Information
IMPACT: IMProved Anticipatory Care and Treatment
An Edinburgh based nurse-led Community Long Term Condition team, who support patient and carers with self-management and reduce unnecessary hospital admissions.
The team
- Comprises of one Lead Specialist Practitioner District Nurse, four Community Nurse Practitioners and four Community Staff Nurses.
- Works across the 4 localities of the City of Edinburgh
- Operates 7 days 365 days/ year – 08.00-16.30 hrs
We aim to respond within two to three weeks of referral
Contact details:
IMPACT team contact number: 0131 537 9254
Referrals can also be made via SCI Gateway: Astley Ainslie Hospital>Anticipatory Care>LI IMPACT
The IMPACT Service aims to support people with Long Term Conditions, their families and carers. Our focus is to work with patients and carers on symptom recognition, management of exacerbation or decompensation, and prevention of avoidable hospital admissions.
The main conditions include-:
- COPD
- Bronchiectasis
- Pulmonary Fibrosis
- End stage Heart Failure
- Increasing frailty with existing Long-Term conditions
IMPACT supports patients and carers to understand their long-term conditions in order to optimise good health and wellbeing, make achievable lifestyle changes and improve medication concordance.
Any health professional may refer to IMPACT. All referrals will be reviewed prior to acceptance
Please ensure the patient has consented to the referral.
BC & JD 22/09/2025
Information to include with referral:
From acute services: hospital discharge letter with medication or IMPACT referral form
Who to refer:
Patients must
- Be registered with an Edinburgh GP and reside in Edinburgh
- Be aged over 16 years
- Have one or more long term condition that includes a respiratory or cardiac condition
- Be willing to engage with the service, or have someone able to engage on their behalf
Patients must also meet at least 2 of the following criteria
- 2 or more hospital admissions related to a respiratory or cardiac long-term condition in the past 12 months
- 2 or more A&E attendances related to a respiratory or cardiac long-term condition in the past 12 months
- Multiple recent exacerbations of a cardiac or respiratory condition not requiring either of the above
Who not to refer:
- Unwilling or unable to engage with IMPACT
- Where patients are approaching end of life care they should already be known to their district nursing team. IMPACT will be happy to work collaboratively/ advise after discussion with GP/ District Nurse.
- Patients who have a qualifying long-term condition and are actively under the care of Mental Health, Alcohol or Substance Misuse services may require complex collaborative working.
- Patients who have a mental health condition as their only LTC.
How to Refer:
From community services: Via SCI Gateway Astley Ainslie Hospital>Anticipatory Care>LI IMPACT
For services unable to access the above, complete: IMPACT referral form and email to loth.impactclinical@nhs.scot
NHS Inform. Future Care Planning – https://www.nhsinform.scot/care-support-and-rights/decisions-about-care/future-care-planning
TURAS Learn: Realistic Medicine – Having Realistic Conversations https://learn.nes.nhs.scot/60442
