CIS (Community Independence Service)

Our Single Point of Referral number is: 0300 033 0333

Email: cis.3borough@nhs.net

CIS - the 3 Borough Community Independence Service - is about integrating care faster and more thoroughly by drawing on the talents and experience of all in health and social care across the 3 Borough to provide the best service for patients.

The partnership is made up of

  • London Central and West Unscheduled Care Collaborative
  • Central London Healthcare
  • London Medical Associates – West London GP Federation
  • Central and North West London NHS Foundation Trust
  • West London Mental Health NHS Trust
  • Local Authorities in the City of Westminster, Kensington & Chelsea and Hammersmith and Fulham.

About the team 

The CIS team includes nurses, physiotherapists, occupational therapists, social workers, mental health workers, rehab assistants, assessors, HCAs, carers, doctors, pharmacists and administrative team. 

About the service

The focus of CIS is to deliver unplanned care to patients.

There are two pathways:

  • Rapid Response: for urgent help to support acute illness in the community when it is safe and appropriate to do so (response within 2 hours with input for up to 5 days).
  • Rehabilitation and reablement (offered for up to 6 weeks). Rehabilitation provides physical and occupational therapies for housebound people to enable them to achieve functional goals and improve their independence. Reablement services are provided in the home to help a person gain confidence and re-learn the skills to carry out daily activities and practical tasks.

CIS also provides:

  • CIS Liaison – working within A&E departments and pre admission units to determine if people can be better supported at home or by other non- emergency services rather than through hospital admission.

Who is the service for?

The service is for patients aged 18 years and over, including those in normal place of residence, which includes care and nursing homes requiring CIS service and over as follows:

  • Healthcare: Patient must be entitled to receive NHS care and usually a resident in the area covered by the CCG’s.
  • Social Care: Service users must be resident within the relevant London Borough. This will require close liaison with bordering boroughs and implementation of cross border arrangements for social care to ensure equitable care for our population.

How to make a referral?

Via GP

We accept electronic referrals through SystmOne without the need for a referral form. Please choose the appropriate team (rapid response or rehabilitation/reablement) and document the reason for the referral in your consultation.

All rapid response referrals require the referring clinician to call the SPoR on 0300 033 0333 and discuss the patient with a CIS clinician in order to make sure the patient is accepted for the service and can be seen in a timely manner.

Please discuss the importance of being able to share clinical information with those involved in your patient’s care and indicate consent to share data has been given. As the CIS relies on data sharing, not doing so will result in the SPoR returning your referral.

Please note routine and same-day home visits are outside the scope of CIS. There may be occasions where the CIS GP may agree to visit a patient at home on behalf of the patient’s own GP following a discussion directly between these clinicians. The CIS GP will not be expected to carry out a home visit for patients where the clinical need has not been established by the patient’s own GP. An individual CIS GP cannot deal with same-day home visit requests from all practices within the CCG.

From Acute Sector

Referrals can be made directly to the CIS Liaison Team who will be working closely with acute colleagues. For CIS involvement to help complete rehabilitation or reablement goals at home, referrals are to made through the CIS SPoR. The basis of the referral to CIS therapists would be the hospital therapists' assessment, which would be considered as a Trusted Assessment.

From Adult Social Care

Please contact the SPoR

From London Ambulance Service

The London Ambulance Service should follow the agreed Inner London Community Independence Service Pathway and/or the agreed Elderly Fallers Pathway.

Self-referrals for Rehabilitation and Reablement

If known to the service, self-referrals will be considered dependent on the outcomes of previous input and the current potential to achieve goals.

Opening hours

Services are provided between 8am – 8pm, 7 days a week and deliver a coordinated approach to patient care. This means that CIS generally cannot accept any new rapid response referrals after 6pm but if there is capacity within the service to safely complete the clinical episode before 8pm they may be able to accept a new referral. Please note that the rapid response service is not intended to replace urgent district nursing who can respond within 24 hours.