Below you can view information aimed at health professionals and other professionals working with our services to support you to make appropriate referrals to our services in Sefton. This page provides information to help you reach a decision as to whether our service is right for your patient or client and how to make a referral so they can begin accessing support.
If you have any further questions about any of the services below, either visit the service's page on our website (linked below under each service section) or contact the team using the telephone numbers provided.
Adult community health services
We have teams of advanced clinicians working in the community who can respond within two hours if someone’s health or wellbeing suddenly deteriorates at home, which will avoid the need for an ambulance and prevent hospital admissions.
Our advanced nurses and therapists can provide assessment, treatment, support and a two hour rapid response for Sefton via the ICRAS team for registered patients who are aged 18 and over and at risk of a hospital admission.
Open 8am to 8pm, seven days per week. The last referral accepted by the service will be at 7pm.
To make a referral, please call 0300 323 0240 and select option 1.
Visit the service page for more information.
Our eating disorder service provides psychological assessment, formulation and intervention for adults (aged 16 and over) who are experiencing an eating disorder. Referrals for the eating disorder service, including the FREED pathway are accepted from GPs and other medical practitioners.
First Episode Rapid Early intervention for Eating Disorders (FREED)
FREED is a novel early intervention service, based on the staging model and has been developed specifically to target adolescents and young adults (16-25 years) in the early stages of an ED (less than three years illness duration).
The FREED service model includes a rapid and proactive referral process, a holistic and non-stigmatising assessment (within two weeks of referral) based on a biopsychosocial approach, followed by an evidence-based treatment plan. Not all eating disorder services offer FREED, but it is always worth referring early.
For a list of helpful resources for patients and carers please visit the FREED website.
To refer to the eating disorder service or FREED, please complete the referral form and send it to: eatingdisorder
Remember: Refer early for the best outcomes
For further information see our guidance on completing referrals for GP’s and the information provided by FREED below:
Rapid detection and treatment of eating disorders (EDs) are crucial in promoting a fullrecovery. This leaflet provides guidance for GPs to aid the detection and rapid referralof those with EDs.
What are EDs?
- Eating disorders are serious psychiatric conditions characterised by abnormal or disturbed eating behaviours
- Anorexia nervosa has the highest mortality of any psychiatric disorder
- Onset of ED is typically in adolescence or early adulthood
- Psychiatric comorbidities are common, e.g. anxiety, depression, and obsessive-compulsive disorder.
- Patients with EDs often use a higher number of primary care appointments.
Scoff screening tool
S: Do you make yourself Sick because you feel uncomfortably full?
C: Do you worry you have lost Control over how much you eat?
O: Have you recently lost more than One s tone?
F: Do you believe yourself to be Fat when others say you are too thin?
F: Would you say that Food dominates your life?
1 point for each ‘yes’.
Score of 2 indicates a likely eating disorder.
DiagnosisMajor criteria (adapted from ICD-10 and DSM-5)
- Low BMI (<18.5kg/m2) due to restriction of energy intake
- Fear of fatness or weight gain
- Significant body image disturbance
- Usually normal weight
- Regular binge eating (>3 months duration) with compensatory behaviours, such as vomiting, laxatives, or excessive exercise
- Body image disturbance or weight concerns
Binge eating disorder
- Often overweight or obese
- Regular binge eating (>3 months duration) with associated distress
- No regular compensatory behaviours
Avoidant/Restrictive Food Intake Disorder (ARFID)
- Substantial weight loss and nutritional deficiency
- Weight loss not due to shape/weight concerns, or due to unavailability of food
- If this arises in the context of a medical condition, weight loss exceeds that expected due to the condition
Other specified feeding or eating disorder (OSFED)
- Replaces the previously used term of ED not otherwise specified (EDNOS)
- Includes AN, BN and BED of low frequency and/or limited duration, Purging Disorder and Night Eating Syndrome
What are the barriers to detecting EDs in primary care?
- Patients may be ashamed or worried about stigma, be unable to recognize the severity of their ED,be ambivalent about change, or lack of knowledge about available help
- Individuals with EDs do not readily present to primary care services with ED pathology as their maincomplaint
- Patients may initially present with other mental health problems (e.g. depression), gynaecological/contraceptive problems, or gastro-intestinal problems.
Why are early detection and intervention crucial?
- EDs are not likely to remit without treatment
- Watchful waiting does not work
- If someone has only been ill for a short period oftime (i.e. has a short Duration of Untreated EatingDisorder, DUED), treatment works better
- After three years of illness duration, treatmentresponse becomes more muted, probably dueto the impact of ED symptoms on the brain.
