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Information for our GP teams about Adult Community Health Services and Mental Health Services.
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
How GP can make a referral
Telephone: 07710 066161 calls to discuss first then:
Important: If you are unable to make contact with us please call SPA on 0300 033 5000.
The team includes a senior nurse and therapist who will pick up patients between 0800 and 2000 who have fallen at home. Following clinical triage, a response in made within 30 - 60 minutes.
Our Referral Criteria
Exclusion Criteria
How GP can make or discuss a referral
Phone: 07710 066161
Important: If you are unable to make contact with us please call SPA on 0300 033 5000
Patients can also self refer by calling NHS 111
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:
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
Exclusion Criteria
How GP can make a referral
Pad Prescription Only Required:
Contact details to discuss a referral
Important: If you are unable to make contact with us please call SPA on 0300 033 5000.
Our opening times are:
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
Exclusion Criteria
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
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
How GP can make a referral
Contact details for GP to discuss referral
Patients can self-refer to this service through this email or telephone contact
Our Referral Criteria
How GP can make a referral
Contact details for GP to discuss referral
Phone: 0300 033 5000 and request for a call to pass to Triage and Assessment Team
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.
Our Referral Criteria
*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
Contact details for GP to discuss referral
Phone: 0300 033 5000 and request for a call to pass to Triage and Assessment Team
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
How GP can make a routine referral
How GP can make or discuss an urgent referral
Contact details for GP to discuss routine referral
| Locality | MH staff |
| North East | Daniel Tanganyika daniel.tanganyika@nhs.net 07966 067 732 |
| North West | Tracy Humphries tracy.humphries@nhs.net 07584 387 083 |
| South East | Juliet Usiade Juliet.usiade@nhs.net 07931 862 136 |
| South west | Esther Adenekan esther.adenekan2@nhs.net 07855 342 720 |
| Rapid response | Folu - Tuesday and Thursdays only foluketaiwo@nhs.net 07824 836 828 |
The team provides comprehensive Occupational Therapy assessment, treatment and care within the person's home to improve their ability to do everyday tasks. This can include offering strategies and/or functional aids.
Hours: 9am to 5pm (Monday to Friday)
Our Referral Criteria
Exclusion Criteria
How GP can make a referral
Use the template (RP) Single Point of Access CHS Referral TH CEG v12 and complete relevant sections
Save the consultation then the document named CHS SPA (Adult) referral form TH CEG (RP) v5 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 Triage and Assessment team. Please discuss this with the triage therapist on duty.
Email: elft.triageandassessment@nhs.net
The team provides comprehensive physiotherapy assessment, treatment and care within the home to improve physical health and wellbeing through movement and exercise
Hours: 9am - 5pm (Monday to Friday)
Our Referral Criteria
Exclusion criteria
How GP can make a referral
Use the template (RP) Single Point of Access CHS Referral TH CEG v12 and complete relevant sections
Save the consultation then the document named CHS SPA (Adult) referral form TH CEG (RP) v5 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 requests for call to pass to Triage and Assessment Team. Please discuss referral queries with the triage therapist on duty.
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
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 (RP) Single Point of Access CHS Referral TH CEG v12 and complete relevant sections
Save the consultation then the document named CHS SPA (Adult) referral form TH CEG (RP) v5 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
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
How GP can make a routine referral
Use the template (RP) Single Point of Access CHS Referral TH CEG v12 and complete relevant sections
Save the consultation then the document named CHS SPA (Adult) referral form TH CEG (RP) v5 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
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
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
The Long COVID Service are a therapy-led service and their work with patients is primarily virtual.
The service will provide an initial assessment and then decide on the most appropriate therapy pathway. This may involve in-house therapeutic options or onward referral to other support services. Whilst the service has medical input, it is a therapy-led service and primarily staffed by Allied Health Professionals.
Listen to a podcast with our service lead and a patient here.
Our Referral Criteria
How GP can make a referral
Referrals are accepted from the GP only and need to be sent via EMIS/Email using the Long COVID referral form
Contact details for GP to discuss referral
Telephone: 0207 909 3676
Email: longcovid.elft@nhs.net
The community health services below are managed by Barts Health NHS Trust Community Services
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:
Contact number/email for GP to discuss referrals - bartshealth.thfrailtyvw@nhs.net or 07729046924
Please visit the Barts Health Community Respiratory website page for further information.
Whizz-Mobility are commissioned to run the NHS wheelchair service based in Mile End Hospital. Our clinical team includes occupational therapists, a technician, therapy assistant and administrators.
Hours : 9am - 5pm Monday to Friday
Our Referral Criteria
How GP can make a referral
The four Neighbourhood Mental Health Teams (NMHT) provide mental health care in close collaboration with primary care.
Referrals continue to be accepted via the electronic Single Referral form to ELFT Adult and Older Adult Mental Health Services on Resource Publisher, EMIS. GPs can refer or seek advice via daily/weekly huddles with the wider MDT via Microsoft teams and the teams can be contacted via email or telephone.
Please note, in case of urgent care for mental health care in the community support is organised through the crisis pathway.
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).
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:
Perinatal Service
Autism Service
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:
How GPs can make a referral:
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
