the equivalent of the NHS service e.g., online service only, do not have GMC registered doctors and are not UK based. We are unable to recommend any specific clinics. However, signs of a safe and effective service according to NHS England’s current commissioning protocol (2013) would be:
 

• The assessment and diagnosis of gender dysphoria is made by a clinician e.g., psychologist who specialises and is experienced in gender dysphoria. This is over a minimum of two core assessment consultations
• They ask for your full medical history
• The decision to start hormone therapy is made by a doctor who is registered and based in the UK, has relevant training in gender dysphoria and at least two years’ experience working in a specialised gender dysphoria practice, such as an NHS Gender Identity Clinic
• The clinic is based in the UK
• They discuss the following with you and give you opportunities to ask questions:
  • potential risks and limitations of, and alternatives to hormone therapy, as well as its potential benefits
  • The likely impact of hormone therapy on fertility including egg or sperm storage and how to access this.
  • The likely permanent changes that hormone therapy will make to your body
  • When on hormone therapy the need for effective contraception, regular monitoring (blood tests, blood pressure, weight), smoking cessation, maintaining a healthy weight. Also, what changes you should make to your medication if you were to have an operation

 
Local Support Groups

• TransBristol – a safe space where trans identified people in Bristol can share ideas, provide support and plan things.
• Bristol Crossroads – a safe, secure, friendly social meeting place for TG people of all kinds and those questioning their gender, their partners and close family. A community support group run by volunteers,
• Gay West website is a social and support group for LGBT people in Bath, Bristol, and surrounding areas.
• Hidayah website are a charity providing support, mentoring, and social connection opportunities to LGBTQI+ Muslims.
• LGBTQ+ support services for young people, their carers and families here

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Pilning Surgery discussion with GP about changing gender marker on NHS records
Please note, no proof of ID is necessary, you do not need to have undergone any form of gender affirmation treatment, have been referred to a gender identity clinic or have any official documentation.
 
Patient Name
Patient Address
Patient DOB
 
We support all patient groups and are committed to accessibility and inclusion but we also know we may not always get things right. If there is anything you think we can improve or change to make accessing our services easier for you, please let us know.
The aim of this document is to inform you of the process, discuss how your medical information is stored and the important screening tests you need. We hope that it is helpful.
 
The process of changing gender marker on your NHS records
When you change your gender marker on your NHS records, you will be given a new NHS number. Your previous NHS records will be merged onto your new NHS record (excluding any information related to my previous identity e.g., gender, title, name, pronouns, previous NHS number). This process is not reversible. Should you wish to revert back to your original gender marker, you would receive a third NHS number. This system is currently very binary and only accepts a male or female gender marker on your NHS records. This is a national process and out of our hands. If you wish to choose non-binary or another gender identity, we can add an alert to your notes, so we as a Practice know your gender identity.
A new NHS number can take over 4 weeks to come through to us. Once we receive your new NHS number, we will create a new registration for you at the practice within 5 days to ensure minimal interruption to your care. We will aim to merge your old records to your new records (excluding any information related to your previous identity) in a timely manner. You should be informed of your new NHS number by PCSE. If you do not receive this, please contact us and we can give it to you.  Please also inform any hospitals you are currently under (e.g., outpatients, surgery waiting lists etc.) of your new NHS number so they can update your records.
 
Consider prescribing 2 months’ supply of current medication in advance of doing this process so that medication supply is not interrupted.

We offer a travel consultation and will only administer the free NHS travel vaccines:

• DTP (diptheria/tetanus/polio)
• Hepatitis A
• Typhoid
• Cholera

Many people will be travelling to countries where they will also require vaccinations that are not available on the NHS and a private travel clinic appointment will be required:

• Hep B
• Japanese encephalitis
• Meningitis
• Rabies
• Yellow Fever

See Travel vaccinations – NHS (www.nhs.uk) for further information.

Contact the surgery as early as possible and ask for a ‘Travel Appointment’ You will then be sent a  ‘Pre-travel questionnaire’ text OR email depending on your preference. If you are unable to complete the questionnaire electronically, please collect a paper travel form from reception. This must be completed and returned to the surgery prior to attending for the appointment so that vaccination requirements can be planned. One questionnaire needs to be completed per family member as it forms documentation in individual clinical notes.

Full range of contraception options, menopause and hormone replacement therapy, and general gynaecological advice.

We have a Social Prescribing Link Worker who works at a PCN level.

Social prescribing link workers connect people to community-based support, including activities and services that meet practical, social, and emotional needs that affect their health and wellbeing. This includes connecting people to statutory services for example housing, financial and welfare advice.

Social prescribing works particularly well for people with low level mental health needs, who feel lonely or isolated, with long term conditions and complex social needs.

Social prescribing link workers work collaboratively across the health and care system, targeting populations with greatest need and risk of health inequalities. They collaborate with partners to identify gaps in provision and support community offers to be accessible and sustainable.

Mental health practitioners support adults whose needs cannot be met by local talking therapies, but who may not need ongoing care from secondary mental health services.

This service is provided at a PCN level.

The mental health clinician can see patients face to face at Almondsbury Surgery or by telephone appointment.

Access this service by telephoning the surgery or sending an eConsult.

This is a remote service which is provided at PCN level. Access by telephoning the Surgery or sending an eConsult.

Health and wellbeing coaches support people to increase their ability to self-manage, motivation levels and commitment to change their lifestyle. They are experts in behaviour change and focus on improving health related outcomes by working with people to set personalised goals and change their behaviours. They work with people with physical and/or mental health conditions and those at risk of developing them.

Health and wellbeing coaches can be an effective intervention for people experiencing a range of long term conditions, including respiratory, cardiovascular (including type 2 diabetes and hypertension), and stress/low mood. They can also support people with weight management, diet and increasing activity levels.

There is a Physiotherapist based on at the Surgery one day per week.

Access by telephoning the surgery or by sending an eConsult.