Early intervention is key to halting illness progression and promoting full recovery.Rapid identification, assessment, and evidence-based treatment are crucial for improving outcomes.People can fully recover from an ED with the right treatment
Medical risk assessment:
- BMI (NB this is less reliable at extremes ofheight)
- BP and pulse (sitting and standing)
- Muscle strength (e.g. sit up/squat test)
- Regular bloods including FBC, U+Es, andLFTs, particularly if BMI <15 or currentpurging
- ECG recommended if BMI <15
The following markers signify concern,and should be followed by urgent referralto a specialized eating disorder team:
BMI< 14 kg/m2
Weight loss/week> 0.5kg
Systolic BP< 90
Diastolic BP< 70
Postural drop> 10
Children and young people's services
Our Health Visiting Services works across the Sefton community, and offer support for pregnant women and families with children below school age. We visit families at home and in community venues such as health centres and children’s centres, and work closely with GPs, midwives, hospitals, schools and voluntary services. We have a number of different health visiting teams based across Sefton covering different localities.
Visit the service page for more information.
We provide safeguarding services across Sefton. You can contact the service directly on 0151 285 4661.
Long COVID service
Referrals are being accepted from GPs only, by submission of this form.
You will need to confirm that it is over 12 weeks since COVID symptoms started (or as early as four weeks in patients with a high symptom burden or significant, unmet rehabilitation needs), and you must include all of the information, test results etc. requested in the form.
Referrals are checked and if accepted, patients may be offered an initial assessment by phone prior to their appointment with the multi-disciplinary team (MDT).
The service is suitable for patients who were treated for COVID-19 either in hospital or in the community and have signs and symptoms that developed during or after an infection that have continued for more than 12 weeks after initial infection (and are not explained by an alternative diagnosis) or as early as four weeks if clinically appropriate.
Timing is based on individual need and is at the discretion of the assessing clinician. Recovery time is different for everyone, for many people symptoms will resolve by 12 weeks (NHS, C1248, April 2021).
If predominantly organ specific problems have been identified, patients should be referred via existing routes to local specialists, rather than the Long COVID service. If patients have an underlying long-term respiratory condition and are experiencing an increase in breathlessness, once treatment has been optimised, they can be referred to the Long COVID service for further support and referral to appropriate services.
COVID disease is an infection caused by a corona virus. Long COVID is a term to describe the effects of COVID-19 that continue for weeks or months beyond the initial illness. The health watchdog NICE defines Long COVID as lasting for more than 12 weeks, although others consider symptoms that last more than eight weeks to be Long COVID.
Details of how some people are affected by Long COVID are still emerging, but research suggests around one in five people who test positive for COVID-19 have symptoms for five weeks or longer. For around one in ten people, they last 12 weeks or longer.
These long-term effects are often reported by people who didn’t need to go to hospital during the acute phase of COVID. Long COVID symptoms commonly experienced by patients include:
- anxiety and depression
- chest pains
- joint or muscle pain
- not being able to think straight or focus (‘brain fog’)
- persistent cough
- loss of taste or sense of smell.
At our clinics, people can be seen by different members of the team. Each patient will have different problems due to their COVID-19 and our aim is for you to see the right people to help you and, meet your needs.
Members of the team you could see on the day of your appointment may include:
- GP and Community Matron
- Social Prescriber
- Pulmonary rehab physiotherapist.
Each appointment will focus on the different symptoms that you may be experiencing so you may not need to see every member of the Long COVID Team.
The clinic is designed to help people who still have symptoms related to a COVID infection after 12 weeks. The aim of the clinic is to identify what symptoms a person is experiencing and how this is affecting them day to day. We help them find resources and/or treatments to manage these symptoms effectively so they can rehabilitate to living a fulfilling life.
The community matron will phone to introduce the service and complete the COVID-19 Yorkshire Rehab Screening Tool. This information allows us to understand whether the patient is experiencing problems related to coronavirus and allows us to focus on the things that are important to them.
If an assessment by phone is offered, the call usually takes place the week before the clinic appointment. It will take up to 30 minutes. This call focuses on the wider holistic assessment which means that we will assess physical problems but also consider the social, mental or financial impacts that symptoms have had.
A social prescriber from the health improvement team may also phone the patient. This call focuses on the wider holistic assessment which means that we will assess physical problems but also consider the social, mental or financial impacts that symptoms have had.
On completion of appointments, this may include referrals to other services, the team will meet to produce a care plan. This will be a summary of the plan that each person has discussed during the patient’s appointments. The care plan will be posted to the patient and the GP.
