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

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
Adult Social care is about giving advice and support to people who may need help because of their age, an illness, a disability or learning difficulty. It enables people to live as independently as possible at home or in the community by providing people with information about available services or assessing their needs and recommending the most appropriate support required.

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

Age UK Sunderland
Age UK Sunderland offers a wide range of services for older people ranging from advice; and social activities to personal aids and appliances transport.  The charity is also a key partners in All Together Better (Vanguard new care model) with front line ‘Living Well Links’ workers and Hospital Discharge workers working hand in hand with health and social care staff and Sunderland Carers Centre. Call: 0191 514 1131 General / 0191 500 5004 Web:
The team need a Malnutrition Universal Screening Tool (MUST) score. To determine this, please use the following documents:
MUST scoring
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.

Geriatrician (community-based)
Specialist care to proactively manage frail and elderly patients in their own home or care home, including medical conditions; mental health issues; nutritional status review; pressure care; falls and continence.

Referral form:
Download Word document: Community Geriatric team referral
Open pdf: Community Geriatric team referral pdf

Fax: 0191 541 0552. Hot bleep: 0191 5656256 bleep 51080 Mon-Fri 8.30am – 4.30pm Email:

Information sharing - patient opt out form
This form is for use by GP practices.  It is for people who do not want their information held by GPs shared with community health teams via EMIS web.  Please provide the patient with two copies to sign.  One is held for your records and the other is handed to the patient to keep.

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


Mental Health
The Initial Response Team The team supports people to access the right to help to resolve their current difficulties. The team provides practical advice, emotional support from qualified nursing staff and when appropriate, routing to the right service. They provide specialist advice urgently – including for those not formally diagnosed with a mental health problem. For advice or to refer, call: 0303 123 1145

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: 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:

Occupational Therapy
The council employs Occupational Therapists and Therapy Assistants and Independent Living Officers to work with adults and children who have disabilities in order to help them to find ways of living independently within their own homes. The support you can expect to receive includes: Information, advice and guidance, assistance to access specialist equipment, assistance to apply for a Disabled Facilities Grant in order to adapt then environment within your home, provision of a programme of rehabilitation in order to help you gain or regain the skills that will help you live independently, support to apply for re-housing with a Registered Social Landlord, support to leave hospital following a period of illness or trauma.

Patients / Clients can be referred via self-referral or clinician referral, by ringing 0191 520 5552 or sending an email to

Patient Centred Health and Social Care Plan Held by Patient
This form is to be used when, in the exceptional circumstance where a core member of an MDT is not able to attend, prepared information must be recorded on the relevant section of the Person Centred Health and Social Care Plan and sent to the MDT coordinator to be presented at the MDT in their absence. If possible, core member should arrange for cover/deputies who they feel can attend the meeting on their behalf.

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

There are a number of pharmacists working across Sunderland carrying out the medication review work, with a named pharmacist for each locality. There are also pharmacy technicians in each locality, who will identify hospital discharge patients and new admissions to care homes, carrying out waste audits and completing necessary reports. You can email the team with medication queries and if you provide an email address they can send discharge information direct to your practice or care home.

Email: For urgent queries you can contact your locality pharmacist: North: East: West: Washington: Coalfields:

All CIT staff can refer to physiotherapy / MSK service by filling in this form:
Download Word document: Referral Form MSK Physio
Open pdf: Referral Form MSK Physio pdf

Complete and fax to: 0191 541 0502.

GPs should refer via Choose and Book. Other staff can refer by downloading and completing the form:
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
Recovery at home is a 24/7 single point of contact service providing, doctors; nurses; social-workers; carers and other health professionals (like pharmacists and therapists); reablement and occupational therapy staff.  They also provide access to two community bed units – Houghton ICAR unit and Farnborough Court Rehabilitation Unit. Call: 0191 561 6666

Speech and Language
All CIT staff and care home staff can refer into the speech and language department by downloading and completing this form:
Download Word document: Communication Assessment Tool
Open pdf: Communication Assessment Tool pdf

For swallowing problems referral, download and complete this form:
Download Word document: Swallowing Assessment Tool
Open pdf: Swallowing Assessment Tool pdf

Both can be completed and faxed to 0191 569 9790.

Sunderland Carers' Centre
Sunderland Carers’ Centre can provide information and advice to carers to help them in their caring role.  As everyone’s caring situation is different, they can give carers information relevant to their particular needs. This may be information about a specific illness or condition or information about local services available for both carer and the person they care for.

All CIT / care home staff can refer via this form:
Download Word document: Carer Referral Form
Open pdf: Carer Referral Form pdf

Patients, families and carers can self-referral: Call: 0191 549 3768 Email: