The team provides comprehensive Physiotherapy and Occupational Therapy assessments, treatment, and ongoing care within a person’s home environment.

We aim to improve physical health and wellbeing through movement, exercise, and tailored rehabilitation. We also support individuals in regaining or maintaining their ability to carry out everyday tasks. This may include providing practical strategies and recommending or supplying functional aids to enhance independence.

Hours: 9am to 5pm (Monday to Friday)

Our Referral Criteria

• 18 years and above
• Tower Hamlets resident
• Limited functional ability resulting in being housebound (temporary/permanent)
• Indoor Mobility/mobility aid assessment to progress the functional ability to access community amenities/services
• Falls assessment, prevention and management
• Stairs assessment within the home
• Transfer and manual handling assessments, including the use and provision of equipment
• Functional and environmental assessment, including fall prevention and management
• Equipment assessment, including minor adaptions to the home environment (stair rails, bath, toilet) with the potential to improve function within the home
• End of Life Care where there is potential to improve quality of life

Exclusion Criteria

• Referrals that require urgent 2hr -48hr response or prevention of hospital admission - please refer to Rapid Response team call 07710 066161
• New/ recent strokes, Parkinson's, Motor Neurone Disease, Huntington's Disease and other progressive degenerative neuro conditions
• We do not accept referrals for wheelchair assessments
• We do not accept referrals for equipment only with no other therapy requirements - please refer directly to social services Tower Hamlets Connect enquiry@towerhamletsconnect.org or call 0300 303 6070 for major adaptations e.g. wet floor shower, stair lift

How GP can make a referral

• Use the template 'Single Point of Access Referral Form' and complete relevant sections.
• Save the consultation then the document named CHS SPA (Adult) referral form TH CEG will automatically open.
• Select the service and the rest of the form will be populated automatically.
• Save and close the document and send via Accurx Accumail to thgpcg.spa@nhs.net 

Contact details for GP to discuss referral
Phone: 0300 033 5000 to request for call to pass to Community Therapy Team. Please discuss this with the triage therapist on duty. 

Email: elft.thcommunitytherapyteam@nhs.net 

Patient Information Leaflet about the service

Tracheostomy Service Page

The service offers specialist advice and treatment to support the alerted airway patient, family, caregivers and community teams with regard to the specialist management required for patients living in Tower Hamlets.

Please refer directly to Hannah McDonald at the email address below. 

Our Referral Criteria
Over 18 patients with an altered airway (tracheostomy or laryngectomy) living in Tower Hamlets. 

Contact details to discuss and make referral: 

• Email: Hannah.mcdonald3@nhs.net
• Phone: 07917 599881 

The aim of the continence service is to promote continence, improve or achieve continence and manage incontinence for any adult experiencing bladder/ bowel dysfunction. 

Listen to our podcast episode with a local GP and patient.

Our Referral Criteria 

• Over 18 years old
• Resident in Tower Hamlets (TH)
• Urinary and/or Faecal Incontinence
• Bengali women with stress incontinence for Pelvic Floor Exercise Group
• Please state whether the patient is housebound or able to attend appt in person at Mile End 

Exclusion Criteria 

• Do NOT refer just for pad prescription
• We do not offer our services to children (adults only)
• Please visit Barts Health NHS Trust Community Services for more information on how to refer children for continence issues

How GP can make a referral

• Use the template 'Single Point of Access Referral Form' and complete relevant sections.
• Save the consultation then the document named CHS SPA (Adult) referral form TH CEG will automatically open.
• Select the service and the rest of the form will be populated automatically.
• Save and close the document and send via Accurx Accumail to thgpcg.spa@nhs.net  

Pad Prescription Only Required:

• If patients need to re-order their pad please ask them to call 0800 030 44 66
• If discharged from the NHS supply chain, please ask the patient to call the continence service at 0207 771 5795

New Pad Formulary Update 
click on the link for information about the change in continence pade provison

Contact details to discuss a referral

• Telephone: 0207 771 5795
• Email: elft.th.continence.service@nhs.net

Important: If you are unable to make contact with us please call SPA on 0300 033 5000.

