For Multi-Disciplinary Teams
Seamless collaboration with hospital, community and specialist teams — for safe discharges and genuinely integrated care.
One team around the person
The best outcomes happen when providers work as part of the clinical team — not alongside it. We integrate closely with discharge coordinators, community nursing, specialist nurses, therapists and GPs to make care at home safe, coordinated and consistent with the wider clinical plan.
Supporting safe, timely discharge
- Early engagement in discharge planning, including ward visits and joint assessments
- Training and competency sign-off completed before discharge day
- Equipment, medication and escalation planning coordinated in advance
- Discharge-to-Assess (D2A) and step-down support
- Clear feedback loops to referring teams after transfer
Ongoing clinical collaboration
- Care plans aligned with MDT goals and therapy programmes
- Structured observations and reporting that inform clinical reviews
- Prompt escalation of deterioration via agreed pathways
- Participation in MDT meetings, CPA reviews and best-interests processes
Refer a patient or discuss a discharge — call 0330 016 4609 and ask for our clinical team.