PUBLIC HEALTH ETC. (SCOTLAND) ACT 2008
IMPLEMENTATION OF PART 2: NOTIFIABLE DISEASES, ORGANISMS AND
HEALTH RISK STATES
Purpose
1.
This circular advises that Part 2 and Schedule 1 of the Public Health etc.
(Scotland) Act 2008 come into effect on 1 January 2010 and provides supporting
guidance to registered medical practitioners, directors of diagnostic laboratories and
health boards on their duties under the Act with regard to the notification of infectious
diseases, organisms and health risk states. Current responsibilities under the Public
Health (Notification of Infectious Diseases) (Scotland) Regulations 1988 and the
Infectious Disease (Notification) Act 1889 cease to apply on 31 December 2009.
Background
2.
The aim of statutory notification is to give early warning of potential threats to
human health caused by infectious disease, contamination and other hazards in
order to assess what, if any, health protection action might be required to minimise
the spread of such diseases and the subsequent risk to human health. The new Act
amends the current list of diseases to be notified by registered medical practitioners
to health boards (and includes the notification of ‘health risk states’); amends the
information to be notified; amends the level of information to be passed on from
health boards to Health Protection Scotland (HPS); introduces statutory notification
of specific organisms from diagnostic laboratories testing human samples for
infection; introduces timescales for notification; and removes the fee to registered
medical practitioners for notification.
3.
Part 2 and Schedule 1 of the Act, along with further detailed information about
the Act and its implementation, can be accessed at
http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/publicact
Guidance
4.
Guidance is contained in the following papers, attached:
Paper 1 (and Annexes A & B):
Notifiable diseases and health
risk states: duties on registered medical practitioners
Paper 2 (and Annex C):
Notifiable
directors of diagnostic laboratories
organisms:
duties
on
Paper 3:
Notifiable diseases, notifiable organisms and health risk
states: duties on health boards
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Action
5.
NHS Boards:
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should bring this Circular to the attention of all registered medical
practitioners in their areas, for action, in order to ensure practitioners
meet their new duties under the Act (as set out in Paper 1 and Annexes
A & B) on 1 January 2010;
should bring this Circular to the attention of all diagnostic laboratories
in their areas, for action, in order to ensure laboratories meet their new
duties under the Act (as set out in Paper 2 and Annex C) on 1 January
2010;
should ensure that they are in a position to meet their own statutory
obligations (as set out in Paper 3) on 1 January 2010;
should also issue the guidance to those registered nurses leading
clinics or out of hours services or working in isolated communities
without immediate access to a registered medical practitioner.
Methods of notification
6.
The opportunity is being taken, where possible, to move from paper-based to
electronic notification. For registered medical practitioners working in primary care,
all notifications with effect from 1 January 2010 will be via the Scottish Care
Information (SCI) Gateway.
7.
In other settings, paper based arrangements will also be available, as set out
in the attached guidance.
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PAPER 1
PUBLIC HEALTH ETC. (SCOTLAND) ACT 2008
NOTIFIABLE DISEASES AND HEALTH RISK STATES:
DUTIES ON REGISTERED MEDICAL PRACTITIONERS
Registered Medical Practitioners should note that the current arrangements for the
notification of infectious diseases will change from 1 January 2010, when Part 2 of
The Public Health etc. (Scotland) Act 2008 comes into effect.
Current
responsibilities under the Public Health (Notification of Infectious Diseases)
(Scotland) Regulations 1988 and the Infectious Disease (Notification) Act 1889
cease to apply on 31 December 2009.
The new statutory duties are set out below:
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All registered medical practitioners must notify their health board if they have
a reasonable suspicion that a patient whom they are attending has one of the
diseases set out in Annex A. Practitioners should not wait until laboratory
confirmation of the suspected disease before notification.
As well as those diseases which are notifiable in their own right, registered
medical practitioners are required to notify any case suffering from a ‘health
risk state’ (HRS), and anyone likely to have been exposed to such a case with
an HRS, or the same risk factor. Further guidance is contained in Annex B.
Please note that we would expect notification of a health risk state to be an
exceptional occurrence.
Practitioners must notify their health board, in writing (which includes
electronic transmission) within 3 days of suspicion, unless he/she has
reasonable grounds to believe that another practitioner has notified the
disease/HRS. This does not include the potential notification by a laboratory
of the organism which causes the disease.
Separate notification
arrangements are in place for diagnostic laboratories.
