Midstream urine (MSU) samples

Instructions for collecting midstream urine samples

First, remove and set aside any packaging from the sample bottles. In the kits we provide, the sample bottles themselves have red tops, and will need to be taken out of the larger transport tube with a white top, and the foam insert. Before you collect the sample, please make sure that your name, date of birth and the date of collection are on the bottle(s). If we have labelled them for you, do please correct the collection date if appropriate.

Please also check that the request card has been completed correctly.

We recommend collecting two samples, preferably before starting any antibiotics. The first sample should ideally be collected on the first occasion that you pass urine in the morning. If you would prefer not to wait until the next morning, please try to collect the first sample more than two hours after you last passed urine, if possible. Alternatively, if your symptoms tend to be worse later in the day, you can collect the first sample then.

The second sample should be collected on the next occasion that you pass urine.

Before collecting the sample on each occasion, women should rinse and squeeze out a clean baby wipe, and gently insert it into the lower vagina (even if on their period). This helps to prevent contamination.

Please do not part your labia or pull back your foreskin.

Now you should be ready to collect the sample. Unscrew and set aside the red cap of the sample bottle. Then start passing urine and pass the sample bottle into the stream of urine, holding it there until the level of urine in the bottle reaches the red line.

Then screw the red cap back on the sample bottle, double-check that your name, date of birth and today’s date are on the bottle, wrap the foam insert around the sample bottle, place it into the transport tube, and screw the white cap onto the transport tube.

Once you have collected both samples in this way, place them in the blue postage paid mailing bag provided along with the completed request card, seal the mailing bag and simply put it in the post. It physically takes a few days for the laboratory to culture the sample. We aim to email you the report within 5 working days.

Chickenpox and shingles vaccinations (draft)

Why should I have a chickenpox or shingles vaccination?

Serious illness as a result of chickenpox in childhood is rare. It can be more problematic in adulthood, especially in pregnancy or in the context of other underlying health conditions. Most adults have been exposed to chickenpox and are therefore immune to it. However, the virus which caused chickenpox can be reactivated and cause shingles, usually later in life. Shingles can be unpleasant, and sometimes results in lasting discomfort.

Immunity as a result of chickenpox vaccination might wear off, such that it is better at preventing chickenpox in childhood (usually a relatively mild illness) than in adulthood. There is therefore some concern that having the chickenpox vaccination as a child might increase one’s risk of the more severe chickenpox illness as an adult. This has to be balanced against the benefits of reducing the risk of shingles.

Evidence suggests that 9 out of 10 children vaccinated with a single dose will develop immunity against chickenpox, but there is an even better immune response after two doses of the vaccine, so it is strongly recommended that two doses are given (4-6 weeks apart).

The vaccines

Vaccines to reduce the risk of shingles are available for adults. The NHS offers these to people aged 70 to 79. Zostavax (a “live” vaccine) is given as a single dose, while Shingrix is given as 2 separate doses 2 months apart.

Vaccines to prevent chickenpox are also available for those who have not already had chickenpox (usually, but not always, young children). They are usually given as 2 doses 4-8 weeks apart.

Are they safe for me?


If you have ever had a severe allergic reaction to any ingredient of the vaccine, you might not be able to have it, or special precautions might be necessary (such as administering it in hospital). Depending upon the particular vaccine, ingredients might include the antibiotic neomycin, gelatin, and/or polysorbates.

Immune suppression and pregnancy

If your immune system is severely suppressed, or if you might be pregnant, Zostavax or either of the chickenpox vaccines might not be suitable for you. This is because they are ‘live’ vaccines which contain a tiny amount of the virus.

Private GPs warn patients about Sunak’s “Pharmacy First” scheme

Two Merseyside GPs are warning patients to think carefully before starting antibiotics prescribed by pharmacists. When Knowsley MP Sir George Howarth asked the Prime Minister 3 weeks ago if he supported NHS England’s “Pharmacy First” scheme, Sunak agreed that pharmacists “can do more for us over time“.

Formby GP’s Dr John Cosgrove and Dr Heather Ryan welcome the government’s latest idea for taking pressure off NHS GPs. In many areas, including Southport and Formby, chemists have been able to prescribe medication for common conditions. Since April, community pharmacists in Merseyside and elsewhere have been able to repeat prescriptions of the contraceptive pill.