Our opening times are:

• Monday to Friday 09:00 - 17:00, not bank holidays, and no out-of-hour service is available.

We complete a holistic multidisciplinary assessment for patients with long term complex physical or mental health needs to see if they qualify for free social care arranged and funded solely by the NHS. 

NHS continuing healthcare can be provided in a variety of settings outside hospital, such as in the patient's own home or in a care home.

Our Referral Criteria 

• Over 18 years old
• Resident in Tower Hamlets
• Known to London Borough Tower Hamlets Social Services and/or have a Community health team involved in their care
• Have a condition which requires ongoing and prolonged care
• Urgent/ Fast track referral is for patients whose condition is rapidly deteriorating and may be entering the terminal stage

Exclusion Criteria 

• Children under the age 18
• Patients with a registered GP not in Tower Hamlets
• Patients undergoing rehabilitation who have not yet met their goals
• Patients who are medically unwell or waiting further investigations or specialist assessments to be completed
• Patients in acute hospital setting 

How GP can make a referral

Routine

• Please complete CHC checklist and referral form and send via email elft.thchc@nhs.net 

Urgent (Fast Track)

• Please complete CHC Fast track pathway tool and referral form and send via email elft.thchc@nhs.net
• Fast Track can only be completed by registered nurse or doctor

Contact details to discuss a referral

Telephone: 0207 771 5680/5675 (Monday to Friday 0900- 1700 not bank holidays, no out of hour service available)

Email: elft.thchc@nhs.net

Care Navigation

The Care Navigation service provides support and coordination for patients who have complex health and social care needs as well as patients and carers who are struggling to navigate the health and social care system. 

The Care Navigator will undertake a home visit and carry out a holistic assessment. The patient will be asked about their health and social care needs and other issues such as housing, safety and financial concerns.  

Our Referral Criteria

• High-intensity users of acute services who do not meet the criteria for social care intervention
• Frequent visits to GP and/or requests for a home visit
• Complex care needs including end-of-life care
• Patients who self-neglect or are at risk of neglect and hard to engage
• Patients who could be taught to self-manage
• Patients with social issues that impact on health eg environmental or housing issues
• Any patient with a cancer diagnosis who would benefit from holistic care navigation

How GP can make a referral 

• Use the template 'Single Point of Access Referral Form' and complete relevant sections.
• Save the consultation then the document named CHS SPA (Adult) referral form TH CEG will automatically open.
• Select the service and the rest of the form will be populated automatically.
• Save and close the document and send via Accurx Accumail to thgpcg.spa@nhs.net  

Contact details for GP to discuss referral 

• Email: elft.thepct.care.navigation@nhs.net
• Phone: SPA on 0300 033 5000 and ask for the Care Navigation Service 

Patients can self-refer to this service through this email or telephone contact

Our Referral Criteria

• Housebound patients
• Insulin treatment, Enoxaparin injections, Eye drops, Pain patches, B12 injections, EPO (Endogenous erythropoietin ) injections, Warfarin monitoring, IV antibiotic therapy
• Wound care, Negative Pressure (VAC) Dressings, Leg Ulcers, Pressure Ulcer Management, Pressure Relieving Equipment, Lymph-oedema management, palliative care/end-of-life care
• Drain site care, chemo disconnection/PICC (Peripherally Inserted Central Catheter) line care
• Bowel care - enema/suppository
• Re-catheterisation
• Blood tests if patients on active caseload -form and bottles need to be in patients property
• Equipment and consumables for the transition of young adults (from 17 years 6 months) 

How GP can make a referral 

• Use the template 'Single Point of Access Referral Form' and complete relevant sections.
• Save the consultation then the document named CHS SPA (Adult) referral form TH CEG will automatically open.
• Select the service and the rest of the form will be populated automatically.
• Save and close the document and send via Accurx Accumail to thgpcg.spa@nhs.net  

Contact details for GP to discuss referral 

• Phone: 0300 033 5000 and request for a call to pass to Triage and Assessment Team

• Email: elft.triageandassessment@nhs.net

Our District Nurses welcome referrals for patients in the last year of life for holistic assessment and care planning. We also welcome urgent referrals for those patients in the last few days of life to alleviate symptoms and provide support. 

