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MoE West Lothian

Current services for Medicine for the Elderly in West Lothian

  • SCI gateway single point of contact referral for non-urgent
  • REACT for urgent 01506 524149
  • Referral should be based on patient’s postcode, not GP Practice
REACT Hospital at Home (H@H)Acutely unwell frail, older peopleAlternative to hospital admissionShort term (few days)Comprehensive geriatric assessment at home (inc care home) in the acutely decompensatedPhone call to REACT hub 01506 524149 if urgent (same day/next day) visit required – clinical conversation is usefulNot an alternative to a GP visit.SCI gateway referral if able to wait 2-3 days for assessment.
REACT Rehab (AHPs) AHPs only – physio and OTFull assessment at home (inc care home for physio) Phone call to REACT hub (01506 524149) if urgent (same day/next day) visit requiredSCI gateway referralSt Johns Hospital > REACTH@H will often refer during/ on discharge from H@H
REACT Rapid Access ClinicWe triage to home visits, face to face clinic, and phone/video as appropriate. Please make clear if patient could physically come to clinic.We will refer to AHPs if neededSCI gateway referralSt Johns Hospital > REACT We aim to see within 2 weeks.  
Parkinson`s Disease clinic(see Parkinsons RefHelp guidance)PD patientsNew patients with ?PD / tremor etc.We triage to home visits, face to face clinic, and phone/video as appropriate.SCI gateway referralSt Johns Hospital > Geriatric Medicine 
Osteoporosis clinic(see Osteoporosis RefHelp guidance)No longer based in West LothianSCI gateway*All referrals now to Edinburgh rheumatology service*
General MOE clinicWe triage to home visits, face to face clinic, and phone/video as appropriate.SCI gateway referralSt Johns Hospital > Geriatric Medicine
Stroke/TIA clinic(see TIA And Stroke RefHelp guidance) Centralised stroke/ TIA hotline available for GPs to obtain immediate  advice and appointments organised- please see the RefHelp page 0131 536 1019
St Michael’s HospitalLinlithgowTippethill House Hospital, ArmadaleHospital Based Complex Clinical Care (HBCCC)Palliative care for West Lothian patients. *Please refer to community hospitals Pathway for referrals to community hospitals/ inclusion criteria (Please discuss with patient / family. Clear anticipatory planning / escalation of care conversation needed before referral.Patient not for transfer to acute sector for diagnostics/interventionNot requiring daily specialist consultant palliative care input) Weekdays 9am-6pmIf community hospital admission required, please refer to REACT 01506 524149 stating that assessment required for admission.REACT will assess if appropriate.  
  • Frail older people in need of secondary care assessment
  • Single point of contact – SCI referral for all but urgent (triaged daily)
  • Same day / next day urgent assessment should be via REACT H@H and discussed with REACT coordinator (i.e. referral is to avoid hospital admission)
  • Geriatrician is available for advice via above
  • Please include question to be answered and if possible rockwood_cfs clinical frailty score (or equivalent assessment of frailty) as this helps us to triage to correct service.

Who to refer:

Appropriate referrals for REACT/rapid access/general MOE clinic (equivalent) assessment (excl stroke and PD):

  • Falls, frailty syndromes including dizziness
  • Weight loss in frail older patients
  • Multiple/complex symptoms in frail
  • Single symptom suggestive of malignancy if frail (consider if single organ specialty referral more appropriate especially if clinical frailty score <4)

Who not to refer:

  • Weight loss in non-frail patients (ie clinical frailty score <4) – should be referred to General Medicine in West Lothian
  • Iron deficiency anaemia (single issue) – should be referred to GI in West Lothian
  • Memory loss only – should be referred to Memory Clinic / Old Age Psychiatry in West Lothian
  • Polypharmacy reviews – Integrated Care Pharmacists in GPs can help with this
  • Incontinence – consider continence nurse / DN referral
  • End of life support – palliative care team (REACT if considering admission to community hospital)
  • Care home support – West Lothian Care Home Liaison Team, WelPAT.
  • ALL the above do not preclude the referral being appropriate – clinical judgment is required. We are more than happy to discuss referrals/give advice. 

Primary Care Management / Pre-referral work-up / Information needed

  • Please see also specific guidance for each condition; FallsWeight LossDizziness.aspxDeliriumParkinsons disease
  • Bloods – FBC, U&E, LFTs, calcium, TFTs, B12/folate +/- iron studies and ferritin for all clinic referrals.
  • E&S BPs if referring for Falls
  • Meds have been reviewed (at least initially)

Information needed:

  • Some indication of frailty – functional status/baseline and POC/family support is most helpful. Clinical frailty score also helpful.
  • What is the aim of referral and what are the patient and family’s expectations. (i.e. if frail patient not for investigations of possible malignancy – what is it that is hoped the referral will achieve?)

Alternatives to referral / advice

  • Email and/or phone advice always available
  • Telephone via REACT – coordinator initially – ask for consultant geriatrician if needed