If the case is ‘urgent’, notification should take place by telephone as soon as
reasonably practicable. The need to notify urgently is determined by the
registered medical practitioner, having regard to the nature of the disease, the
ease of transmission of that disease, the patient’s circumstances and any
guidance issued by Scottish Ministers (see overleaf). All urgent oral
notifications must be followed up, in writing (which includes electronic
transmission), within 3 days of suspicion.
For the purposes of electronic notification, a document is to be taken to be
received on the day of transmission.
Information to be notified (in so far as it is known)
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the patient’s name;
the patient’s address and postcode;
the patient’s occupation (if the practitioner considers that it is relevant);
the name, address and postcode of the patient’s place of work or education (if
the practitioner considers that it is relevant);
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the patient’s sex;
the patient’s date of birth;
the suspected disease; and
the patient’s NHS identifier, i.e. the patient’s community health index number
or where that number is not known, the NHS identification number, or where
neither of these numbers are known, any other number of other indicators
which is used to identify a patient individually.
Method of written notification
For those registered medical practitioners working in primary care, all written
notifications with effect from 1 January 2010 should be undertaken
electronically via the Scottish Care Information (SCI) Gateway. A new
destination ‘Health Protection Scotland – <NHS board name>’ has been set up on
SCI Gateway and a new specialty ‘Notifications reporting’. Registered medical
practitioners should use this new destination to inform their local NHS Board Health
Protection Team of notifiable disease cases.
Enquiries relating to technical issues with SCI Gateway should be addressed to the
local SCI Gateway Coordinator.
Those registered medical practitioners operating in secondary care who have access
to SCI Gateway, are also expected to notify in this way. Where there is no access to
SCI Gateway in secondary care, two other methods of notification are available:

online – by completing a notification form, available on the Health Protection
Scotland (HPS) website at http://www.hps.scot.nhs.uk/publichealthact/index.aspx and
sending it by secure e-mail, within the time limits set out in this guidance, to
the Health Protection Team in the Health Board.
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for those without ready access to a PC – by completing a paper copy of the
above form and sending in a secure manner, or sending by secure fax to the
Health Protection Team in the Health Board.
Local contacts
The Act requires notification to the health board for the area in which the practitioner
works, in effect the local Health Protection Team. Contact details of health boards’
Health Protection Teams are set out in Annex D.
Guidance

It is recommended that those diseases marked with an * in Annex A require
urgent notification, i.e. within same working day. However, there may be
other circumstances where immediate notification might be necessary, e.g. if
there are a cluster of cases. Further guidance on the need for telephone
notification may be provided locally from time to time, based on changing
epidemiology or particular local circumstances. If in any doubt, call the Health
Protection Team at your local health board.
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It is recognised that there may be nurses leading clinics or out of hours
services, or working in isolated communities who may well form a suspicion
that a patient has a notifiable disease which requires immediate action. If
such a nurse were to communicate a suspicion by telephone to a registered
medical practitioner, the practitioner may choose to commence notification
procedures immediately on this basis. Should there be delay in contacting a
registered medical practitioner to facilitate notification, for any reason, the
registered nurse should call the health protection team at the local health
board directly to inform them of their suspicion. However, this does not
constitute a formal notification under the Act. The registered nurse should
continue to pursue formal notification through the relevant registered medical
practitioner. Nurses should ensure that they clearly document all action taken
and advice given when raising a suspicion.
Registered medical practitioners should not attempt to ‘denotify’ when the
laboratory results indicate that the patient does not have the suspected
notifiable disease.
The Health Protection Team should, however, be
contacted if an administrative error has been made in the notification process.
Where a patient presents with a notifiable disease for the first time in Scotland
and the patient has already been diagnosed with that condition in another part
of the UK, or abroad, registered medical practitioners should notify.
Once statutory notification is made, it would be helpful if the notification is
noted in the patient’s records.
This should help to avoid duplicate
notifications.
Further information
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Notifications will be considerably reduced from pre-2010 levels because the
list only contains diseases which may prompt urgent public health
investigation and action. For example, food poisoning and chickenpox, which
constituted about 80% of notifications prior to 1 January 2010, have been
removed.
The fee to registered medical practitioners has been removed, recognising
that notification of the significant diseases on the new list will become an
unusual event for a medical practitioner and should be undertaken under
his/her general duty of care to protect public health.