Our Advance Care Planning Nurses and OT work with our district nurses to support those nearing the end of life.

You can listen to our  podcast with our ACP nurses. 

MAAR Charts

For help with completing MAR (medical administration record) charts please look at the St Joseph’s Clinical Guidelines. If you are still unsure and need advice call St Joseph’s on 0300 30 30 400.

For more detailed information a WEBINAR hosted by St Joseph’s Hospice is available.

Syringe Driver Information for Patients

Our Referral Criteria 

• Over 18 year old
• Housebound
• In the last year of life (For help in identifying use the SPICT (Supportive & Palliative Care Indicators)  tool) or
• In the last few days of life 

*GP can consider a separate referral to St Joseph's  for complex end-of-life patients or for end-of-life patients with young children for access to specialist support or we can refer directly if we feel this is appropriate for any patient on our caseload*

How GP can make a referral 

• Use the template 'Single Point of Access Referral Form' and complete relevant sections.
• Save the consultation then the document named CHS SPA (Adult) referral form TH CEG will automatically open.
• Select the service and the rest of the form will be populated automatically.
• Save and close the document and send via Accurx Accumail to thgpcg.spa@nhs.net  

Contact details for GP to discuss referral 

• Phone: 0300 033 5000 and request for a call to pass to Triage and Assessment Team

• Email: elft.triageandassessment@nhs.net  

We support and work closely with the community staff in identifying and managing patients with mental health concerns. 

The integrated care mental health liaison team was introduced to improve links between community health teams, GP and secondary mental health services. We provide mental health assessment and interventions to people not known to other secondary mental health services. 

Each locality has a Community Mental Health Nurse who can undertake joint assessments with CHS (Community Health Service) staff, provide short-term interventions and attend meetings with GP teams. We provide information on whether a patient is known to mental health services and support joint working between CHS and mental health services. Mental health nurses are also based in the rapid response team. 

Our referral criteria 

• Mental health concerns in patients with multiple co-morbidities (frailty) not known to the secondary mental health services (patients do not need a mental health or dementia diagnosis)
• Patients with increased confusion
• Exacerbation of behavioural/psychological symptoms of dementia

How GP can make a routine referral 

• Use the template 'Single Point of Access Referral Form' and complete relevant sections.
• Save the consultation then the document named CHS SPA (Adult) referral form TH CEG will automatically open.
• Select the service and the rest of the form will be populated automatically.
• Save and close the document and send via Accurx Accumail to thgpcg.spa@nhs.net  

How GP can make or discuss an urgent referral 

• Telephone: 07710 066 161 (8am - 7pm)
• Important: If you are unable to make contact with us please call SPA on 0300 033 5000

Contact details for GP to discuss routine referral

• Telephone: 0300 033 5000 and ask for Triage and Assessment team
• Email: elft.triageandassessment@nhs.net
• Other useful contacts for our GP Teams:

Our District Nursing team care for housebound patients with pressure ulcers supported by Pressure Ulcer Improvement Facilitators (PUIF).

The PUIF are a team of three nurses who specialise in pressure ulcer prevention and management. They support the community teams by providing specialist evidence based wound care advice and support for patients with category 3, category 4 and unstageable pressure ulcers. Also for those patients with category 2 and suspected deep tissue injury that does not respond to treatment after two weeks. 