“Pharmacy First” goes a step further, and promises to begin rolling out to pharmacies nationwide by the end of 2023 the ability to prescribe antibiotics for sinusitis, sore throat, earache, infected insect bite, impetigo, shingles, and uncomplicated urinary tract infections.

Dr Cosgrove, who has been a GP for 20 years, agreed that impetigo, shingles and urinary tract infections should be easy for pharmacists to diagnose and prescribe appropriately so long as they follow guidance from Public Health England.

Dr Ryan pointed out that sinusitis, sore throat, and earache usually get better without treatment. She warned that antibiotics taken for these conditions can cause more harm than good. “Furthermore, insect bites often flare up badly for a few days, people fear they are infected, but they clear up all by themselves. It can be difficult to tell whether an insect bite is infected and needs antibiotics.”

Common side effects of antibiotics include diarrhoea, vomiting, rashes, suspected allergic reactions, and thrush. Dr Cosgrove warns that patients are more likely to have side effects than to benefit from antibiotics prescribed under Sunak’s plan.

“We also know that if people are prescribed antibiotics unnecessarily for such illnesses, they will – quite understandably – come back sooner next time for the same unnecessary treatment again. There is a real risk that Sunak is opening the taxpayer up here for a totally unnecessary blank cheque.”

The two private doctors, encourage anyone concerned about taking antibiotics prescribed by their pharmacist to consult their GP. Dr Ryan explained, “experienced GPs are second-to-none at advising whether an illness is likely to settle on its own, and what to do if it doesn’t. It’s what we do!”

Dr Cosgrove added: “when working as an NHS GP, I am painfully aware that many patients believe that I withhold tests, treatments and referrals to save me money. This is laughably untrue! So much so, that Heather and I decided to set up Formby GP. In private practice, there genuinely is a temptation to test and treat more so as to generate fees and encourage repeat business. To head this off, we are crystal clear that Formby GP will be ‘ethical’: we will only recommend tests, treatments and referrals if they are appropriate.”


Treating obesity could save NHS money

A private GP sugery in Formby offers help as new research reveals that obese patients cost the NHS twice as much as non-obese patients.

Dr John Cosgrove, Clinical Director of Formby GP, suggested that no-one would be surprised that obesity comes at a cost not only in terms of healthcare but also individuals’ wellbeing. “It is not that people who are overweight do not want to lose weight – it is just that it is really hard to do so. Our appetite dictates so strongly how much most of us eat that it takes a great deal of effort to diet by willpower alone.”

Formby GP, run by Dr Cosgrove and his wife Dr Heather Ryan, offers specialist weight management services. Dr Cosgrove said, “It will be very difficult for NHS weight management services to expand to meet the need. I believe that private weight management clinics such as our own have a great deal to offer. This research suggests that we could help our patients save the NHS money.”

Dr Cosgrove explained that they work in conjunction with diet counsellors, support groups and personal trainers to offer medical support for weight management over and above lifestyle changes.


DNACPR orders

Two Merseyside GPs have expressed their concern following the BBC report on “do not resuscitate orders”.

Formby GP’s Dr Heather Ryan was appalled to hear that an ambulance service had refused to respond to a care home resident simply because his doctors had advised against treatment after cardiac arrest. She said: “Just because CPR is not likely to be successful does not mean that we should not make every effort to intervene to prevent a person from needing CPR!”

Dr John Cosgrove, Formby GP’s other doctor, explained their surprise when setting up their practice to hear that services in Merseyside do not accept the standard ReSPECT form produced by the UK Resuscitation Council and used in many other parts of the UK. This is a standardised form for doctors to use when making recommendations about treatments likely to be in a patient’s best interests should their condition suddenly deteriorate. “Whether CPR is likely to be successful is a medical opinion like any other treatment recommendation,” he explained. “It’s also really helpful to be able to set out on such a form whether a patient would want other emergency treatments such as emergency hospital admission or being put on a life support machine.”

“People dying in Merseyside are being put at risk of treatment that will do them no good, for lack of a standardised form,” he said.

Dr Ryan added: “We have even been warned that our advice might be ignored by paramedics if we use the wrong colour paper! All we want is to support our patient’s wishes to live with dignity even in their last days.”

Formby GP is a private GP surgery in Formby. They offer traditional cradle to grave care. Since they opened in January 2023, they have diagnosed terminal illnesses in patients who found it too difficult to access NHS General Practice, including one in the last days of their life.