Non-notification is a governance issue which falls to the health board for
employed doctors, and for GPs as independent contractors, through their own
clinical governance systems, and ultimately through the GMS contractual
requirement in Schedule 5, paragraph 115 of The NHS (General Medical
Services Contracts) (Scotland) Regulations 2004 and Schedule 1, paragraph
79 of The NHS (Primary Medical Services
Section 17C
Agreements)(Scotland) Regulations 2004, i.e. the contractor shall comply with
all relevant legislation; and have regard to all relevant guidance issued by the
health board and the Scottish Ministers.
Scottish Ministers may amend the list of diseases to be notified, by regulation,
by adding to or removing an item from the list, and varying the description of
an item in the list.
Scottish Ministers may also, by regulation, amend any other aspect of the
notification arrangements.
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PAPER 2
PUBLIC HEALTH ETC. (SCOTLAND) ACT 2008
NOTIFIABLE ORGANISMS:
LABORATORIES
DUTIES
ON
DIRECTORS
OF
DIAGNOSTIC
Directors of diagnostic laboratories in Scotland, as defined overleaf, should
note the new statutory notification duties being placed on them by The Public
Health etc. (Scotland) Act 2008, with effect from 1 January 2010.
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The director of a diagnostic laboratory in Scotland must notify the organisms
set out in Annex C to the health board in whose area the laboratory is
situated and Health Protection Scotland (HPS).
Notification must take place, in writing, within 10 days of identification.
Electronic notification, e.g. through Electronic Communication of Surveillance
in Scotland (ECOSS), is acceptable.
For the purposes of electronic notification, a document is to be taken to be
received on the day of transmission.
If the case is ‘urgent’, notification should take place by telephone as soon as
reasonably practicable. ‘Urgency’ is determined by the director of the
laboratory, having regard to the nature of the organism, the nature of the
disease caused by the organism, the ease of transmission, the patient’s
circumstances (where known) and any guidance issued by Scottish Ministers.
See guidance below. All urgent notifications require to be followed up in
writing within 10 days of identification.
Where a diagnostic laboratory requires, under an arrangement, to send a
sample to another laboratory for analysis (e.g. to a specialist facility in
Scotland or elsewhere in the UK), statutory notification is required from the
originating laboratory. In these cases, the day of identification for the
purposes of notification will be the day on which the first diagnostic laboratory
becomes aware of the identification by the other laboratory with which it has
the arrangement.
Information to be notified (in so far as it is known)
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the name of the person to whom the identification relates;
the person’s address;
the person’s sex;
the person’s date of birth;
the organism which has been identified; and
the person’s NHS identifier, i.e. the patient’s community health index number
or, where that number is not known, the NHS identification number, or where
neither of these numbers are known, any other number or other indicator
which is used to identify a patient individually.
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Method of notification
The existing ECOSS reporting system, already in use at most NHS diagnostic
laboratories, meets the new statutory notification requirements, and should continue
to be used from 1 January 2010. An e-mail alert will be sent to the Health Protection
Team of the local health board when an electronic Weekly Report is available.
Those laboratories not currently using ECOSS should continue with existing
methods of notification until such time as ECOSS is implemented.
In the case of private laboratories, an automated electronic reporting system will be
implemented, where possible. However, in the short term, private laboratories
should send a secure electronic notification via email or secure fax to the health
board in whose area the laboratory is situated and to HPS within the time limits
specified in the Act and as set out in this guidance.
Local contacts
The Act requires notification to the health board in whose area the diagnostic
laboratory is situated, in effect the local Health Protection Team. Contact details of
health boards’ Health Protection Teams are set out in Annex D.
Guidance
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It is recommended that those organisms marked with an * in Annex C require
urgent notification, i.e. within the same working day.
There may be circumstances where notification well within the 10 day period
would be appropriate, but might not necessarily merit urgent telephone
notification, or where organisms might need to be notified to health boards
before formal identification. Laboratories should therefore ensure that they
have mutually agreed Standard Operating Procedures or other agreements in
place with local health boards, which clarify these issues and take into
account their new statutory obligations. These agreements may also cover
emerging organisms which have public health consequences.
‘Diagnostic laboratory’ means an institution (or facility within an institution)
which is equipped with apparatus and reagents for the performance of
diagnostic tests for human infections.
‘Director of a diagnostic laboratory’ means –
- the clinical microbiologist, consultant pathologist or other registered medical
practitioner or other person in charge of a diagnostic laboratory; or
- any other person working in the diagnostic laboratory to whom the function
of making a notification under this section has been delegated by the person
mentioned above.