Our Referral Criteria 

• Housebound
• Pressure Ulcer
• Not in a nursing home 

Non - housebound patients with complex wounds or ulcers and Nursing home patients with pressure ulcers should be referred to Accelerate >>  

How GP can make a referral 

• Use the template 'Single Point of Access Referral Form' and complete relevant sections.
• Save the consultation then the document named CHS SPA (Adult) referral form TH CEG will automatically open.
• Select the service and the rest of the form will be populated automatically.
• Save and close the document and send via Accurx Accumail to thgpcg.spa@nhs.net  

Contact details for GP to discuss patients 

• Phone: 0300 033 5000 and request for a call to pass to Triage and Assessment Team

• Email: elft.triageandassessment@nhs.net for any patients with ulcers or elft.puifteam@nhs.net if the patient is known to our specialist nurses 

Important: If your enquiry is urgent please call SPA on 0300 033 5000 and ask for the triage and assessment team. 

Tower Hamlets Foot Health Service

We help with a range of conditions which affect foot health such as diabetics with foot complications, circulatory conditions or congenital deformity. 

Listen to a podcast with our service lead and a patient here

Our Urgent Referral Criteria 

• Blisters and sores
• Discharging and infected wounds
• Inflamed areas such as acute ingrowing toenails

All patients with urgent conditions should self- refer to Emergency Clinic Mile End Hospital at 8:30 am, Monday-Friday, excluding Bank Holidays.

Service users should please bring their NHS Number for speedy registration for care

Our Routine Referral Criteria

• Mental health condition, learning disability or dementia unable to self-foot care
• Active or previous foot wounds /ulcerations
• In - growing toe nails
• Peripheral sensory neuropathy (numbness, not pain) in all patients, including diabetics
• Rheumatoid arthritis affecting tissue viability
• Circulatory problems, including vascular or arterial disease
• Congenital foot deformities for shoe wear 

How GP can make a routine referral 

• Use the template 'Single Point of Access Referral Form' and complete relevant sections.
• Save the consultation then the document named CHS SPA (Adult) referral form TH CEG will automatically open.
• Select the service and the rest of the form will be populated automatically.
• Save and close document and send via Accurx Accumail to thgpcg.spa@nhs.net 

How patients can self - refer for routine referral 

• Patients can self refer for routine referrals using this self-referral form and email form to elft.thchsfoothealth@nhs.net
• If a patient does not fulfil the criteria You can find a list of local non-NHS providers here

Contact details for GP to discuss referral 

• Telephone: 0207 771 5775
• Email: elft.thchsfoothealth@nhs.net

Important: If you are unable to make contact with us please call SPA on 0300 033 5000

Frailty Assessment Team

The Older Person's Clinic offers advice, guidance, investigations, treatment, and onward referrals if needed. It is based at RLH and includes ELFT and Bart's Health Colleagues, including a RLH geriatrician. 

The purpose of the clinic is to improve outcomes for older adults by reducing avoidable hospitalization, providing comprehensive old age assessment, planning individually tailored interventions and supporting patients to be cared for in their own homes/communities.

Our Referral Criteria

• resident of Tower Hamlets London
• over 65 years old
• has multidisciplinary needs:
  • Physical frailty
  • Deteriorating complex co-morbidities
  • Recurrent emergency attendances
  • Polypharmacy
  • Difficulty with managing Activities of Daily Living
  • Mobility problems
  • Multiple falls
  • Cognitive and mood issues

How GP can make a referral 

• GPs can refer their patients through advice and guidance via E-referral. Search for 'Older Peoples Services' and 'RLH'
• If you're a GP and need to refer someone under the age of 65 please contact bhnt.op@nhs.net for advice on how to do this

Contact details for GP to discuss referral 

Telephone: Call 0207 377 7000 and ask for "Geriatrician of the Day" on 45799 available via switchboard at the Royal London Hospital. This is available Mon-Fri 9am-5pm and Sat and Sun 9am-3pm  

Email: Through Advice and Guidance E-referral service 

Rapid Response Team

The team provides urgent assessment, treatment and care within the person’s home to prevent ED (emergency department) attendance and/or hospital admission.

