Adult Stoma

Adult Stoma Referral Form

Before we begin

Please read the criteria below

We are happy to take referrals from Health Care Professionals/Care Home staff for patients registered with a Greater Huddersfield GP practice and who are housebound.*


We are happy to take referrals or provide telephone advice for the following:

  • Any stoma/peristomal skin complication not responding to basic measures
  • Any complex stoma/peristomal complication
  • From district nurses where the trouble-shooting guide suggests referral
  • Where a patient is needing psychological support
  • Where the patient is needing/requesting an appliance review
  • Any situation where specialist colorectal or stoma advice/support is required
  • Complex bowel management plans
  • Support in the management of sigmoid volvulus
  • Support in the management of rectal irrigation
  • We are happy to take urgent referrals or provide urgent telephone advice for the following:

  • High output stoma (greater than 1.5 litres in 24 hours)
  • Sore peristomal skin where appliances are not remaining intact for 24 hours
  • A fistula where leakage is a problem
  • Undiagnosed problems requiring specialist assessment
  • Ulceration on peristomal skin
  • From district nurses where the trouble-shooting guide suggests urgent referral
  • We do not take referrals for the following:

  • Acute or chronic constipation where first line treatments have not been initiated (Refer to Adult Continence team)
  • Patients who are registered with a North Kirklees GP practice
  • Patients requiring routine bowel/stoma care
  • Persons under the age of 18 years
  • Patients who are not housebound, i.e. if a patient normally visits their GP. These patients should be referred to Huddersfield Royal Stoma Nurses for an outpatient appointment.

  • *The term ‘Housebound’ refers to those patients who are unable to use private or hospital transport and require their GP to visit them routinely in their own home.


    All general enquires should be made via our Single Point of Contact by calling 030 304 5555.

    You can download our service criteria below:

    Locala Colorectal and Stoma Support Service Referral Criteria (PDF)
    Patient details
    If contact details are incorrectly input where mandatory the referral cannot be processed

    Referrer details
    If contact details are incorrectly input where mandatory the referral cannot be processed
    Does the patient normally visit their GP or Hospital Consultant?

    If yes, please cancel and refer to the Stoma Care Nurses at Hudderfield Royal Infirmary


    Are there any risks associated with a home visit?*

    Are there any communication issues?*

    Patient has consented to info sharing*

    Patient has consented to referral*
    Best interest decision made by

    Patient condition information

    Optional attachment

    If you do not receive an email acknowledgement your referral has not been submitted. Please check that all details are correct, mandatory fields completed and re-submit.