A specialist community-based service run by specialist nurses. Lymphoedema referrals are triaged according to category and allocated to the most appropriate local clinic dependant on GP surgery.

The aim of the service is to:

• assess and treat patients with
  • primary lymphoedema: where swelling is related to an underlying intrinsic problem with the lymphatic system, which is often hereditary
  • secondary lymphoedema: where swelling, in any part of the body, is caused by extrinsic factors including damage to the lymphatic system or disruption to drainage pathways which can be as a result of cancer or its  treatment, infection, injury or trauma, inflammation of the limb, or a lack of limb movement
• advise and support health care professionals on the management of patients with all classifications of lymphoedema
• increase awareness of cellulitis management in patients with lymphoedema including current management practice and guidelines.

Waiting times on receipt of referral

• palliative patients within two weeks
• all other referrals will be prioritised and seen within six weeks.

Domiciliary visits/hospital transport

Hospital transport can be requested if Haringey or Islington patients meet the eligibility criteria.

In Islington, all requests for domiciliary visits for patients with an Islington GP will be assessed on an individual basis and patients will be asked to attend a clinic if there are no health-related contra-indications noted.

Eligibility Criteria

Inclusions

Over-18s living or with a GP in Haringey or Islington who are

• oncology patients with swelling, or who are at risk of swelling secondary to cancer treatment or disease progression.
  • A priority triage category will be given to referrals for assessment of lymphoedema secondary to oncological causes or those where the patient is receiving palliative or end of life care.
• non-cancer related referrals for patients with swelling lasting >3 months duration, not responding to elevation or diuretics.

Exclusions

• Patients referred for implementation or maintenance of standard care including routine Doppler assessment and fitting garments for uncomplicated venous oedema
• ulceration or wounds to the legs
• Haringey resident requiring a home visit
• if the referral information is incomplete, the referral can not be accepted

How to Refer