Hours: 8:00 to 20:00 (7 days a week, including bank holidays). 

Please take a listen to our podcast episode that highlights the work of the Rapid Response Team.

Our Referral Criteria

• Over 18 years old
• Resident in Tower Hamlets
• Acute illness or delirium
• Acute palliative care needs
• Exacerbation of behaviour or psychological symptoms of dementia   
• In crisis requiring intervention within 2 hours to stay safely at home/usual place of residence and avoid admission to an acute hospital

How GP can make a referral

Telephone: 07710 066161 calls to discuss first then:

• Once discussed with the team and accepted GP can refer through EMIS
• Use the template 'Single Point of Access Referral Form' and complete relevant sections.
• Save the consultation then the document named CHS SPA (Adult) referral form TH CEG will automatically open.
• Select the service and the rest of the form will be populated automatically.
• Save and close the document and send via Accurx Accumail to thgpcg.spa@nhs.net 

Important: If you are unable to make contact with us please call SPA on 0300 033 5000.

The Respiratory Virtual Ward is a consultant-led, multidisciplinary team of specialist respiratory practitioners—nurses, therapists and support workers. It provides safe, specialist respiratory care at home as an alternative to hospital admission for patients with acute respiratory infections and underlying chronic respiratory diseases such as COPD, ILD and Bronchiectasis. The service is part of Adult Respiratory Care and Rehabilitation (ARCARE) within Barts Health.

Patients are monitored through remote-monitoring technology, virtual or telephone reviews, and home visits when needed. The team can deliver home nebulisation, chest physiotherapy, medicines optimisation, community prescribing (antibiotics, oral steroids, inhalers), intravenous antibiotics (with the OPAT team), point-of-care testing, oxygen weaning after hospital discharge and other acute respiratory treatments. The service cannot initiate oxygen acutely in the community; patients with new or acute desaturation must attend ED.

The service operates 8am–6pm, seven days a week.

How to Refer - GPs can refer via the ARCARE Triage phone (07983 177719) followed by an email to bhnt.arcare@nhs.net, or through the Single Point of Access (CHS Referral) via EMIS.

Referral criteria include Tower Hamlets - Registered Adults (18+) with acute respiratory infection on a background of COPD, ILD or Bronchiectasis.

Exclusion criteria include the following:

• Signs of sepsis or severe deterioration
• Acute Asthma (must be seen in ED first),
• Symptoms not due to respiratory exacerbation,
• Residence outside Tower Hamlets,
• Unmet social or care needs,
• End-of-life care needs. 

For further queries, contact 07983 177719 or bhnt.arcare@nhs.net 

The Tower Hamlets Virtual Frailty Ward is a geriatrician-led, multi-professional team of Frailty Practitioners (from a nursing and therapy background), GP’s and Geriatrician’s.

Patients receive regular contact and monitoring of condition and symptoms by allocated health care professional, a daily virtual ward round and twice weekly MDT with consultant geriatrician. Interventions provided by the service include assessment and observation including Comprehensive Geriatric Assessment, therapeutic interventions, diagnostics including blood tests and imaging and onward referrals as appropriate.

The service operates between 9am - 5pm – 7 days a week

How GP can refer – Referrals via email to bartshealth.thfrailtyvw@nhs.net or via phone to 07729046924

Referral Criteria - Tower Hamlets registered patients over 65 years old living with frailty (typically Rockwood Clinical Frailty Score ≥ 5)

Focussed (but not solely) on patients with a history of frailty syndromes including:

• Falls
• Decreased Mobility
• Delirium
• Continence Issues
• Polypharmacy

Contact number/email for GP to discuss referrals - bartshealth.thfrailtyvw@nhs.net or 07729046924

Download the poster

Please visit the Barts Health Community Respiratory website page for further information.

Our service provider will no longer be with Whizz Mobility and we won't be based in Mile End Hospital. From the 1st of July the new provider will be with North East London Wheelchair Service - AJM Healthcare - Unit 18, The Io Centre, 59-71 River Road, Barking IG11 0DR.

