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Sussex Local Maternity & Neonatal System is developed to bring together all the people involved in providing and organising maternity and neonatal care in Sussex. Such as midwives, obstetricians, health visitors, GPs, neonatal staff, managers, commissioners, public health, educators, perinatal mental health providers and service users.
We designed a Pelvic Health Physiotherapy Referral Form so our patients can access the most appropriate support. Service users may have been asked by a health professional to complete it, or to seek advice yourself and self-refer.
Self-referral allows you to access the pelvic health physiotherapy service without having to see your GP or a health care professional.
This privacy notice tells you what to expect us to do with your personal information when you use the self-referral to physiotherapy web form.
You can find more detailed information about how the ICB processes personal data information for specific purposes here: NHS Sussex ICB – Fair Processing Notice
We are the joint controller for your information, along with East Sussex Healthcare NHS Trust, University Hospitals NHS Foundation Trust, and Sussex Community NHS Foundation Trust. A controller decides on why and how information is used and shared.
The Data Protection Officer for NHS Sussex ICB is Cat Scott and they are responsible for monitoring the ICB’s compliance with data protection requirements. You can contact them with queries or concerns relating to the use of your personal data by the ICB at SXICB.IG@nhs.net.
The other controllers are:
The personal information we collect is provided directly from you when you complete the via Self-referral to Physiotherapy web form to seek care – this is used directly for your care.
Personal information
The online self-referral form will be collecting the following personal information:
More sensitive information
We process the following more sensitive data (including special category data):
NB: The NHS Sussex ICB only hosts the form. Although the LMNS is part of the NHS Sussex ICB, the LMNS website does not hold, save, or review any data.
On submission of your details into the online referral form, the information will be emailed directly to either East Sussex Healthcare NHS Trust (ESHT), University Hospitals NHS Foundation Trust (UHSx), and Sussex Community NHS Foundation (SCFT) Trust physio teams depending on which GP surgery you are registered at.
UHSx, ESHT, SCFT – Physio teams will use the data to triage service users into the appropriate pathway of their service.
NHS Sussex ICB does not save the information submitted in any way, and cannot see it, only physio teams have access to the data.
The website server is in the United States (West). It is a secure server with all security updates and protocols in place.
More information regarding security and ISO27001:2013 certification can be viewed here: https://www.godaddy.com/en-uk/trust-center/compliance.
Under the UK General Data Protection Regulation (UK GDPR), the lawful basis we rely on for processing the personal information in the webform is:
(e) We need it to perform a public task – a public body, such as an NHS organisation or Care Quality Commission (CQC) registered social care organisation, is required to undertake particular activities by law.
More sensitive data
Under UK GDPR, the lawful basis we rely on for using information that is more sensitive (special category):
(h) To provide and manage health or social care (with a basis in law).
Common law duty of confidentiality
In our use of health and care information, we satisfy the common law duty of confidentiality because you have provided us with your consent by completing this form. (Should you wish to be referred to physiotherapy without using the form you can do so via your GP or other clinician involved in your maternity care.)
The NHS Sussex ICB only hosts the form. Although the LMNS is part of the NHS Sussex ICB, the LMNS website does not hold, save, or review any data.
Under data protection law, you have the following rights which you may be able to exercise* with any of the data controllers involved:
Your right of access – You have the right to ask us for copies of your personal information (known as a subject access request).
Your right to rectification – You have the right to ask us to rectify personal information you think is inaccurate. You also have the right to ask us to complete information you think is incomplete.
Your right to erasure – You have the right to ask us to erase your personal information in certain circumstances.
Your right to restriction of processing – You have the right to ask us to restrict the processing of your personal information in certain circumstances.
Your right to object to processing – You have the right to object to the processing of your personal information in certain circumstances.
Your right to data portability – You have the right to ask that we transfer the personal information you gave us to another organisation, or to you, in certain circumstances.
*Please be aware not all rights are absolute rights that can be exercised for all data processing activities. We will suitably explain if a right you wish to exercise cannot be used.
You are not required to pay any charge for exercising your rights. If you make a request, we have one month to respond to you.
Please make contact using the following details if you wish to make a request relating to the data you have entered into the webform:
If you have any concerns about our use of your personal information, you can make a complaint to NHS Sussex ICB here: SXICB.IG@nhs.net.
Or use the above Trusts websites to contact them directly.
Following this, if you are still unhappy with how your data has been used by one of the organisations, you can then complain to the ICO.
The IC’s address is:
Information Commissioner’s Office Wycliffe House Water Lane Wilmslow Cheshire SK9 5AF
Helpline number: 0303 123 1113
ICO website: https://www.ico.org.uk
Date of last review: March 2024
To be reviewed after the one year if collection of the information via this referral form is continued.
This form has been designed so you can access the most appropriate support. You may have been asked by a health professional to complete it, or you may have taken the decision to seek advice yourself. Self-referral allows you to access the pelvic health physiotherapy service without having to see your GP or a health care professional.
It takes approximately 8 minutes to complete.
Please complete all the questions fully as possible, as the more information we have about your symptoms the better we are able to support you.
Below is a list of common problems that can often be helped with pelvic health physiotherapy:
Problems that occur during pregnancy or after birth such as:
Problems at any stage in life:
This form should not be used if you are under 16 years old. Please make an appointment to see your GP who can refer you if necessary.
Once you have submitted your self-referral from, a confirmation email will be sent to the email address you have provided. If you have not received a confirmation email, please check your Junk Mail folder.
A specialist pelvic health physiotherapist will look at the information you provided and place you on the correct waiting list.
If you are pregnant you should receive an appointment within 3 weeks of submitting this form, either by letter or phone call. You will be notified by way of letter, how long you can expect to wait for all other conditions.
If you have you any of the following symptoms WITHIN THE LAST 2 WEEKS then please do not complete this form and call NHS 111 or attend A&E as you may require immediate medical attention:
Please choose an option
Please do not complete this form and call NHS 111 or attend A&E as you may require immediate medical attention.
If you are pregnant and have any of the following symptoms then please do not complete this form and instead call your midwife, GP or your local delivery suite Immediately as pelvic health physiotherapy is not appropriate at this time:
Please do not complete this form and instead call your midwife, GP or your local delivery suite Immediately as pelvic health physiotherapy is not appropriate at this time
In the last 6 weeks if you have experienced any of the following symptoms and you have not spoken to your GP about them then please make an appointment to do so rather than continue with this self-referral form
Please select a GP location
Please select an option
Please enter your first name
Please enter your surname
Please enter how you identify your gender
Please enter your preferred pronoun
Please enter your date of birth
Please enter information on your special requirements
Please enter a valid email address
Please enter a valid telephone number
Please enter your address. Must be at least 5 characters
Please enter how weeks pregnant you are
Please enter your expected delivery date
Please enter your delivery date
Please enter at least 5 characters
Please enter a pain score
Please tell us how long have you had your current symptoms for
Please enter more than 5 characters
It's important to continue taking any medication prescribed unless your GP/specialist specifically tells you to stop. Please visit our Existing Health Conditions page for more information, or visit 'Bumps' ('Best Use of Medicines in Pregnancy').
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