Dr Cosgrove remarked that they found it truly an honour to be able to support people so unwell. “I just hope that we can simplify the process of advance care planning in Merseyside and, preferably, nationwide, so that more people receive the dignity they deserve and care they need when they are at their most vulnerable.”


Know your patient before testing for ADHD!

As BBC’s Panorama investigates the reliability of online ADHD diagnoses, two private doctors in Merseyside say this is an unfortunate example of why diagnostic tests should only be arranged if recommended by an experienced clinician.

In this case, the tests in question were questionnaires or structured interviews, potentially just as misleading as high-tech scans of those with no symptoms of physical illness.

When they set up Formby GP, a private GP service in Formby, these doctors were keenly aware of the temptation for private doctors to sell unnecessary tests and treatments. They describe Formby GP as ethical because they explicitly strive never to recommend unnecessary tests and treatments. They argue that GPs can really help patients by recommending referrals only after excluding other explanations

Formby GP’s Clinical Director, Dr John Cosgrove, worries that it can be difficult for those that are not doctors to recognise good clinical practice. “Panorama compared ‘mystery shopper’ style consultations with online clinics to a consultant who had explicitly invited television cameras in. Panorama rightly referred to NICE guidelines. Guidelines, however, are not protocols, and are often simply the opinion of one particular panel of experts. It would not be appropriate for clinics always to follow guidelines blindly. This is really difficult for regulators such as the Care Quality Commission, whose approval of services could be mistaken for endorsement of the quality of clinical care, rather than just governance processes.”

Dr Heather Ryan, Managing Director, explained that they started Formby GP so as to be able to offer unhurried face to face consultations to anyone that wanted it. She enjoys getting to know her patients in person, which also provides so much more information than an online chat.

Dr Cosgrove said, “Around 5% of children are believed to have ADHD. Left untreated, it can significantly impact upon a child or adult’s life, so it’s great news that there is more awareness of this condition now, and various effective treatments are available. On the NHS, it can be hard enough to get an ADHD assessment for a child; in adults it is almost impossible. Clinics that can carry out proper assessments are invaluable, and we could use more of them, whether private or NHS!”


Why don’t we offer “all inclusive”?

We aim to offer our patients an unhurried, high quality GP service, with continuity of care at its core, and allow them to make the choice about whether to access secondary care on the NHS or privately, and in all things to make meaningful choices about treatment options.

If you think about it, paying a fixed fee for any service for which demand is unpredictable is “betting against the house” – and the house is always going to win (or go out of business).

There are some private practices that offer an all-inclusive package for around £100 per month (over the age of 50). I would hope that a typical 50 year old would need to pay considerably less than £100/month in consultation fees, but we would expect to be there for them when they need us.

Most concierge-style services that we are aware of set a limit on the number of contacts in a year. Furthermore, many seek to attract the healthy and undertake assessments and tests that are not indicated, and therefore have significant potential to cause harm such as anxiety and complications of unnecessary treatment.

Further, such an arrangement necessarily encourages people to consult when they might not necessarily need to.

One of the challenges for NHS General Practice is that it is free at the point of delivery and therefore has had placed on it expectations (in terms of access, helping people who are not ill, etc) that it could never meet.

We want to form long term, adult-adult relationships with our patients, where we are no longer the gate-keepers, but can help to guide them through their options when they are ill.

Additionally, our practice has a strong emphasis on not recommending unnecessary investigations or treatments, for fear of doing harm. In private medicine, where one is paid for activity, we believe it is important to resist the temptation to encourage unnecessary consultations.

Finally, consider how eager we will be to book each appointment if that is the only way we get paid! We certainly do not want to become embroiled in contractual disagreements about whether we are failing to offer appointments of sufficient length or readily enough, or whether our patients use of our service is “fair” – hardly a respectful interaction!

Our approach might not be for everyone. We consider it to be ethical where others might not always be. Our price list is at www.FormbyGP.com/pricing.

We do, however, offer Priority Club membership, benefits of each include a guarantee of access, waiving of our prescription fees, half price text consultations and access to our community forum. If this appeals, why not ask at your next appointment whether it could be right for you!


We are of course happy to prescribe most medication that you might need. In practice, we have a little more prescribing freedom than an NHS GP might.

We can prescribe controlled drugs if you are happy for us to share this information with other prescribers involved in your care, including your NHS GP.

