Practice Policy on Period Delay Medication (Norethisterone)

We want to keep patients fully informed about changes to NHS prescribing rules. Please take a moment to read the following important update.

---

New Guidance – Effective May 2025

The National Institute for Health and Care Excellence (NICE) has issued new guidance which means:

• NHS GPs are no longer advised to routinely prescribe norethisterone or similar medication to delay periods for holidays, travel, or other non-medical reasons.

• From May 2025, these medications are no longer routinely prescribed on the NHS by the practice for non-medical purposes.

• Patients wishing to use period delay tablets for holidays, weddings, or other events will now need to seek private care.

---

What Has Changed?

• Previously: Some GPs could prescribe period delay tablets at their discretion, depending on your health.

• Now: GPs are no longer able to prescribe these medications on the NHS for non-medical reasons.

• Alternative Access: You can still obtain period delay tablets (such as norethisterone) through private clinics or online doctor services, but these will usually involve a consultation fee.

---

Where to Access Period Delay Medication Now

• Private Clinics – Many offer same-day consultations and prescriptions.

• Online Doctor Services – Certain providers (e.g. Superdrug Online Doctor, Lloyds Pharmacy Online) can supply norethisterone following an online consultation.

---

Important Medical Considerations

• Not suitable for everyone: Norethisterone is not appropriate for patients with a history of blood clots, liver disease, or certain other health conditions.

• Typical use: As advised by your prescriber but typically taken as one tablet three times a day, starting three days before your period is due.

• Risks: Period delay tablets can increase the risk of blood clots. If travelling, especially on long flights, it is important to move around regularly and stay hydrated.

---

Summary

• Birchwood NHS GPs will no longer prescribe norethisterone for period delay related to holidays or other non-medical reasons.

• To access period delay medication, you will now need to seek private care.

• Your safety remains our top priority, so always ensure you are medically suitable before taking norethisterone or similar medication.

If you have any questions about your individual health circumstances, please discuss them with a healthcare professional.

ADHD Assessment and Support Policy – ADULTS & CHILDREN – WITH EFFECT FROM THE 1ST APRIL 2025

We understand that many adults are curious about whether they might have ADHD. We are pleased to advise, there is a clear pathway in Bristol for assessing ADHD. You can find all the necessary information about the Bristol Adult ADHD pathway here.

Commissioned Services in Bristol, North Somerset & South Gloucestershire (BNSSG)

There are currently only 2 fully commissioned services in BNSSG :

• Avon & Wiltshire Partnership (AWP)
• Clinical Partners

Birchwood will provide shared care and ongoing prescribing for the above 2 providers following initial diagnosis and stabilised prescribing. Wait times vary and we recommend you contact the providers or use their websites via the links above for further information.

Private ADHD Assessments and Shared Care with Right To Choose Providers

Patients have the right to go privately or to select a provider on the Right to Choose Pathway. Many people make this decision as they can receive an assessment and diagnosis more quickly.

We are aware that more providers are offering ADHD assessments and then asking GP practices to prescribe the medication. At Birchwood, we do not provide ‘shared care’ or ‘shared prescribing’ with private or Right to Choose providers. 

If you choose to go privately or use a Right to Choose provider for an ADHD assessment, you are entitled to do so. However, we do not take on the prescribing of ADHD medication due to the significant amount of variance in referral quality, monitoring processes and the volume that we simply do not have the capacity to manage.

Some of the providers will prescribe for you directly, but it is important that you contact these providers and get their responses in writing. If any of these providers state the GP practice will take on the prescribing this is false. The practice will only do shared care prescribing for AWP and Clinical Partners.

Bristol Children’s ADHD Pathway

Click here for information on the ADHD pathway for children in Bristol. As with Adult ADHD services, Birchwood only prescribes for BNSSG ICB directly commissioned services and not for Right to Choose or Private providers.

School Referral (Preferred Route)

If your child is suspected of having ADHD and is aged 5 or older, the school SENCO can usually assess and refer them. We recommend parents raise concerns through this route first, as the school is best placed to observe your child daily, whereas a GP only gets a brief snapshot in a 15-minute appointment.

GP Referral

If a school referral is not possible, a GP or other healthcare professional can refer your child to community paediatrics. For children with more complex mental health issues, a referral to CAMHS can be made. Please note that a cardiovascular examination is required.

