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Social Prescribers

Social Prescriber Referral Form

to be completed by a Professional wishing to refer an Adult Carer

"*" indicates required fields

Barnet Carers Referral Process

All referrals are sent to our Carers Services Team. We aim to follow-up the referral within 3 working days. At busy times, these planned times may be extended.

Importance in acquiring Carer's Consent
It is important to receive the consent of the named carer. We require the confirmation that the consent of the carer has been given as part of this referral in order to proceed in making contact on completed submission.

Respite: a break from caring Please note, Barnet Carers Centre do not offer this support. Please make a professional referral to Barnet Adult Social Care for this service.

Has the person you are referring given consent for this referral?*

Please tick this box to indicate that consent has been given

Please complete the questions below

Name of Professional*

if Name is not listed, please select 'Not Listed'

Contact Name*

First Last

Please state the name of your organisation*

Primary Care Network*

Are you wanting to refer a carer under the age of 18?*

Yes

No

Referral to Barnet Young Carers

Should you be wishing to refer a young carer, our referral form for the young carers service can be accessed by clicking Barnet Young Carers Professional Referral.

Job Title of Professional*

Contact No. of Professional

Email of Professional*

How did you hear about us?*

If Other, please state*

Name of Carer*

First Last

Please give the person's full birth name

Gender of Carer*

Carer's Date of Birth*

DD slash MM slash YYYY

Carer's Preferred Contact No:*

Carer's Email*

Does the carer require an interpreter?*

Yes

No

What is the carer's preferred language?*

Please enter the postcode below and click on the Lookup Postcode button

Carer's Address

City

Postcode

Please select services that the carer would be interested in accessing via Barnet Carers (select as many that apply)*

Carers Needs Assessment and Support Plan

General information and advice

Form-checking (for benefits forms)

Training

Carers Trust Grant

Emergency Card Scheme

Counselling

Health and Wellbeing Services (i.e. exercise classes, peer-support groups, social events)

Barnet Leisure Pass

This field is hidden when viewing the form

Main Area of Need [Age UK]

This field is hidden when viewing the form

Main Area of Need [Barnet Mencap]

This field is hidden when viewing the form

Main Area of Need [Inclusion Barnet]

This field is hidden when viewing the form

Main Area of Need [Mind]

This field is hidden when viewing the form

Other Area of Support

Is the carer affected by any medical or health condition?*

Yes

No

Not aware of

If Yes, what condition is the carer affected by?*

Please give additional details on diagnosis

What is the relationship between the carer and the person being cared for?*

If Other, please state*

How long have you or your organisation been supporting the carer?*

Please give details of the support provided that may help us gain a better understanding of the carer's situation*

Is there a person(s) under the age of 18 involved in caring for the named Person(s) Being Cared For?

Yes

No

Are there any young carers involved?

If you wish to refer a young carer, please follow this link

Name of Person Being Cared For*

First Last

Person Being Cared For's Date of Birth*

DD slash MM slash YYYY

Please enter the postcode below and click on the Lookup Postcode button

Person Being Cared For's Address*

City [Person Being Cared For's]*

Postcode [Person Being Cared For's]*

Condition Person Being Cared For is affected by*

Is the person being referred or the cared for person, current members or veterans of the Armed Forces?*

Yes

No

Don't Know

Barnet Carers Partners Forum

The forum has been created with the collective aim being to better support the carers across Barnet. By inviting organisations who may be in regular contact with carers and bring their individual area of expertise to share their views on a regular basis, it is our aim that carers can access specific support between organisations.

If you are interested in representing your organisation, please indicate below.

I would like to be contacted regarding the Barnet Carers Partners Forum*

Yes

No

Receiving Feedback Regarding Your Referral

We do not generally provide feedback on referrals due to pressure on our resources. However, if there is a particular reason for you needing a response, please give us details and we will do our best to accommodate your needs. .

Would you like us to provide a response for this referral?*

Yes

No

Please provide the reason for your need for a response to this referral*

Professionals Supporting Carers - Mailing List

To join our mailing list for professionals, please click on this link, Mailing List for Professionals Supporting Carers .

Next Steps

On submission of your referral, you will be emailed a PDF copy for your records.

A member of the Adult Carers Team will be in touch with the carer to complete our registration form and carers assessment. We will make 3 attempts to contact the carer to complete these forms. In the event we are unable to get in touch with the carer, we may seek your assistance in making the carer aware of our communication attempts. Referrers can re-refer after closure.

While we endeavour to respond to your referral as soon as possible, depending on our available staff resources, it may be up to 10 working days before we contact the carer you have referred.

Δ

Your contact

Kirsty Kemp

Kirsty 1

Kirsty is responsible for our relationship with the Social Prescribing Team in Barnet and will be the first point of contact for your referrals and any queries you might have.

Please use our electronic referral form where possible. If you do not wish to make a full referral but would like to simply register a carer or get other information, please feel free to email Kirsty direct.

Email Kirsty

Kirsty’s work days are:
Monday – Friday
9.30am to 2.30pm

Resources you might find useful

This section is under construction. We are currently creating a directory of resources that will be useful to you in your role. If there is anything specific that you would find useful, please email Kirsty.

Finance & Benefits

Carers Allowance
Benefits Calculator
Local Support

Carers Support

Leisure Pass Applications
Carers Star support
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In need of care

Guide to choosing homecare
Respite care
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Barnet Mencap
Mind in Barnet and Enfield
Dementia Club UK

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London N12 8NP

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