Our prescriptions should be accepted by any pharmacy in the United Kingdom. Whenever possible, we will give you a paper prescription which you can take to the pharmacy of your choice. If that is not possible, we can send the prescription to you by email, which you can then show to the majority of pharmacies in the UK.

We make a charge for each item that we prescribe. We waive that charge for our Priority Club members. Our current prices can be reviewed at www.FormbyGP.com/pricing.

Regrettably, we are unable to issue NHS prescriptions.

Your pharmacy will charge you for dispensing your medication, even if you do not pay NHS prescription charges. They will usually not have to charge VAT. It is likely that prices will vary, so you might like to shop around before choosing a pharmacy.

Why these local private GPs don’t agree with pharmacy antibiotic plan

As the Government announces its recovery plan for NHS General Practice, GPs at a private surgery in Merseyside have expressed concerns about proposals for community pharmacies to start prescribing antibiotics.

Under the Government’s new plan, pharmacists will be able to prescribe antibiotics for the treatment of certain infections, including earache, sinusitis, and sore throat. Yet evidence shows that, in most cases, antibiotics are not needed as these infections will get better on their own. If antibiotics are taken, they risk causing harm – by increasing rates of antibiotic resistance, or by causing side-effects such as diarrhoea. For this reason, doctors at Formby GP, a private practice in Freshfield, have spoken out against the plans.

Clinical Director, Dr John Cosgrove, says: “As GPs we know that the vast majority of upper respiratory tract infections do not require antibiotics. At Formby GP we pride ourselves on offering our patients whatever treatment they need, based on the highest quality evidence available. As highly experienced GPs, we are particularly concerned by the risks posed by unnecessary antibiotic treatment.”

Formby GP is a private GP service in Freshfield, run by married couple Dr Heather Ryan and Dr John Cosgrove. Heather and John launched Formby GP in January, a private surgery that promises unhurried appointments with a continuity of care. They describe their service as “ethical” because they aim to avoid unnecessary tests and treatments.


Why these Merseyside GPs are branching out into private practice

Two Merseyside GPs have set up their own surgery in a bid to offer face-to-face appointments to people in the area.

Married couple Heather Ryan and John Cosgrove, from Formby, have 24 years’ experience of working in NHS General Practice between them. But recent events and changes have led to both doctors becoming increasingly frustrated at the level of care they are able to offer patients.

For many years, work has shifted from hospitals to GPs, and new treatments have become available that increase the workload for GPs, without additional  funding. At the same time, there has been a political drive to improve access to GPs, and offer telephone, video and email consultations.

These consultations are much less efficient than the old-fashioned 10 minute face-to-face consultation, which they must replace, as there is not the capacity to offer both. This was mandated by NHS England, and coincided with but was not entirely due to the Covid-19 pandemic.

Heather and John launched Formby GP in January. Formby GP is, a private surgery that promises offers a more ethical service, as people can receive unhurried appointments andwith a continuity of care. They describe their service as “ethical” because they will only recommend treatments that their patients need. They take a targeted approach to testing which reduces the dangers of unnecessary treatments. In offering a private service to those who can afford to pay for it, they hope to relieve some of the pressure on local NHS GPs.

Heather, who grew up in Netherton, said: “We came up with the idea of opening a private GP surgery as both patients and doctors grow more annoyed with the status quo. We both love the essence of General Practice but are put off by the challenges of delivering good care in the underfunded NHS system.

“Because patients are paying for our time, we can offer 30 minute face-to-face appointments at a time that suits them. We can also offer referrals and treatments when these might be discouraged or difficult to access owithin the NHS.”

Heather and John, who both still work in the NHS part time, say that as patients choose to use Formby GP, this will free up more NHS appointments for others.

John added: “Despite political promises, GPs have been driven out faster than the government has replaced them. NHS general practice has now reached a tipping point; there are truly not enough GPs. While some practices are undoubtedly doing a fantastic job, it seems unlikely that NHS GP can ever again meet patient expectations.

“There has long been a market for private healthcare, just as there is for private schools, and even privately owned cars as an alternative to public transport. We haven’t moved into the private sector with the intention of undermining the NHS, on the contrary, we hope to take some pressure off local NHS practices by offering an alternative for those who choose to use it.

“If our society would prefer there not to be a need for private general practice, it needs to make the necessary political decisions to improve the NHS”.


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