There are many helpful resources available:
- Your COVID Recovery | Supporting your recovery after COVID-19
- Information for the public | COVID-19 rapid guideline: managing the long-term effects of COVID-19 | Guidance | NICE
- Long COVID rehabilitiation booklet
- Managing fatigue: The Royal College of Occupational Therapists has put together some useful pacing advice to help you slowly build up your activity level
Having Long COVID is very distressing and can often impact your mood, making you feel sad or low or more anxious than usual. There is support available, you can find the support local to you by following the links:
- Improving Access to Psychological Therapies (IAPT): A talking therapies or online mood management course offered as one to one or group depending on your needs.
Psychology Tool has produced a couple of free booklets on Post traumatic Stress Disorder and anxiety linked to COVID: Critical Illness Intensive Care And Post-Traumatic Stress Disorder (PTSD) – Psychology Tools
Many people talk to us about the worry of getting COVID again. This booklet tackles this issue: Living With Worry And Anxiety Amidst Global Uncertainty – Psychology Tools
This booklet helps you to work through how to do what matters in times of stress: Doing What Matters in Times of Stress (who.int)
A short video on managing anxiety linked to COVID: FACE COVID – How To Respond Effectively To The Corona Crisis – YouTube
Managing tinnitus (ringing in your ears): The British Tinnitus Association explains what tinnitus is and some ways to manage it - COVID-19 guidance for people with tinnitus
Building up exercise: The Chartered Society of Physiotherapy (CSP) has put together some advice on building up strength, managing breathlessness and pacing up activity
If you need information on sick leave please visit the following websites:
- Taking Sick Leave (GOV UK)
More information when planning return to work:
Other charities or services that you may find helpful offering emotional support and information to those experiencing mental health difficulties, their families and carers:
- Samaritans call free on 116 123 or email jo
- SANE Mental Health helpline: 0845 767 8000
Call NHS 111 (free from a landline or mobile) when you need medical help fast but it’s not a 999 emergency. Available 24 hours per day.
Mersey Care also provides phone support for people experiencing a mental health crisis via the freephone numbers below:
- If you live in Liverpool and Sefton and are aged 16 and over, call our 24/7 freephone helpline: 0800 145 6570
- If you live in Halton, Knowsley, St Helens and Warrington and are any age, call our 24/7 freephone crisis line on: 0800 051 1508
- If you live outside of the above areas find your local mental health crisis line on the NHS website.
Patient’s may be invited to attend the clinic six months later. The decision whether the patient needs to be seen in the clinic will be a joint one between the patient and the member of the team who contacts them.
Mersey Care Assessment Team
The national framework sets out a single policy on who should receive NHS funding, this can be fully funded NHS Continuing Healthcare (where the NHS funds the whole care package) or NHS Funded Nursing Care (where the NHS is responsible for the nursing required from a registered nurse in a care home through a single payment).
Mersey Care is responsible for the assessment processes within the National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care and will also contribute towards care planning for individuals who meet continuing healthcare eligibility.
Our assessment team will accept referrals completed by a health or social care professional who has sufficient knowledge of the patient and is involved in their care i.e. GP, district nurse, ward nurse and or a registered therapist or social worker.
- Before completing the referral form, the referrer is responsible for ensuring that consent is obtained from the patient and this is recorded. Where the patient does not have capacity and the family member has a registered Lasting Power of Attorney (LPA) – for Health and Welfare (please ask the family member to provide the original authorisation documentation and check that the document clearly identifies the authorisation to act in the persons best interest and that this has the official court stamp and it is signed and dated. Please ensure that a copy is retained and submitted with the completed referral form.
- Where the person does not demonstrate mental capacity, the referrer must ensure that a full mental capacity assessment and ‘Best Interests’ consent to screening and assessment for NHS Continuing Healthcare/Funded Nursing Care/Fast Track tool has been undertaken.
- Once the referral is complete and sent to the team, it will go through an initial screening to book in a checklist or a full NHS Continuing Healthcare assessment if appropriate.
- If the referral meets the criteria for a full CHC assessment, a member from the Mersey Care team will contact the referrer and the patient (or the most appropriate person to arrange a suitable date for the assessment to take place).
- A comprehensive assessment to support completion of the decision support tool (DST), involving two or more disciplines from the multi professional disciplinary team (MDT) will then take place including a social worker where possible.
- The Mersey Care nurse assessor coordinates the assessment process, which usually involves requesting additional supporting evidence from other specialists e.g. physiotherapist, speech and language therapists, consultant neurologists, psychiatrists, care providers. The nurse assessor will also keep you and/or the appropriate person informed and involved in the assessment process.
- Once the multi disciplinary team has agreed a recommendation, this will be sent to the Commissioning Support Unit for verification of eligibility. The person or family representative will be notified in writing by the Clinical Commissioning Group of the decision.