December 2025
Frail patients need individualised diabetes care. In line with realistic medicine, consider when de-escalating treatment is safer and more appropriate. See https://apps.nhslothian.scot/refhelp/diabetes-frailty/
Abnormal perianal lesions where there is diagnostic uncertainty should be referred as USoC. Patient should be counselled that this referral is for diagnosis rather than treatment of haemorrhoids per se. More info on primary care management here: https://apps.nhslothian.scot/refhelp/guidelines/colorectal/haemorrhoids/
Thrombocytosis can be a risk marker for malignancy. Consider LEGO-C cancers and if suspicious features, please refer to the relevant specialty. Please see Primary Care Management for more detail including initial investigation: https://apps.nhslothian.scot/refhelp/guidelines/haematology/thrombocytosis/
New page on Situational Headache covering provoked headaches including exertional, cough, and sex related headache. For advice on initial management in primary care please see: https://apps.nhslothian.scot/refhelp/situational-headache/
From 10th of December onwards, Hospital at Home offers an alternative to hospital admission for patients who are acutely unwell with Influenza this season. For services offered & referral criteria please see the RefHelp page: https://apps.nhslothian.scot/refhelp/guidelines/admissionsurgentcare/hospital-at-home/
All active ulceration cases should be referred to the Diabetic Foot Clinic via SCI Gateway (RIE, WGH or SJH) and those with moderate/high risk or in remission can be referred to Podiatry Community Clinics. For detailed referral criteria see here: https://apps.nhslothian.scot/refhelp/guidelines/diabetes/management-of-the-diabetic-foot/
Orthodontics accepts referrals for patients with significant malocclusion & ‘great need’ for ortho treatment, as defined by the Index of Orthodontic Treatment Need (IOTN) & the Index of Orthognathic Functional Treatment Need (IOFTN). More referral info: https://apps.nhslothian.scot/refhelp/guidelines/dentistryoralhealthservice/orthodontics/
The East Lothian Falls pathway is hosted within the East Lothian Rehabilitation Service (ELRS) and offer falls prevention, education, and management through two pathways: 1-1 outpatient clinic and ‘steady-on’ falls prevention classes. More info here: https://apps.nhslothian.scot/refhelp/guidelines/rehabilitation/east-lothian-falls-pathway/
iThrive Edinburgh is an online space dedicated to mental health & wellbeing. It brings together information, resources, & support to help people in Edinburgh look after their mental health, find the right services, and connect with others. More info here: https://apps.nhslothian.scot/refhelp/guidelines/mentalhealthadult/mentalhealthlocalityservicesadult/edinburgh-mental-health-services/ithrive-edinburgh/
New page added to RefHelp’s Neurology section on Incidental MRI Brain Findings. Check out the factsheet with information about how common these are in the normal population including advice for primary care about when and who to refer: https://apps.nhslothian.scot/refhelp/incidental-mri-brain-finding/
Most GTPS/lateral hip pain can be managed without orthopaedic referral. Early exercise and education are key to preventing chronicity. Guidance here. Please see the fact sheet for GPs and referrers: https://apps.nhslothian.scot/refhelp/greater-trochanteric-pain-syndrome/
All referrers please be aware from 15th December onwards, the MOE Referral pathway to Liberton Day Hospital has changed to Ellen’s Glen Community Hospital. Please see updated RefHelp MoE pages here: https://apps.nhslothian.scot/refhelp/guidelines/medicineoftheelderlygeriatrics/
New page on Thrive Welcome team which supports people in Edinburgh with their mental health and offers short-term periods of support, on average 6-8 sessions. However once someone has worked with the service, they can contact Thrive again for further help. Detailed referral info: https://apps.nhslothian.scot/refhelp/thrive-welcome-team/
