COVID-19: Devon Partnership NHS Trust (DPT) service guide

To access DPT services for all age adults

• For crisis referrals 24/7 - please contact DPT's Single Point of Access (SPA) on 0300 555 5000, 'crisis' referrals have up to a four hour response time
• For routine and urgent referrals (Adult/Older Adult/Devon Memory) – there is no change to this process, please continue using the electronic referral system. Please note that 'urgent referrals' have up to a five day response time
• Please note that all DPT services have open access via the SPA telephone number. Once dialled, there will be a number of options to select, one option is specifically dedicated to 'professionals' to ensure a prompt response time

To access TALKWORKS

Usual criteria applies but services are currently being provided by phone or other digital platforms. To access:

• Through self-service, please telephone 0300 555 3344 or visit TALKWORKS (website has online self-referral form). Self-referrals will be contacted by phone to offer an initial appointment. This will be via phone/telehealth rather than face-to-face during the COVID-19 pandemic
• TALKWORKS are also offering a bespoke, prioritised entry into this service for ALL NHS and SOCIAL CARE workers. Contact details are the same as listed above

To access DPT services for children

Child and Adolescent Mental Health Services (CAMHS) are for all children and young people under the age of 18.

Referrals into the service are accepted from GPs, professionals, parents/carers and children/young people themselves.

GPs can advise patients to self-refer or make a referral on behalf of their patients.

All referrals are screened within 24 hours of being made and urgent clinical needs identified and responded to on same day as referral. GP, parents, young people and professionals can phone in for pre-referral advice.

To make a referral:

• In hours - for all referrals (includes new & existing patients) during (8am – 5pm Monday - Friday) for Devon call: 03300 245 321, for Torbay call: 01803 655692 or email: cfhd.devonspa@nhs.net
• Urgent/emergency support out of hours between 5pm – 8am (7 days a week) call 0300 555 5000.

To access DPT's Community Mental Health Teams (CMHT)

CMHTs for Older Adults and Adults are working remotely wherever possible, using telephone contact to support individuals except where face to face is absolutely necessary (for example, depot medication).

CMHTs are supplementing this with a CBT-based online offer. Where identified as appropriate, individuals on caseload will be prescribed modules and supported by a mental health practitioner. CMHTs may need to reduce this input if there are reductions in workforce and therefore ensure that we are targeting clinical resource where it is most needed. This will be determined by prioritisation of need and risk.

DPT has not stopped or withdrawn services, other than dementia assessments. However, this is likely to change if we are required to deploy staff into urgent and inpatient care. In the event that community teams become depleted, we will continue to support those identified as a priority in the community but this may be delivered by someone who is not their care coordinator or from their local team.

To access DPT's Community Eating Disorders Service (CEDS)

During this period, the CEDS team are putting additional steps in place to support GPs and other professionals and its patients.

In the first instance, for initial advice, please contact 0300 555 5000. Furthermore, in order to support GPs/other professionals and our patients during this challenging period, the CEDS team have revised requirements for physical health monitoring for eating disorder patients, see below:

• GPs and Community Mental Health Teams have been informed of patients identified as 'red risk' on caseload, and revised reduced monitoring information has been sent
• GPs are asked to contact CEDS via dpn-tr.CommunityEatingDisorders@nhs.net to alert the service of any abnormal parameters, ideally using subject heading 'Abnormal Results'. Service will then consider required steps with GPs
• GPs are asked to contact CEDS via the SPA number above if your surgery has had to close due to COVID-19, or a patient has not attended
• An advice letter has been sent to all CEDS patients detailing the importance of reducing the risk of Coronavirus, and support & signposting during this period
• CEDS are continuing to offer telephone/skype contact with patients during this period

To access DPT's Learning Disabilities Service (LD)

• For all Learning Disability (LD) services, in the first instance please contact 0300 555 5000

To access DPT's Perinatal Service

• For all new referrals, in the first instance please contact 0300 555 5000
• Email referrals will continue as normal but through one central email address - dpt.perrinatalreferrals@nhs.net

Please note that during the COVID-19 pandemic, the service will prioritise women and families with the highest risk from their mental health. As pregnant women are now advised to self-isolate we have had to adapt to align with government guidance. We will work towards discharge with women with lower-level concerns, and will be adapting our triage system to only accept new referrals where perinatal "Red Flag" risks are identified.

The team will collate online resources for other pregnant and postnatal women, to support them in managing their distress and isolation they may experience. We will share these with midwives, health visitors, GPs, and maternity service providers. These will also be detailed on the DPT website

Due to significant patient safety risks please be aware of specific advice & arrangements for supporting the continued safe supply and treatment of patients on clozapine.

• It is a requirement that patients receiving treatment with clozapine have regular blood tests (FBC- full blood count) to minimise their risk of developing agranulocytosis.
• The pharmacy cannot make a supply of clozapine without a valid blood test result.
• If the medication is stopped suddenly there is a risk of relapse and rebound psychosis. Where clozapine doses are missed for more than 48 hours it must be re-titrated slowly, potentially taking 2-3 weeks to reach a therapeutic level.
• Re-titration usually requires admission to hospital.
• Signs of clozapine side effects, flu like symptoms, are very similar to symptoms of COVID-19, blood tests need to done to ensure they are not neutropenic so that the right treatment is offered.

Therefore, please prioritise monthly FBCs for people on clozapine. If you are experiencing difficulties with this due to service changes and/or individual patient circumstances (e.g. self–isolating) please contact DPT services for your locality.

• DPT have set up a dedicated clozapine helpline 9am - 4pm Monday – Friday on 01392 675682 and 0300 555 5000 out of hours

• For medicines advice - contact 01392 675688

Useful links:

Clinical guidance for prescribers - shared care guidelines

COVID-19 Patient Info Leaflet

Pathway Group

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group

Publication date: May 2020