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Referral
Falls/Sudden change in mobility
This clinical referral guideline is for GPs and Allied Healthcare Practitioners who are considering a referral to the strength and balance (S&B) 12-week programme that is available to patients who meet the Falls criteria below.
The Strength and Balance (S&B) 12 week programme is back running as face to face groups, government restrictions allowing, in a variety of towns across Torbay and South Devon. It consists of an initial group assessment, regular structured home exercising then a follow up group assessment. Attendance at the group sessions is a requirement of participation
The aims of this S&B service is to improve strength and balance thus reducing falls risk and improving confidence. Please only directly refer patients who are able to stand to exercise, using a chair for support. See table below for other referral options. Please note Community health & social care teams will refer to the S&B programme once the patient is appropriate. (i.e. following rehab). Please see form for guidance of what information is really helpful, but a dictated letter is acceptable. Postural BP drop is a common contributor to falls and often missed. So wherever possible please check and record a lying and standing BP prior to referral.
See the RCPEguidance on how to do a lying and standing blood pressure assessments
Falls Assessment levels including prevention -
| How patient presents | Clinical Frailty Score * | What to do | Where to refer | |
| Pre-frail | Lacking confidence but able to stand | 1-3 | Consider medical cause & assess cognition/mood Arrange investigations if needed | Refer to S&B using e-referral form(embedded in EMIS/Systm 1) OR - Dictate a letter including patient summary Send to Healthy Lifestyles team OR patient self-refers by phoning Healthy Lifestyles - 0300 456 1006. This is available for Torbay AND South Devon patients |
| Mild frail | Mobility declining | 3-4 | As above Likely to need home equipment/fuller mobility assessment | Community health & social care team referral
By telephone if urgent. By email or electronic form EMIS/Systm 1 Consider Intermediate Care referral if at risk of admission |
| Moderately Frail | Already falling At risk of more falls | 4-5 | Medical assessment including lying/standing BP, cognitive assessment, de-prescribing, bloods Refer for investigations if indicated/ appropriate | Community health & social care team referral
By telephone if urgent. By email or electronic form EMIS/Systm 1 Consider Intermediate Care referral if at risk of admission |
| Patient declining in mobility and/or strength | Concerns re maintaining independence and at high risk of falls | 5+ | Medical assessment in Primary Care including lying/standingBP, cognitive assessment, de-prescribing, bloods Refer for investigations if indicated/appropriate | Community health & social care team referral
By telephone if urgent. By email or electronic form EMIS/Systm 1 Consider Intermediate Care referral if at risk of admission |
| MSK or joint-specific issues | Patient self-referral to MSK physio | 0300 456 9987 |
Please follow this link for more helpful information regarding early intervention of Falls and Frailty
Where possible please use the Rockwood Clinical Frailty Scale (CFS) to score patient’s frailty and please follow this link to view a quick reference guide on how to effectively use the Rockwood Clinical Frailty Scale (CFS).
Please consider hydration or medication that may contribute to falls. Follow this link for further useful information.
For easy use, please use the CFS App, available to download (Free) onto smart phones.
A training and learning module is also available to help with the understanding, assessment and management of Frailty and can be viewed here.
For urgent advice regarding Healthcare of the elderly/frailty, please telephone 07900 34 34 39
To refer to Strength and Balance programme
Refer to S&B using e-referral form(embedded in EMIS/Systm 1)
OR - Dictate a letter including patient summary
Send to Healthy Lifestyles team
OR patient self-refers by phoning Healthy Lifestyles - 0300 456 1006. This is available for Torbay AND South Devon patients
Patients referred to the S&B programme do not have a medical review as part of their assessment.
To refer to community health & social care team referral
By telephone if urgent. Consider Intermediate Care referral if concerned about risk of hospital admission.
By email or electronic form EMIS/Systm 1
Consider Intermediate Care referral if at risk of admission
To refer to Healthcare of the Older Person team
Attendees to the Strength and Balance programme do not have a medical review
Wherever possible, undertake lying and standing Blood Pressures, history, examination and medication review in Primary Care.
If consultant medical review is required, please send an e-referral to Healthcare of the Older Person. If urgent, email them via tsdft.hop@nhs.net
Pathway Group
This guideline has been signed off on behalf of NHS Devon.
Publication date: February 21
Last updated: February 22
Pathway Group
This guideline has been signed off on behalf of NHS Devon CCG.
Publication date: February 21
