Posted Nov 2025                                      

The Community Independence Service helps people maintain or regain their health and independence at home.  We are an intermediate care service helping general practice.

About the Community Independence Service (CIS)

CIS is a service providing short-term person-centred care to people with immediate health issues or needs which affect their mobility or day-to-day activities. The service aims to provide safe clinical care at home which helps people to avoid unplanned hospital admission or returning to hospital after a recent discharge. 

Who the Service is For

Adults over the age of 18 who live in and are registered with a GP, in the following boroughs: 

• Hammersmith & Fulham  
• Kensington & Chelsea 
• Westminster 

Including nursing and care homes. 

Our Pathways of Care

In CIS we provide 3 key pathways of care: Urgent Community Response, Rehabilitation and Home First (Pathway 1) as well as Case management in H&F and we work with our social service Reablement partners. In addition to this we will now host a Hospital at Home pathway that is supported by our GP with Special interest, and we will be taking your patients who have had a stay in hospital but can be cared for in the community following Frailty Review or ED review.

• Urgent Community Response urgent under 2 hr or same day visit including Point of Care Testing. For admission avoidance we deliver a hospital at home pathway for Frail patients and also for your patients who have attended ED and had a Frailty referral in Acute Care. (up to 14 days of clinical input with GPSI and Geriatrician input).
• Home First also known as discharge to assess – Your patient’s safe discharge from Hospital.
• Community Rehabilitation – 6 weeks or visits to work towards an improved level of function at home
• Case-management and ICAP team in H&F

We encourage GP referrals for Urgent community response and Community Rehabilitation.

Urgent Community Response

UCR Referral follows the national guidance for acceptance – a clinician-to-clinician phone conversation will help us Triage and respond to the patient’s needs. We can visit anyone over the age of 18yrs in their own home or care home, who Is in a crisis and needs intervention within two hours to stay safely at home and avoid admission to hospital. Please consider alternate pathways if the person would require an acute hospital bed & diagnostics or specialist mental health intervention.

Rehabilitation

The CIS rehabilitation pathway vision is to help people to maintain or regain their health and independence at home: to enable people to live well, in their own homes, completing roles and tasks that are important to them with as much independence as possible.

Rehabilitation is focused on patient centred goals and progression is monitored throughout their treatment with weekly visits from clinicians and rehabilitation assistants.

For us to triage the referral effectively it’s important to include the persons aims from rehabilitation and what you think they will be able to achieve with support from the therapy team.

Leadership Team

Our Services are led daily by Senior Clinical Decision Makers, with input from our Borough Leads and Pathway Leads.

Teams are made up of a compliment of Nurses/Paramedics/Therapist/Pharmacy and support staff who can escalate to Senior Team members up to 10pm daily.

We have a wealth of knowledge and experience to ensure patient caseloads are reviewed daily, with medical input in our MDT as well as discussion of cases with the Patient’s own GP.  

Lucy Allen – Head of Service

Michele Gardner – Clinical Lead

Alasdair Tootle – Borough Lead Kensington & Chelsea  

Sher Banu Jhala – Borough Lead Westminster

Byron Flint – Borough Lead Hammersmith & Fulham

Patricia Swales – Business Manager

We are always happy to hear from GPs with any feedback on the service, especially if there are areas where we can improve or work together more closely. Please do get in touch!

Key Contact email:

Lucy Allen [email protected]

Michele Gardner [email protected]

Find Out More on our website:

https://www.cnwl.nhs.uk/services/community-services/community-independence-service