Offences

It is an offence for the director of a diagnostic laboratory to fail, without
reasonable excuse, to comply with the duty of notification. Where the director
of a diagnostic laboratory commits an offence and is employed by a body
corporate, the body corporate also commits the offence. There is a defence
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of due diligence and that all reasonable steps were taken to avoid committing
the offence, both for a director of the diagnostic laboratory and a body
corporate, or its employee or agent.
Further information
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Scottish Ministers may amend the list of organisms to be notified, by
regulation, by adding to or removing an item from the list, and varying the
description of an item on the list.
Scottish Ministers may also, by regulation, amend any aspect of the
notification arrangements.
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PAPER 3
PUBLIC HEALTH ETC. (SCOTLAND) ACT 2008
NOTIFIABLE DISEASES, NOTIFIABLE ORGANISMS AND HEALTH RISK
STATES: DUTIES ON HEALTH BOARDS
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Where a health board receives a notification of a disease or health risk state
from a registered medical practitioner and the patient to whom the information
relates usually resides in that health board area, the board must send a
return, in writing (in practice electronic transmission via Scottish Infectious
Disease Surveillance System (SIDSS2), to Health Protection Scotland (HPS),
containing the information set out below.
The return should be sent by the end of the week in which the information is
received (in the Act ‘week’ is defined as meaning a period of 7 days ending on
Friday at the expiry of the normal working hours of the board’s principal
office), or, if it is not practicable to do so, as soon as practicable afterwards.
For the purposes of electronic transmission of data, a document is to be taken
to be received on the day of transmission.
If the patient to whom the information relates does not usually reside in that
health board area, the board must without delay transmit the information to
the health board for the area in which the person usually resides.
Where a health board receives information from another health board about a
patient who usually resides in its area, that board must send the return, in
writing, to HPS, by the end of the working week in which it is received (i.e. by
close of play on Friday of that week) or, if it is not practicable to do so, as
soon as practicable afterwards.
Where a health board receives information from a laboratory and that
information relates to a person who does not usually reside in its area, the
board must, without delay, transmit that information to the health board for the
area in which the person usually resides.
Information to be included in return to HPS (in so far as it is known)
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the patient’s postcode;
the patient’s occupation;
the patient’s sex;
the patient’s date of birth;
the suspected disease or suspected health risk state; and
the patient’s NHS identifier, i.e. the patient’s community health index number
or where that number is not known, the NHS identification number, or where
neither of these numbers are known, any other number or other indicator
which is used to identify a patient individually.
Method of notification
SIDSS2 will continue to be the means of electronic notification from the health board
to HPS. A number of changes have been made to the input screen to reflect the
information that now requires to be captured to meet the requirements of the Act.
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ANNEX A
DISEASES TO BE NOTIFIED BY REGISTERED MEDICAL PRACTITIONERS
WITH EFFECT FROM 1 JANUARY 2010: NOTIFICATIONS ARE BASED ON
REASONABLE SUSPICION AND SHOULD NOT AWAIT LAB. CONFIRMATION
* Anthrax
* Botulism
Brucellosis
* Cholera
* Clinical syndrome due to
E.coli O157 infection (see Note 1)
* Diphtheria
* Haemolytic Uraemic
Syndrome (HUS)
* Haemophilus influenzae
type b (Hib)
* Measles
* Meningococcal disease
Mumps
* Necrotizing fasciitis
* Paratyphoid
* Pertussis
* Plague
* Poliomyelitis
* Rabies
Rubella
* Severe Acute Respiratory
Syndrome (SARS)
* Smallpox
Tetanus
Tuberculosis (respiratory or
non-respiratory) (see Note 2)
* Tularemia
* Typhoid
* Viral haemorrhagic fevers
* West Nile fever
Yellow Fever
*It is recommended that those diseases above marked with an * require urgent notification,
i.e. within the same working day. Follow up written / electronic notification within 3 days is
still required.
Note 1: E.coli O157
Clinical suspicion should be aroused by (i) likely infectious bloody diarrhoea or (ii) acute
onset non-bloody diarrhoea with a biologically plausible exposure and no alternative
explanation. Examples of biologically plausible exposures include:
 contact with farm animals, their faeces or environment;
 drinking privately supplied or raw water;
 eating foods such as undercooked burgers or unpasteurised dairy products;
 contact with a confirmed or suspected case of VTEC infection.
Further guidance is available at:
http://www.hps.scot.nhs.uk/giz/e.coli0157.aspx?subjectid=18
Cases notified as HUS (Haemolytic Uraemic Syndrome) should NOT be notified as “Clinical
syndrome due to E.coli O157 infection” as well.