Children Under 5

While children can show ADHD symptoms from an early age, local community paediatric services do not prescribe medication for children under 5 and restrict assessments until they are older. However, families with children under 5 showing ADHD symptoms can receive support through local behavioural interventions, such as the Incredible Years course, which focuses on managing attention difficulties and challenging behaviour. These courses can be accessed without a formal ADHD diagnosis – Link for courses available for Bristol

We appreciate that it can be disappointing to wait longer for a service the practice can prescribe for, but we trust you understand that it is simply not feasible for the practice to deal with multiple different providers with differing policies and procedures.

Transition Period

We recognise this is a change to our prescribing policy. From 14th October 2024 to 31st March 2025, the practice agreed to provide shared care prescribing with a limited number of ADHD providers for new referrals. A small number of patients will already be on the referral pathway with the expectation that shared care prescribing may be required.

To support these patients fairly, we are introducing a transitional arrangement. Shared care prescribing will be offered where all of the following criteria are met:

1. The patient submitted a referral form to Birchwood between 14th October 2024 and 31st March 2025, and has remained continuously registered at the practice.

2. The referral was made to one of the following providers:

   • Psychiatry UK (18+)

   • Problem Shared (18+)

   • ADHD 360 (14+)

   • Dr J and Colleagues (18+)

3. Where an assessment has already taken place, the patient’s medication is stabilised, and there has been no break in prescribing or contact with the provider exceeding 3 months.

---

Exclusions

• Patients referred before 14th October 2024 to any of the above providers are not eligible for shared care prescribing and must continue with private prescriptions.

• Where a patient does not meet the above criteria, or has had a break in prescribing for more than 3 months, the options are:

  • remain with their current provider on a private basis (arranging reviews and prescriptions directly), or

  • request a transfer via the practice to one of our fully commissioned providers, with whom we can offer shared care.

---

Additional Notes

• Patients already receiving shared care prescribing from the practice are not affected by this change.

• Patients may have had a referral submitted from 14th October 2024 to 31st March 2025 and still remain on the waiting list, so No. 3 above will not apply until after they have been assessed.

• Patients remain responsible for funding private prescribing arrangements during any transitional periods.

• The practice reserves the right to review its prescribing policy for all providers. Should we no longer be able to support a shared care pathway, we will provide a minimum of 3 months’ notice.

New to Birchwood Patients

We do not accept continuing prescribing (except BNSSG Commissioned providers) where a patient registers with us from the 1st April having been prescribed at a different GP surgery. We do not accept the ongoing prescribing for prescribing commenced by other surgeries as we become the responsible prescriber when you register with us. Patients can contact their provider and arrange prescribing directly or transfer to a provider commissioned by the BNSSG ICB; or ask their previous practice to retain them as an out of area patient if their policy permits.

Understanding Our Practice’s Policy

Our practice has been receiving requests from private providers to review patient notes to ensure it is safe for them to prescribe weight loss medications including, but not limited to Wegovy, Saxenda or Mounjaro. Here’s what you need to know:

---

Responsibility for Prescribing

• The clinical responsibility for prescribing is with the private 3rd party provider
• When a private provider asks us to review your notes, it implies that our practice would take responsibility for prescriptions initiated by other organisations.
• General Practice is under extreme pressure and cannot take on unfunded, non-contractual work for Non-NHS providers.

---

Regulations and Safety

• According to GMC regulations, it is the responsibility of the prescribing clinician to ensure their prescribing is safe. This includes:
  • Taking an adequate history.
  • Examining the patient.
  • Conducting and acting on any appropriate pre-prescribing investigations.
• NICE guidelines require an examination of the patient, including accurate weight measurement at initial assessment and regular reviews.

---

Private Providers’ Responsibilities

• Private providers should not expect NHS GPs to perform private work on their behalf.
• They must not assume that a non-response from us means there are no contraindications to prescribing the medication.

---

Access to Medical Records

• Patients can arrange for private providers to have full access to their NHS records via the NHS app.

---

Our Policy

• We direct third-party private prescribers back to their patients.
• We direct patients to share their medical record via the NHS App
• We cannot take responsibility or get involved in third-party prescribing, which remains the clinical responsibility of the prescribing clinician.

---

What You Should Do

Private Providers: Please contact your patient directly to resolve any queries about their medical history.

