Nursing

This section guides you to the contact information for the MS clinical nurse specialists at St Georges and other Trusts and to the Wandsworth nursing service. There is local clinical guidance in specific areas, such as pressure care and end of life care. Links to local and national guidelines are provided and more information is available through the MS Trust and MS Society websites.

Sections:

MS Nurses

Wandsworth Community Nurses

Wandsworth Community Ward

Tissue Viability

Respiratory nurses

End of Life Care including Trinity Hospice, Mulberry Place; CoordinatemyCare; Gold Standard Framework.

Complex Care Management, Daytime (including Community Nursing, Community Matron, Community Ward) – The Community nurses work closely with the GPs and are based within the GP Practices or Health centres

Complex Care Management, Night (including Night/Twilight Nursing)

Community Tissue Viability Specialist Nursing – This nursing team focuses on the maintenance of skin integrity of people living in the community and in the management of chronic wounds and chronic oedema. For more information see NICE guidelines on pressure ulcers.

Community Diabetes Specialist Nursing

Community Heart Failure Specialist Nursing

Community Respiratory Specialist Nursing

Community Respiratory Physiotherapy

Community Continence Specialist Nursing

EOLC Community Nursing Service

End of life care


1. Multiple Sclerosis Nurse Specialists

There is a single point of access (SPOC) for referrals to Wandsworth nurses:

Phone: 0333 300 2350 (lines are manned Monday to Friday from 8am to 8pm and Saturday, Sunday and Bank Holidays from 8am to 5pm)

Email: clcht.wandsworthspa@nhs.net

Post: PO Box 130, Morden, SM4 9EF

Complex case management CAHS GP Team [Formally known as Wandsworth Community Wards]

Proactive management of patients in the community with long term/chronic conditions to reduce the number of unplanned admissions to secondary care

Reactive response to urgent requests for community services input to enable patients to be managed in an acute phase at home thereby avoiding admission to hospital

Assistance in the safe, early discharge of patients from secondary care back in to the community where difficulties are encountered via usual pathways

Complex Care Management, Daytime (including Community Nursing, Community Matron, Community Ward) – The Community nurses work closely with the GPs and are based within the GP Practices or Health centres

  • Complex Care Management, Night (including Night/Twilight Nursing)
  • Community Tissue Viability Specialist Nursing – This nursing team focuses on the maintenance of skin integrity of people living in the community and in the management of chronic wounds and chronic oedema. For more information see NICE guidelines on pressure ulcers.
  • Community Diabetes Specialist Nursing
  • Community Heart Failure Specialist Nursing
  • Community Respiratory Specialist Nursin

NB: For the Wandsworth Community Respiratory Physiotherapist  – Tel: 020 8812 3016 stgh-tr.referrals@nhs.net

  • Community Continence Specialist Nursing
  • EOLC Community Nursing Service

End of Life Care

In this resource the term ‘End of life’ refers to the advanced stages of a long term disease when support in decision making and help with more complex symptom management may be needed.

For information about ‘end of life care’ in Wandsworth and to discuss individual case details make contact with your GP and local community nursing team via single point of access (SPOC) contact above.

For carer support please contact the Wandsworth Carers Centre

For guidance re Power of Attorney; Advanced directives and Advance directives:

Planning end of life care

www.dyingmatters.org


Local support

Mulberry Place is Trinity’s Outpatient services for patient and family care. They offer exercise classes, complimentary therapies and support.

Also information about volunteer service to people at home.

Trinity Hospice, 30 Clapham Common North Side, London, SW4 0RN Tel: 020 7787 1000

Email: rth.referrals@nhs.net

Care at home

Leaflets for patients and carers

Wandsworth Care Coordination Service:

The Wandsworth Care Coordination Centre – one point of contact for all your patients needs at the end of life.

For information about ‘end of life care’ in Wandsworth and to discuss individual case details make contact with your local community nursing team.

Patients & Carers: Coordinate My Care is a clinical service sharing information between your healthcare providers which should help to coordinate your care and record your wishes of how you would like to be cared for.

Healthcare Professionals: As a shared clinical service Coordinate My Care allows healthcare professionals to record patient’s wishes and ensures their personalised care plan is available to all those who care for them.

The GSF is about giving the right care in the right place at the right time for people who are nearing the end of their lives. This is used by Wandsworth GPs and nursing.

The patient can be referred to the MS clinical nurse specialist for assessment of constipation and faecal incontinence. Assessment will be completed and referral will be made to other services as appropriate such as community nursing, dietician, and hospital bowel clinics.