Note 2: Tuberculosis
For the purposes of notification, respiratory TB or non-respiratory TB should be taken to
have the same meanings as the World Health Organisation definitions of pulmonary TB and
non-pulmonary TB respectively.
Pulmonary TB is tuberculosis of the lung parenchyma and/or the tracheobronchial tree.
Non-pulmonary TB is tuberculosis of any other site.
Where tuberculosis is clinically diagnosed in both pulmonary and non-pulmonary sites, this
should be treated as pulmonary TB.
If you are in any doubt about the diagnosis of suspected cases, you should contact
the local Health Protection Team for advice (Annex D).
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ANNEX B
NOTIFICATION OF HEALTH RISK STATES (HRS)
Why is it necessary to notify suspected 'health risk states'?
The aim of notifying suspected health risk states is to identify diseases or
conditions which are not notifiable in their own right but which pose or may
pose a significant risk to public health. The definition of ‘health risk state’ and
‘exposure to a health risk state’, as provided in the Act is set out in the footnote1.
Pubic health authorities need to be able to identify and respond quickly to new and
emerging public health threats, even when a condition is identified from its symptoms
and epidemiology and the causative organism is not yet identified. This is particularly
relevant in the modern world of global travel and trade. For example, urgent public
health action was required in the early stages of the SARS (Severe Acute
Respiratory Syndrome) outbreak in 2003 and the Influenza AH1N1 outbreak in 2009,
even before the causative agent was known.
Other examples from the past of conditions that would fulfil the criteria of a health
risk state include the initial five cases of Pneumocystis carinii pneumonia heralding
the AIDS epidemic, avian flu, Polonium exposure and poisoning in the Litvinenko
case.
What should be notified?
This is for practitioners to determine, based on reasonable suspicion. However, the
following advice should assist.
(a) If a novel serious condition occurs at home or abroad, it may be designated an
HRS by the Scottish Government's Chief Medical Officer (CMO), who will provide a
case definition for exactly what should be notified.
(b) In the absence of a definition from the CMO, medical practitioners should notify
as an HRS any condition which is:
1. Serious:
A case must be very ill or have died, or be likely to become very ill or die.
AND
2. Be potentially serious to others.
1
Section 14 (7) of the Public Health etc. (Scotland) Act 2008 defines a ‘health risk state’ as (a) a
highly pathogenic infection; or (b) any contamination, poison or other hazard which is a significant risk
to public health.
References to a patient having been ‘exposed to a health risk state’ is defined in section 14 (8) as (a)
having been in physical contact with a health risk state; (b) having been contaminated by a health risk
state; or (c) having been in physical contact with or contaminated by a person who, or an object
which, has been in physical contact with or contaminated by a health risk state.
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The three principal ways in which an HRS might be serious for others are if it
is:
(i) infectious;
(ii) the result of contamination with, for example, a radioactive material;
(iii) the result of a toxin or poison to which others may be exposed.
An HRS is likely to be new, rare, unexplained, or difficult to diagnose. Obviously, the
more serious the condition, and the greater the likelihood of spread, the more
important it is for the medical practitioner to notify it. The more cases the medical
practitioner sees within a given period of time, the more likely is the potential for
spread, but an HRS presenting in a single case may still have the potential to affect
others.
Notifications of an HRS will be an exceptional occurrence and should only be made
on the basis that the registered medical practitioner considers there is a risk of
significant public health implications of the condition. If in doubt whether to notify a
condition, on grounds of either its seriousness or potential to affect others, the
medical practitioner should discuss the condition with the local Health Protection
Team (Annex D).
How to notify
Immediate oral notification by telephone is strongly recommended in these
circumstances, followed up in writing / electronically with the required information
within 3 days of forming the suspicion of the health risk state.