Patients: Ensure your private provider has access to your NHS records through the NHS app.

---

Additional Information

Contact Information

If you have any further questions or need assistance with accessing your NHS records, please contact us.

---

Frequently Asked Questions (FAQs)

Q: How can I give my private provider access to my NHS records?

A: You can do this through the NHS app. Here’s a link to the NHS app guide. If you have limited visibility, please contact the practice either by phone, in person or digitally via the Admin request online.

Q: What should I do if my private provider insists on the practice reviewing my notes?

A: Inform them of our policy and direct them to contact you directly for any necessary information.

---

Patient Support

Your care and safety are our top priorities. These policies are in place to ensure that all treatments are safe and effective.

---

Links to Resources

For more information, you can refer to the GMC regulations and NICE guidelines.

---

We appreciate your understanding and cooperation in this matter. If you have any questions, please do not hesitate to contact us directly.

 

The practice undertakes work that is classed as not NHS e.g. private letters/private medical reports/insurance claims at the absolute discretion of the practice.

We do not undertake private clinical procedures.

The practice reserves the right to decline private fee paying work requests and examples of this can be found on our fees page.

Where a patient has chosen to go private for a clinical pathway the patient has the choice to remain on that pathway or transfer to the NHS pathway at any point. The patient cannot mix and match their care. For example if a patient is seeing a non NHS private provider for a pathway such as fertility or weight loss, the patient must either stay with that provider for all associated tests and advice or end the treatment with the private provider and restart from the beginning with the NHS provider. The patient is not permitted to request the GP practice undertakes diagnostic tests (inc blood tests) for the use by their private care provider. The responsibility remains with the consulting, responsible clinician.

Naturally, should a patient end treatment with their private provider, the NHS doctor will recommence the care and request the appropriate tests on the NHS.

The NHS Guidlines are very explicit and state:

• Private and NHS care should be kept as clearly separate as possible.
• Private care should be carried out at a different time to the NHS care that a patient is
  receiving.

Birchwood Medical Practice does not accept responsibility for continuing to offer a private service, even if a previous GP surgery has provided it for you. We understand this may be disappointing to some patients. You may wish to enquire at other GP surgeries as to whether they would provide it.

This does not affect your access to NHS care as a result of other health issues not related to your private treatment.

The practice acts in line with NHS Policy which can be found here.

The practice has procedures in place for appropriate prescribing for patient safety. Please refer to the relevant sections below.

Fear of Flying

People sometimes ask the doctor or nurse to prescribe diazepam, or similar drugs like lorazepam, temazepam or clonazepam, for fear of flying or to help sleep during flights. In the past, this type of prescribing was permitted, but guidance has changed and the practice has updated its protocols to reflect National, safe guidance on prescribing policy in this area.

Birchwood Medical Practice does NOT prescribe sedatives for fear of flying. This policy decision has been made by the GP Partners and is adhered to by all prescribers working in the practice.

Prescribing these drugs is not recommended any more for these reasons:

1. Although plane emergencies are rare, taking Diazepam reduces awareness and reaction times for patients so you risk not being able to react to save your life if you have to escape quickly. You may also put other people in danger by getting in their way or making them help you.
2. The use of these drugs can make you sleep in an unnaturally deep sleep. This means you won’t move around as much as during natural sleep so you have a bigger risk of getting a blood clot (Deep Vein Thrombosis – DVT) in the leg or lungs. Blood clots are very dangerous and can kill. This risk is bigger if your flight is longer than 4 hours.
3. They have short term bad effects on memory, co-ordination, concentration and reaction times, and are addictive if used for a long time, with withdrawal leading to fits, hallucinations, agitation and confusion. They have also become widely used drugs of abuse since they first came on the market. Diazepam in the UK is a controlled drug. The prescribing guidelines doctors have to follow say that that use to treat short-term ‘mild’ anxiety is inappropriate. They are only to be used short term for a ‘crisis in generalised anxiety’. But if you are having such a crisis you are not likely to be fit to fly. Fear of flying in isolation is not a generalised anxiety disorder.
4. Some people get agitated and aggressive after taking diazepam and similar drugs, and behave in a way that they would not normally, which can pose a risk on the plane. This affects everyone’s safety and could get you into trouble with the law. A similar effect can be seen with alcohol, which has led to people being removed from flights.
5. There is evidence use of these drugs stops the normal adjustment response that would gradually lessen anxiety over time, and may increase anxiety in the long term, especially if used repeatedly.
6. Diazepam and similar controlled drugs are illegal in a number of countries. They may be confiscated or you may find yourself in trouble with the police.
7. Diazepam stays in your system for some time. If your job or sport needs you to have random drug testing you may fail this having taken diazepam.
8. It is important to tell your travel insurer about your medical conditions and medications you take. If not, there is a risk of your insurer not paying if you try to make a claim.

