Referral pathways for older people - Draft

Overview

Geriatric (Care of the Elderly) medicine clinics are available in BNSSG at NBT and UHBW. However the way these clinics are arranged differs between the 2 trusts. This can make it difficult to know how to appropriately manage patients who may have complex needs. The following page is a summary of options available in BNSSG although there may also be other locality and PCN based pathways that may also be considered.

Before Referral

Older patients may often have a combination of co-morbidities and social care needs. An individual and holistic assessment is required to direct patients to the most appropriate care and support.

There may be several options available within the community to support patients without needing referral to secondary care.

Please see the following pages that may be helpful:

• Live Longer Better - self care program for over 60's.
• Falls & Balance
• Frailty
• NHS@home - Frailty pathway
• Community Therapy
• Dementia - Assessment & referral
• End of Life Care and Hospice
• Social Prescribing
• Polypharmacy - link to BNSSG formulary resources to support review of polypharmacy in frail and/or  older patients.

Red Flags

Suspected malignancy

If you suspect a patient has malignancy and further investigation is considered appropriate then please investigate in the usual way and refer via the specific USC/2WW pathway.

Non-specific symptoms

For patients with non-specific symptoms where malignancy is suspected then please consider the Non-Specific Symptoms - USC (2WW) pathway. Please note that certain baseline investigations should be completed in primary care prior to referral.

Seconday Care Referral Options

Same Day advice/ admission avoidance 

If you wish to discuss a patient who needs same day advice or might need admission then there consider using community services or the NBT Geriatrician advice line - see then following pages:

• Frailty - Urgent Care or
• Frailty - ACE - Assessment for and Coordination for Emergency and urgent care
• Urgent Community Response - Sirona 

Urgent Assessment - RACOP clinics

Patients who are older and have complex co-morbidities who are deteriorating and particularly if they are at high risk of admission should be referred to RACOP clinics available at both trusts. Criteria and methods of accessing these clinics differ between the trusts. See the Rapid Assessment Clinic For Older People page for details. Waiting times for assessment are usually between 2-4 weeks.

Routine Assessment

If a routine referral is appropriate then there are several options available:

• Specialty clinics - Patients with specific symptoms should be initially investigated in primary care and then referred to the relevant specialty according the most likely underlying cause e.g. if cardiac condition suspected then refer to cardiology, if respiratory condition then refer to respiratory, if ENT condition the refer to ENT etc. Alternatively consider using relevant specialty Advice & Guidance services available via eRS.
• Movement Disorder clinics - Patients with movement disorders or suspected Parkinson's disease can be referred to the available clinics in either trust depending on age (60 and over for UHBW, 70 and over for NBT). Waiting times for these clinics is generally much quicker than for neurology outpatients. See the Parkinson's Disease page for details.
• Bone Health for Older People clinics - Patients aged 75 and over with osteoporosis who require further assessment / secondary fracture prevention can be referred to Bone Health for Older People clinics via eRS which are available in either trust. See the Osteoporosis page for details.
• Falls - There are no specific falls clinics in BNSSG. See the Falls & Balance for advice on appropriate steps if a patient is having falls or is at risk of falls.

   

General Geriatric clinics - including advice and guidance

NBT -  There are no general geriatric clinics available at NBT. Please consider the options listed above or consider using the Geriatric medicine A and G service (for patients aged 65 and above) for 'advice on handling general medical problems in frail, older persons.'

UHBW - There is a general geriatric RAS clinic at UHBW. Please consider the options listed above initially before submitting a referral to this service. Referrals will be triaged by a consultant and will either be returned with advice or booked into the most appropriate clinic.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.