The Community Frailty Service supports patients to live well alongside their existing long-term conditions.
Long-term conditions are described as health problems which need managing over many years. They are not curable but can be managed well with medication and lifestyle choices. As well as providing health support, we also support the patient's wellbeing. This is achieved by supporting the patient to set goals that are personal to them.
The Community Frailty Service consists of a multidisciplinary team of health professionals, including a Consultant Community Geriatrician and Physician, Frailty GPs, Nurse Consultants, Advanced Clinical Practitioners, a Pharmacy team, Frailty Nurses, Assistant Practitioners, and primary care assistants.
The service covers the whole Fylde Coast with appointments offered in the home setting, via telephone, video link or across a number of community clinic settings. Initially the patient will receive a comprehensive geriatric assessment where the clinician and the patient/carer will develop a plan of care.
Following the comprehensive geriatric assessment, the patient will be allocated to a community frailty nurse who will visit the patient at home and begin to work through this plan. This may include education and advice to help the patient to manage their long-term conditions and support them to keep well at home, ordering any necessary equipment to ensure they can mobilise safely and signpost to any other services that may be of benefit.
We can also offer the patient a medication review by our Pharmacy team and answer any questions they may have about their medication.
The service also offers a daily telephone triage service to support patients when they feel unwell due to their long-term conditions. This same day service aims to treat patients at home wherever possible in order to prevent an admission to hospital.
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Select either:
- Community Frailty Service North
- Community Frailty Service South
- Frailty Virtual Ward