So we no longer provide Diazepam or similar drugs for flight anxiety. Instead you may wish to consider one of these aviation industry recommended flight anxiety courses.

Fly And Be Calm™

Fly And Be Calm™ is an instant download and comes with a money back guarantee (Guarantee does not apply to app versions).6 MP3 tracks which include instructions, the fear removal tool and two hypnotic tracks. Visit the website: https://flyandbecalm.co.uk/

Easy Jet
www.fearlessflyer.easyjet.com

British Airways
https://www.britishairways.com/en-gb/information/travelassistance/flying-with-confidence

Virgin Atlantic
https://www.flyingwithoutfear.co.uk/

 

General Phobia Prescribing

Many people with a phobia don’t need treatment and avoiding the object of their fear is enough to control the problem. Medication isn’t usually recommended for treating phobias, because talking therapies are usually effective and don’t have any side effects. However, medication may sometimes be prescribed to treat the effects of phobias, such as anxiety once other treatment options have been explored. For more information of phobia treatment pathways, please review the NHS Website and book an appointment if you wish to discuss your phobia and talking therapies further.

Prescribing for Medical Procedures

• Where the practice has made the test request (e.g. lower GI endoscopy/MRI etc)
  • We do not prescribe benzodiazepines for sedation due to the associated risks
  • A patient can request a consultation to discuss available options as relaxants

 

• Where secondary care/3^rd party has made the request – the practice does NOT undertake the prescribing. This is the responsibility of the requesting, responsible clinician/team for patient safety and clinical responsibility reasons.

It is vital we make our practice accessible, so that people who are deaf or have hearing loss can contact us, communicate well during appointments – and fully understand the information we give them.

We have worked with the Royal National Institute for Deaf People (RNID) to ensure we are enabling our patients to access services effectively when they need them and to understand what is available to them.

People with hearing loss may find it difficult or impossible to use the telephone to book an appointment, order repeat prescriptions or receive test results.

Communication Methods we support:

• online booking requests via our eConsultation service for non-urgent appointments
• SMS text replies to patients
• Textphone
• Relay UK (which has replaced Text Relay) – typed messages are relayed to the other caller via an operator
• video relay – conversation is relayed through a British Sign Language (BSL) interpreter using video.
• You can ask any of our team to write something down for you or read something you have brought in – we are here to help

We do not offer email communication as this is not a secure or safe method of communication and can prevent delay in receipt of urgent care. Our eConsultations service provides a digital means of contacting the practice safely and confidentially.

Check in and Patient call systems are in place to support you:

• Highly visible check in screen
• Working hearing loop at our reception desk
• Our patient call system has been changed from audible only to a large screen in reception with the patient name and room number visible
• Our clinicians will also come to reception to check if they know a patient has impaired hearing

When you register, we ask about how you prefer to communicate, but if you need to change this you can do so at any time and we will record this on your record to help us help you better when you access our services. We can provide double appointments on request if this would help you for improved, effective communication.

You may also wish to contact Adult Services at Bristol City Council for support with any equipment that you may need to access the specialist services noted above including textphones / Relay UK.

Please note that where a patient decides not to communicate with the practice using one of the RNID recommended services above to enable safe, timely, effective treatment and care from our clinicians, the practice will have no choice but to ask the patient to register with a new GP practice as patient safety is our priority.

We are providing training for receptionists and other staff members on the different ways people with hearing loss may wish to make contact and be contacted. We welcome feedback on any other ways we could help.

 

Birchwood is dedicated to supporting all patients and understands that to do this we need to adapt how we work with our patients to improve their outcomes.

Autism and Learning Disabilities are not the same and we can help in each area.