For further information regarding referrals and assessments please view the link below it will have the details:

NHS North East London Wheelchair Service | Referrals & Assessments | AJM Healthcare

The current telephone number will not be in use from the 1st of July please contact us on: 0808 169 1040 - North East London Wheelchair Service - AJM Healthcare

You can still send us any questions/queries through this email address: Wheelchairservice1@nhs.net 

Criteria and self referral information here 

The support offered by the NMHTs ranges from professional input directly from NMHT staff (similar to the erstwhile Community Mental health teams or CMHTs e.g. for Serious Mental Illness) to those offered within primary care e.g. via ARRS (Additional Roles Reimbursement Scheme) Mental Health Practitioners and Primary Care Nurses.

The offer includes access to a multidisciplinary team assessment, brief treatment and longer-term complex care in order to meet peoples’ recovery goals. 

This may also include signposting (working closely with voluntary sector partners, local authorities, substance misuse services etc.) and ongoing referrals to specialist mental health services (e.g. Older Adults mental health services, Early Intervention psychosis, Perinatal psychiatry, etc.) or clinics (e.g. for Neurodiversity assessments) or other resources e.g. therapy (e.g. Complex Emotional Needs) or educational or self-help groups (Disordered Eating).

Please take any queries first to the ARRS (Additional Roles Reimbursement Scheme) mental health nurse who covers your GP surgery. If the issue needs to be escalated further they will contact the relevant operational lead.

A full list of contact emails for the neighbourhood teams can be found below:

Isle of Dogs: elft.isleofdogs@nhs.net 

Stepney & Wapping: Elft.cmhtstepneywapping@nhs.net 

Bethnal Green PCN1 (Barnsley Street): elft.bethnalgreencmhtreferrals@nhs.net 

Bethnal Green PCN2: elft.bethnalgreencmhtreferrals@nhs.net 

Bow & Poplar: elft.bow-poplar-newreferrals@nhs.net 

CMHT Older People: elft.thmhcopdutyemail@nhs.net 

Diagnostic Memory Clinic: elft.dmcreferralscreening@nhs.net 

Tower Hamlets Crisis Assessment Team
Response within 4 hours of referral for an urgent mental health assessment which does not require the urgency of A&E
Tel. 0207 771 5811
Email: elft.nel111-cat@nhs.net  

Direct referrals can be made to specialist community teams - Perinatal Mental Health Team, Early Intervention Service and Autism Service using the relevant separate referral form on Resource Publisher, EMIS:

Visit the Tower Hamlets Talking Therapies website.

Talking Therapies is an NHS Primary care service based in Tower Hamlets that offers talking therapies to individuals aged 18 and over with common mental health conditions. We offer a range of therapeutic interventions including workshops, groups and individual therapy.

Our referral criteria: 

• Aged 18 years and over 
• Living in Tower Hamlets +/ GP registered in Tower Hamlets 
• Risk to self and others is low and can be contained within the Primary Care level. 
• Mental Health This includes Depression, Anxiety, Panic Disorder, Phobias, Single Incident Post Traumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD), Loss and Bereavement and Relational difficulties. Clusters 1-4. Patients experiencing “Common Mental Health Problems”, with mild to moderate complexity. (Steps 0-3, National Institute for Health and Care Excellence (NICE) Guidance, 2011, www.nice.org.uk/guidance/cg123/chapter/1-guidance).  

How GPs can make a referral:

• Refer via EMIS (Education Management Information System) 
• Complete the professional referral form which can be found at: www.elft.nhs.uk/tower-hamlets-talking-therapies/get-started

Please take a look at our website: www.elft.nhs.uk/tower-hamlets-talking-therapies to make a referral and get information on the services we provide 

Email address for enquiries: elft.thtalkingtherapies@nhs.net 

• Contact number: 0208 175 1770
• Opening times: Monday – Friday 9:00am to 5:00pm