Long term conditions

Falls and Mobility
Neurological conditions
Stroke
Vestibular

Patients with the above conditions requiring physiotherapy input will be seen by the Physiotherapy Long Term Conditions teams. These teams are based in the BGH and community localities.

Following assessment, patients will be given individually tailored interventions. Interventions may include, rehabilitation programmes, supported self-management, onward referral to third sector providers.

Who to refer, who not to refer, how to refer

Who to refer:

Patient must be aged 16 years or over

Patients are resident of Scottish Borders Council.

Older adults with falls / reduced mobility or function

Patients requiring Physiotherapy assessment and intervention for vestibular, stroke or neurological conditions

When to refer:

Patient has noted a change in their mobility or function

Recent Falls

Patient has identified person centred goals which physiotherapy can support

Who not to refer:

Patient under the age of 16.

Patients being seen by another service for the same reason

Patients who are not a resident of Scottish Borders Council

Patients who primarily have an MSK condition – refer to Physiotherapy MSK services

Patients with a chronic condition which will not change with physiotherapy intervention.

Who can refer:

All Health and social care professionals

How to refer:

Referrals will be accepted by letter, email or SCI Gateway.

Cheviot Team Referral Form: CCHT REFERRAL.docx

Please send email referrals to:

Central locality PhysiotherapyLTC-BGH@borders.scot.nhs.uk

Peebles locality PhysiotherapyLTC-HaylodgeHospital@borders.scot.nhs.uk

Teviot Locality PhysiotherapyLTC-HawickHospital@borders.scot.nhs.uk

Berwickshire Locality bor.berwickshireahpreferrals@borders.scot.nhs.uk

Cheviot locality CheviotCHT.Referrals@borders.scot.nhs.uk

Physiotherapy Prioritisation Criteria

All patients should be assessed by the referrer and consented for the referral
It is recognised that certain groups of patients are going to need to be seen sooner than others. Professional judgement based upon reliable information will determine the urgency required in seeking early physiotherapy appointment, the allocation however will be according to the clinical judgement and discretion of the physiotherapy service
At triage, referrals may be allocated to Home First Team if felt that assessment at home would be in the patient’s best interest.

Patients presenting with one of the following criteria and are at risk of deteriorating are considered to be acute and therefore need urgent appointments.

Requiring early intervention for continuity of specialist neurological rehabilitation.
Recently deteriorated/having unmanaged risks leading to potential risk of injuy (please note we are not able to be an emergency service and referrals for this type of input should be directed to a prevention of admission team e.g. Home First
Likely to deteriorate without timely specialist neurological rehabilitation.
Having significant safety issues where the specialist rehabilitation intervention would reduce the risk.
Problem impacting on ability to work/return to work/caring role
Having a life limiting condition requiring timely intervention e.g. (MND, Parkinson’s plus syndromes). Please note we are not an end-of-life service

Primary care management

If patient requires provision of walking aids or replacement, consider referral to Walking aid clinic via What Matters Hubs What Matters Hubs | Scottish Borders Council
Exclude acute medical cause for deterioration in mobility and function
Consider referral to Falls and Syncope Clinic if appropriate
Consider Level 2 Falls assessment e.g. medication review, Active stand.
Consider referral to Neurology if diagnosis not confirmed or if neurological symptoms worsening with no planned neurology review
Consider if ENT referral required for patient presenting with undiagnosed vestibular symptoms