What we can do for you :

• We can provide a map of the practice rooms to help you around the building
• You can arrange for a staff member to walk you around the building at a quiet time
• We can book appointments at quieter times for you to improve your waiting room experience
• We can arrange for you to wait outside/in a vehicle and arrange for a phone call to tell you when to come in for your appointment
• Click this link for helpful resources on what to expect when you visit the doctor or nurse
• Click here for autism resources that are family friendly
• We can add a note to your records about your preferences – we will do our best to meet reasonable patient preferences
• You do not need to phone us for a routine appointment – you can use our online service here for medical and admin help
• We offer free flu jabs for patients with a learning disability
• We offer free flu jabs for carers of patients
• We offer support for vital smear appointments
• We have regular training
  • As a result of direct feedback we have liaised with the Bristol branch of the National Autism Society and together we created a training video for staff through the lived experiences of an autistic person. This has been rolled out to all staff and forms part of our induction for new staff.
  • We will be completing the The Oliver McGowan Mandatory Training on Learning Disability and Autism when it is fully available

Hospital passports

We recommend that every person with a learning disability and/or autism complete a hospital passport. Although this is usually for hospitals, the practice can review the content and do our best to support your needs.

Here are blank templates kindly provided by North Bristol Trust:

• LD hospital passport.docx
• NBT003387_Autism Hospital Passport.docx

You can email completed hospital passports to us at birchwoodmedicalpractice@nhs.net. Please encrypt your email to make it secure if you can. We will put it on your GP record with an alert for our staff to read it. This email address is only for hospital passports and not general patient contact for health issues as it is not monitored daily.

Please also bring in any important guidelines, care plans or protocols that you may have (e.g. epilepsy protocols, eating and drinking guidelines, positive behaviour support plans etc).

General Information

Referrals for autism and other related diagnosis take time. Wait times can be more than 12 months depending on symptoms so it is important to be prepared for delays.

Please ask your GP about the wait time for a referral during your appointment.

Concerns about possible Attention Deficit Hyperactivity Disorder (ADHD) or autistic spectrum disorders (ASD) will usually be referred to Community Paediatrics if under 18 years. After that it will mean a referral to adult services.

Hospitals in Bristol have dedicated teams to support you when you attend for appointments or if you want to look around in case you may need an emergency appointment. A lot of autistic patients and those with learning disabilities find this helpful.

Bristol Royal Infirmary (BRI)

Link to their support page

Southmead Hospital and South Bristol Community Hospital

Link to their support page

 

At Birchwood we recognise the impact of all areas of our work on the health of our planet, as well as on our patients. We are pleased to announce we will be signing up to up to the Green Impact For Health Toolkit when it is relaunched in early 2023, which will help us move our practice into being more environmentally friendly, reducing our carbon emissions and plastic waste, helping us to care better for both people and the planet at the same time.

The toolkit aims to help General Practices make better decisions in this climate and ecological emergency. The NHS is responsible for 4-5% of the UK’s carbon footprint.

The majority of General Practice’s carbon footprint comes from prescribing. The clinical actions that reduce our carbon footprint are aligned with our existing health priorities and evidence-based, person-centred practice. This BMJ article outlines Six steps to both greener and better primary care. We can significantly reduce our carbon footprint by supporting health and wellbeing (e.g. nature-based interventions, social prescribing, de-prescribing where appropriate and low-carbon prescribing). Person-centred medicine, which works in collaboration with patients on what matters to them, is likely to lead to improved patient empowerment and self-care. Greener practice can deliver win-win solutions for patients and the planet. To learn more, visit the BMJ’s page here.

What We’re Doing to Help

What you can do to Help

We’ve put together a list of a few things you can do to help the planet and our Greener Practice project. A lot of the information here, and more, can be found at Greener Practice – For Patients.

To Help our Project you can:

• Discuss which inhaler you’re using with your GP, nurse or Pharmacist to see if a more environmentally friendly inhaler is suitable.
• Recycle any used inhalers at your local pharmacy.
• Make sure your chronic disease-control is as good as it can be- your GP can help you with this.
• Talk to your GP about any medication you’re not using.
• Keep yourself fit, active and healthy! There are excellent local resources here

 

To Help the Planet Some More, you can:

• Switch your search engines to Ecosia (Ecosia – the search engine that plants trees) which plant trees when you use their search engine.
• Try to reduce your meat intake- This helps your health and the planet’s health!
• Use public transport, walk, or cycle to work whenever you can.
• Work out your carbon footprint: WWF- Your Footprint