REMEDY : BNSSG referral pathways

Nursing Services - Bristol

Checked: 07-11-2018 by vicky.ryan Next Review: 25-10-2019

Community Nursing Healthcare Teams - Bristol Community Health

Community Nursing Teams - Bristol Community Health

Please note that this service is only available to housebound patients who are over 18 years old and registered with a GP in the Bristol area.

Bristol Community Health's dedicated community nursing teams provide healthcare and support to housebound patients in their home 7 days a week, between 8am and 7pm.

Community nursing teams provide a wide range of care and support:

  • coordinating care for patients with long term conditions or complex health needs

  • administering medication

  • dressing and managing wounds

  • caring for patients after surgery

  • supporting issues around continence

  • caring at end of life.

The teams work in partnership with local healthcare professionals – for example GPs and other specialist Bristol Community Health services – to improve the health and independence of local patients.

By actively supporting those with long term conditions to manage their conditions in the comfort of their own home, the community nurses help to prevent hospital admissions.

 

Referral Guidance - Community Healthcare Teams

To get in touch with the Community Nursing Team, contact the Single Point of Access (SPA) number 0117 9030202 - number for HCPs

Contacting a specific Community Nursing Team Once you’ve made a referral with Bristol Community Health through SPA you can speak directly to a specific Community Nursing Team about a patient on their caseload — using the ‘Community Nursing Patient Allocation’ tool to identify which team you need to speak to.  Team Coordinators have oversight of each team's caseload and they are the best people to answer any queries you may have. You can speak to Team Coordinators Monday to Friday 8am - 7pm, to discuss a patient on their caseload. These numbers are:

  • Shirehampton Community Nursing Team: 07796 337875

  • Horfield Community Nursing Team: 07767 653285

  • East Trees Community Nursing Team: 07900 264389

  • Fishponds Community Nursing Team: 07554 770616           

  • Knowle Community Nursing Team: 07899 065459           

  • Amelia Nutt Community Nursing Team: 07786 023386

(Please note: these numbers are for professional use only and should not be given to patients.)

All other referrals to Rapid Response, Out of Hours Nursing, Urgent Therapy and COPD admission avoidance should be made in the usual way – by phoning the SPA on 0117 903 0202.

Any new community nursing referrals that are deemed urgent (where a visit is required within 24 hours) must be made by phoning the SPA on 0117 903 0202.

If the visit is not urgent, you should make a referral through managed referrals on EMIS. If your practice has not been configured to do this yet, a new referral form must be filled in and emailed to briscomhealth.spa@nhs.net.

Referrals should be made using the Community Nursing Non Urgent Referral Form (word doc).

Please ensure you have made contact with their informatics team as soon as possible so they can properly configure your practice to receive managed referrals through EMIS.

To arrange this, please email baljit.chahal@nhs.net

For more information about Community Nursing and how to refer please click here.  

Community Discharge Coordination Centre - Bristol Community Health

The Community Discharge Co-ordination Centre (CDCC) is the single point of referral for all Community rehabilitation and Therapy Services. This includes the Community Therapy Team, Specialist Community neurology Service and Community Rehabilitation Beds.

The CDCC consists of a large administration team, case-manager (trained clinicians including physiotherapists, occupational therapists, nurses) and social care practitioners.

What does this service offer?

The CDCC manages all referrals for patient who require a period of rehabilitation and therapy, this could be provided in the home environment or within a community rehabilitation bed (residential facility).

Who is this service for?

Patients must adhere to the following criteria:

  • aged 18 or over,
  • registered with a Bristol GP and a Bristol resident,
  • requires multi-disciplinary rehabilitation service in the community. Please note that rehabilitation may take place in a number of settings, including rehabilitation centres (provide residential recovery and rehabilitation support for short periods), community rehab beds (provide nursing and some therapy support within a nursing home care setting), or via rehabilitation teams (provide rehabilitation in the patient’s place of residence).

Please see the Bristol Community Health - Community Discharge Coordination Centre website for further information

Referral Guidance - CDCC

Planned referrals for re-ablement, rehabilitation, or to facilitate hospital discharge or prevention of admission to long term care;

  • referrals are accepted from GPs, hospital staff and other health and social care professionals via telephone or emailed referral forms.

  • referral line 0117 342 6667 between Monday and Friday 8am to 5pm (answerphone available outside office hours).

For patients who do not require a service on the day of discharge, you can also download a referral form which can then be emailed to Briscomhealth.cdccreferrals@nhs.net

Palliative Care Home Support - Bristol Community Health

This service is available to patients registered with a GP in the Bristol OR South Gloucestershire area.

The Bristol Community Health Palliative Care Home Support Service (PCHS), work with other healthcare professionals to offer care and support at the end of life. The service is led by clinicians with many years of experience in caring for people at this time of life. The team is based as Avonmouth but care is carried out in patient homes.

For further details please see the website.

Referral Guidance - Palliative Care Home Support

Referrals should be made using the Palliative Care Referral Form (word doc).

If you would like to talk to us about the referral please call 0117 982 8315 for PCHS Bristol or, for PCHS South Gloucestershire only, call 0117 982 8545.

Wound Care

This service is only available to patients registered with a GP in the Bristol area.

The Bristol Community Health Wound Care Service supports patients with non-healing or slow to heal wounds. The specialist nurses support patients and healthcare staff with any type of wound that requires advanced medical attention, including trauma wounds, surgical wounds, leg ulcers and pressure ulcers. Assessments take place within a patient's home, with a practice nurse or within a clinic. Following this a treatment plan is drawn up and shared with the practice nurse or community nurse, who will then undertake the care.

The team also runs a pressure ulcer prevention project in order to advise and work with patients to prevent pressure ulcers developing.

Please access the Bristol Community Health - Wound Care website for more information on the service and on how to refer. There is a link to the referral form on this page.