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ANNEX C
NOTIFIABLE
ORGANISMS
LABORATORIES
FOR
NOTIFICATION
BY
DIAGNOSTIC
*Bacillus anthracis
Bacillus cereus
*Bordetella pertussis
Borrelia burgdorferi
Brucella genus
*Campylobacter genus
Chlamydia psittaci
*Clostridium botulinum
Clostridium difficile
Clostridium perfringens
*Clostridium tetani
*Corynebacterium diphtheriae (toxigenic strains)
*Corynebacterium ulcerans
*Coxiella burnetii
*Crimean-Congo haemorrhagic fever virus
*Cryptosporidium
Dengue virus
*Ebola virus
Echinococcus genus
*Verocytotoxin-producing E.coli (VTEC)
*Francisella tularensis
*Giardia lamblia
*Guanarito virus
*Haemophilus influenzae type b (from blood, cerebrospinal fluid or other normally
sterile site)
Hantavirus
*Hepatitis A virus
*Hepatitis B virus (see Note 1)
Hepatitis C virus
Hepatitis E virus
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Influenza virus (all types, including *those caused by a new sub-type)
*Junín virus
*Kyasanur Forest disease virus
*Lassa virus
*Legionella genus
Leptospira genus
*Listeria monocytogenes
*Machupo virus
*Marburg virus
*Measles virus
Mumps virus
*Mycobacterium bovis
*Mycobacterium tuberculosis complex
*Neisseria meningitidis
Norovirus
*Omsk haemorrhagic fever virus
Plasmodium falciparum, vivax, ovale and malariae
*Polio virus
*Rabies virus
Rickettsia prowazekii
*Rift Valley fever virus
*Rubella virus
*Sabia virus
*Salmonella (all human types)
*SARS-associated coronavirus
*Shigella genus
Enterotoxigenic Staphylococcus aureus
Staphylococcus aureus (all blood isolates)
Methicillin-resistant Staphylococcus aureus (MRSA)
*Streptococcus pyogenes (from blood, cerebrospinal fluid or other normally sterile
site)
Streptococcus pneumoniae (from blood, cerebrospinal fluid or other normally sterile
site)
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Toxoplasma gondii.
Trichinella genus
Varicella-zoster virus
*Variola virus
*Vibrio cholerae
*West Nile fever virus
*Yellow Fever virus
*Yersinia enterocolitica
*Yersinia pestis
*Yersinia pseudotuberculosis
*It is recommended that those organisms above marked with an * require urgent
notification, i.e. within the same working day. Follow up written / electronic
notification within 10 days is still required.
Note 1: For Hepatitis B, only acute infections require urgent notification.
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ANNEX D
HEALTH PROTECTION TEAM CONTACTS IN NHS BOARDS
NHS Ayrshire and Arran
Tel: 01292 611040
Tel: 01563 521133 (Out of Hours)
Fax: 01292 885902
E-mail: HPTeam@aapct.scot.nhs.uk
NHS Highland
Tel: 01463 704886
Tel: 01463 704000 (Out of Hours)
Fax: 01463 717666
E-mail: iris.mackenzie@nhs.net
NHS Borders
Tel: 01896 825560
Tel: 01896 826000 (Out of Hours)
Fax: 01896 823396
E-mail: tim.patterson@borders.scot.nhs.uk
NHS Lanarkshire
Tel: 01698 206326
Tel: 01236 748748 (Out of Hours)
Fax: 01698 424316
E-mail: healthprotection@lanarkshire.scot.nhs.uk
NHS Dumfries and Galloway
Tel: 01387 272724
Tel: 01387 246246 (Out of Hours)
Fax: 01387 272759
E-mail: dumf-uhb.hpt@nhs.net
NHS Lothian
Tel: 0131 536 9192/9092
Tel: 0131 242 1000 (Out of Hours)
Fax: 0131 536 9195
E-mail: health.protection@nhslothian.scot.nhs.uk.
NHS Fife
Tel: 01592 226435
Tel: 01383 623623 (Out of Hours)
Fax: 01592 226925
E-mail: hpt.fife@nhs.net
NHS Shetland
Tel: 01595 743072
Tel: 01595 743000 (Out of Hours)
Fax: 01595 695200
E-mail: shet-hb.PublicHealthShetland@nhs.net
NHS Forth Valley
Tel: 01786 457283
Tel: 01786 434000 (Out of Hours)
Fax: 01786 446327
E-mail: henry.prempeh@nhs.net
NHS Tayside
Tel: 01382 596976/87
Tel: 01382 660111 (Out of Hours)
Fax: 01382 596985
E-mail: healthprotectionteam@tayside.nhs.net
NHS Grampian and NHS Orkney
Tel: 01224 558520
Tel: 0845 456 6000 (Out of Hours)
Fax: 01224 558566
E-mail: grampian.healthprotection@nhs.net
NHS Western Isles
Tel: 01851 708033
Tel: 01851 704704 (Out of Hours)
Fax: 01851 702036
E-mail: angelagrant1@nhs.net
NHS Greater Glasgow and Clyde
Tel: 0141 201 4917
Tel: 0141 211 3600 (Out of Hours)
Fax: 0141 201 4950
E-mail: PHPU@ggc.scot.nhs.uk
Version 1.0
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November 2009