Referral directory and forms
New information for GPs; health and social care teams; care home staff and other front-line staff
We are enhancing community-based services in Sunderland and below is a list of those you can refer patients or service-users to directly, yourself.
You may already know about and use some of them, others may be newly offered through our partners like Age UK Sunderland, the Trust’s community geriatricians service or the rapid response Recovery at Home team.
You don’t have to be a GP to refer you someone look after who might need these services, you can contact them yourself.
Just click on the service you are interested in (below) and more information, contact details and – where required – referral forms will appear.
We will continually update this section as new services are added. Please tell us if you would like to add a service you think is missing. Email email@example.com.
Some of the forms are available as Word documents and as PDF files.
Word Documents will be saved to your computer, these can be filled in on your computer and saved as a new file.
PDF files can be downloaded when opened, printed and then completed by hand.
Adult Social Care
This could include help within their own home with personal care, including bathing, toileting, dressing and general help with personal hygiene or to assist someone with getting up in a morning and going to bed in the evening. It may be that someone requires help with repairs and adaptations to make it easier for them to get about. If someone is no longer to live independently in their own home, there is a range of residential options to choose from to best suit their needs.
To contact a social worker; ask for a care plan or if you are worried someone is at risk, to refer a patient or someone you look after:
Call: 0191 520 5552 Email: to firstname.lastname@example.org
Age UK Sunderland
MUST flow chart
At present care home staff will need to contact a GP or other team member such as your linked Care Home District Nurse to request a referral to dietetics. GPs can download and complete a referral form here:
Download Word document: Dietetic Services Referral Form
Open pdf: Dietetic Services Referral Form pdf
Other professionals and practice team staff can send/fax a written referral (above form or letter) with a MUST score attached to dietetic department City Hospitals Sunderland.
Fax: 0191 569 9276
Post to: Booked Admissions, 2nd Floor Trust Headquarters. Sunderland Royal Hospital, Kayll Road, Sunderland, Tyne & Wear, SR4 7TP.
Fax: 0191 541 0552. Hot bleep: 0191 5656256 bleep 51080 Mon-Fri 8.30am – 4.30pm Email: cis-tr.CHScommunitygeriatricservice@nhs.net
Information sharing - patient opt out form
The opt out process:
- When a patient asks to opt out of local sharing staff need to explain that they will be opting out of sharing with every healthcare professional that may be involved in their care.
- Staff can provide the patient with the opt out form (below) and an information sharing leaflet (or point them to the All Together Better website) and advise them to take it away to read it through.
- If they have read the form/leaflet and still wish to opt out then they have made an informed decision.
- The impact of opting out includes:
- Those treating them will not be able to access their GP record, even in an emergency
- It may lead to complications, such as being prescribed a medication that reacts poorly with one they are already taking which the clinician is unaware of
- It may increase the need to duplicate tests, such as blood tests or x-rays, because the treating clinician won’t have access to the patient’s latest results
- The patient may have to repeat their information numerous times if different people treat, or they may need to fill out more forms
- Treating clinicians can phone the practice and ask for the information to be sent via fax; if the practice is closed, this may lead to increased wait times
- It will also automatically stop their record being shared for any other local data sharing projects (for example, GP practice to practice sharing for extended opening hours)
You can download the form here: Info Sharing Opt Out Form
The Community Treatment Team This team provides specialised evidence based skilled interventions to people with moderate to critical mental health needs that maximise their potential for recovery. The team works with people who have severe and enduring mental illness that often results in complex health and social care needs. For advice or to refer, call: 0303 123 1145
Sunderland Psychological Wellbeing Service A city wide team providing quick access to assessment and a range of psychological treatment interventions to those people with common mental health problems who have a low to moderate level of need. Interventions are offered from a range of community venues across Sunderland. For advice or to refer, call: 0303 123 1145 You can also view a copy of the NTW leaflet here: Sunderland Psychological Wellbeing Referrers Leaflet
Older Peoples Mental Health Service The named Older Persons Mental Health Nurse can offer advice and care home visits. Call: 0303 123 1145
Essence Service for Dementia Patients The Essence Service is a new service managed by Age UK Sunderland to provide support and information for people recently diagnosed with dementia, and their carers, across all areas of the City of Sunderland. For GP or self referral: Call: 0191 522 1310 Email: email@example.com For more information, you can view the service’s leaflet: Essence Service Leaflet There are also some very good self-help leaflets available on the website: http://www.ntw.nhs.uk/pic/selfhelp/
Patients / Clients can be referred via self-referral or clinician referral, by ringing 0191 520 5552 or sending an email to firstname.lastname@example.org
Patient Centred Health and Social Care Plan Held by Patient
Person Centred Health and Social Care Plan Updated Version (editable Word document) Please note: the file will be downloaded into your ‘downloads’ folder and does not open automatically.
The Guide to Multidisciplinary Working is relevant to those attending an MDT meeting. There may be, at times, people who attend the MDT to observe and are not there as participating clinicians. It is vital, to protect patient confidentiality, that those attending these meetings sign and follow our code which is outlines in our Confidentiality Agreement here MDT Confidentiality Agreement
Email: NECSU.Intrahealthsunderlandintegratedcareteam@nhs.net For urgent queries you can contact your locality pharmacist: North: Katherine.Cox@intrahealth.co.uk East: Wendy.Duffy@intrahealth.co.uk West: Andrea.Mellenthin@intrahealth.co.uk Washington: Jenny.Carter@intrahealth.co.uk Coalfields: Lucy.Fleck@intrahealth.co.uk
Download Word document: Podiatry Referral Form
Open pdf: Podiatry Referral form pdf
Complete and fax to: 0191 5699211. Note: Home visits are available however, waiting times are not known at present. At this point, care home visits are not available direct.
Recovery At Home
Speech and Language
Download Word document: Communication Assessment Tool
Open pdf: Communication Assessment Tool pdf
Both can be completed and faxed to 0191 569 9790.
Sunderland Carers' Centre
Patients, families and carers can self-referral: Call: 0191 549 3768 Email: email@example.com