Shaping better health
REMEDY : BNSSG referral pathways


Checked: 01-10-2018 by vicky.ryan Next Review: 06-09-2019

Bristol Pathway

See the Integrated Strength and Balance Pathway for Bristol

This advises a tiered approach to falls management:

Tier 1 - Staying Steady run by Bristol City Council (self referral)

Tier 2 - Community Falls Service - Bristol Community Health

Tier 3 - Falls Clinic - Secondary Care


See also the  Falls Assessment Care Pathway (word doc) for guidance on the assessment of falls.

Tier 1 - Staying Steady

Staying Steady is a programme of strength and balance classes to help build strength and confidence and lower risk of falling. It forms tier 1 of the integrated strenght and balance pathway for Bristol.

There is a small cost for these classes.

Staying Steady classes are for people with: 
        - concerns about falling or avoiding activity due to concern about function/abilities
        - challenges with balance or walking
        - a risk of falling (low to moderate)
- Who are motivated to engage in strength and balance exercise
- Can sit to stand from a chair with or without use of arms AND independently walk around a chair
- Can independently get to a strength & balance class

Further information can be found on the Bristol City Council website.


Tier 2 - Bristol Community Health

This is the Tier 2 step of the falls pathway which can provide assessment in the community for patients registered with a Bristol GP who have already been screened for any unstable medical problems including a falls blood screen which involves thyroid, full blood count, electrolytes, liver function tests, calcium, glucose, vitamin B12 and folate.

If a falls risk assessment has already been completed in the last 12 months this should be reviewed for changes and outcomes before making further referrals.

From the 1st July 2018 if Bristol Community Health staff have considered a patient’s risk of falls this will be listed in the BCH EMIS summary page under active problems as “Falls risk assessment complete” together with the date of the assessment. The detail of the falls risk assessment template will be in the consultation for that date. This problem code will also appear in the Connecting Care record.

Multifactorial falls risk assessment and intervention is provided by all BCH services in day to day contact with older people using

  • a standardised assessment template which includes bone health and meets NICE guidance.
  • a pathway which signposts to more advanced assessment or the frailty pathway
  • the provision of individualised evidence based strength and balance exercises as needed

Please see the Bristol Community Health - Falls in older people website for more information regarding this service.

How to Refer

Referrals can be made through:

Patients with complex backgrounds including frailty should be considered for advanced comprehensive assessment which can be delivered by advanced practitioners within the community nursing and therapy teams or the Falls Specialist Nurse- for non urgent comprehensive assessment of complex patients at risk of recurrent falls. Referrals are accepted from health professionals by letter addressed to Falls specialist nurse; Knowle Clinic, Broadfield Road, Bristol, BS4 2UH, Tel 0117 9190290, Fax 0117 9190296

Please indicate what you hope to achieve from the assessment and ensure that the routine Falls Blood tests have been completed (thyroid, full blood count, electrolytes, liver function tests, calcium, glucose, vitamin B12 and folate ).

For further information contact Ruth Cowell, Falls Specialist Nurse Mobile: 07767 220 976


Falls Pathway - South Gloucestershire

Refer to the Falls Care Pathway for South Gloucestershire.  See also the Falls Risk Assessment.

Falls and Balance Service - Sirona

Service for adults registered with a GP in the South Gloucestershire area who have been identified as being at an increased risk of falling or who have had unexplained falls or black-outs.

Clinics are held at Cossham or Thornbury hospitals, Yate Health Centre or Patchway. Appointments take at least an hour.

Patients may be offered a short exercise and balance course which are run by our specialist physiotherapy team.

Referral Guidance - Falls and Balance Service

This service is for patients registered with a  South Gloucestershire GP practice.

This service is available by referral through GP referral or referral from another health professional.  Contact the service at:

Sirona Care and Health

Downend Clinic (Locality Office)

Buckingham Gardens,

Downend, Bristol

BS16 5TW​

 or by emailing ​

 Please attach/enclose the completed referral form

Secondary Care Assessment - NBT

The North Bristol Trust Falls Clinic for Older People is designed for patients who have fallen due to suspected syncope, patients with unexplained dizziness or who have recurrent falls where a cause has not been found despite performing a multi-factorial falls risk assessment, or patient is falling despite interventions put in place to manage risks. 

Referrers must first complete a Bristol Community Health Multi-factorial Risk Assessment Form (PDF).

Patients attending will receive a Comprehensive Geriatric Assessment by a consultant or Specialist registrar as well as having a review of bone health. If required, investigations will be arranged with results sent to the patient's GP with advice on further management.


-Patients who require physiotherapy / occupational therapy only.

-Patients who have already had a Hospital Medical Assessment of Falls in the last 24 months.


Please also see here for the Falls Assessment and Onward Referral form.

Referral to this NBT service can be made via eRS (General Older Person's Medicine and Falls Specialist Medical Assessment at Southmead or Cossham).

Secondary Care Assessment - UHB

UBHT Care of the Elderly Team has two options for patients with falls.

A Falls Service is available at the Day Assessment Unit in South Bristol Community Hospital. This service is provided for patients aged over 60 who have fallen and live within the UH Bristol catchment area. The service is provided by a multi-disciplinary team with specialist knowledge of falls management and includes a consultant, nurses, occupational therapists and physiotherapists with links to hearing and speech and language therapists if required. There is also access to diagnostic tests e.g. x-ray, bloods, ECG, ultrasound.

A Syncope clinic is also available at the BRI via eRS. This service is for patients with unexplained falls, dizziness and blackouts (including younger syncopal patients). Dr MacMahon, who runs this clinic, is also happy to take telephone queries: 0117 3426309.