Current services for Medicine for the Elderly in West Lothian
- SCI gateway single point of contact referral for non-urgent
- Hospital at Home for urgent medical/nursing input 01506 523173
- Referral should be based on patient’s postcode, not GP Practice
| Hospital at Home (H@H) | Acutely unwell frail, older people Alternative to hospital admission Short term (few days) Comprehensive geriatric assessment at home (inc care home) in the acutely decompensated | Phone call to H@H hub 01506 523173 or mobile 07811710633 if urgent (same day/next day) visit required – clinical conversation is useful. Not an alternative to a GP visit. |
| AHP | AHPs only – physio and OT Full assessment at home | Through the IAP (Integrated Access Point): Urgent Hospital admission avoidance: Phone 01506 523124 or Email: loth.wlcommunityspoc@nhs.scot Routine Referrals: referral via SCI gateway referral St John’s Hospital > Geriatric Medicine > LI Rapid Elderly Assess -REACT |
| Rapid Access Clinic | We triage to home visits or face to face clinic as appropriate. Please make clear if patient could physically come to clinic. We will refer to AHPs if needed | SCI gateway referral St John’s Hospital > Geriatric Medicine > LI Rapid Elderly Assess -REACT We aim to see as soon as possible |
| Parkinson’s Disease clinic (see Parkinson’s RefHelp guidance) | PD patients New patients with ?PD / tremor etc. We triage to home visits or clinic, as appropriate | SCI gateway referral St John’s Hospital > Geriatric Medicine > LI WL Geriatric Medicine Young onset Parkinsons, tremor without any other Parkinsonian features should be referred to Neurology |
| Osteoporosis clinic (see Osteoporosis RefHelp guidance) | No longer based in West Lothian | *All referrals now to Edinburgh rheumatology service* |
| General MOE clinic | We triage to home visits, face to face clinic, and phone/video as appropriate | SCI gateway referral St John’s Hospital > Geriatric Medicine > LI WL Geriatric Medicine |
| Stroke/TIA clinic (see Stroke RefHelp guidance) | Centralised stroke/ TIA hotline available for GPs to obtain immediate advice and appointments organised- please see the RefHelp page Transient Ischaemic Attack (TIA) And Stroke In Hours: For Stroke/TIA Hotline contact please see: Secure Content | |
| Tippethill House Hospital, Armadale | Hospital Based Complex Clinical Care (HBCCC) Palliative care for West Lothian patients. *Please refer to community hospitals pathway first for exclusion / inclusion criteria.* | If community hospital admission required, please refer to Hospital at Home 01506 523173. We will assess if appropriate. Clear anticipatory care planning and treatment escalation plan discussion with patient and family needed before referral, especially regarding appropriateness of diagnostics/intervention and transfer to acute site. |
L.M & J.B – 12-06-26
- Frail older people in need of secondary care assessment
- Single point of contact – SCI referral for all except urgent (triaged daily)
- Same day / next day urgent assessment should be via H@H and discussed with H@H 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 clinical frailty score (or equivalent assessment of frailty) as this helps us to triage to correct service.
Who to refer:
Appropriate referrals for rapid access/general MOE clinic 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 (i.e. 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 Bladder and Bowel Service (BABS) / DN referral
- End of life support – palliative care team (H@H if considering admission to community hospital)
- Care home support – DN team leads via IAP, 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; falls, weight loss, dizziness, delirium, Parkinsons 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. If frail patient not fit for investigations of possible malignancy – what is it that is hoped the referral will achieve?
Alternatives to referral / advice
- Telephone via H@H – coordinator initially – ask for consultant geriatrician if needed
- Email and/or phone advice always available
