Information for Referrers
Mental Health Services for Older People
Birmingham and Solihull Mental Health NHS
Foundation Trust
Greenbank
1025 Stratford Road
Hall Green
Birmingham, B28 8BG
What is the aim of BMAAS?
The overarching aim of BMAAS is to meet the relevant policy commitments of the National
Dementia Strategy by increasing awareness of dementia, and improving access to early
assessment and diagnosis.
What does the service provide?
This is a new service offering early diagnosis for adults and their families presenting with
concerns about age related memory or other cognitive changes requiring diagnostic assessment.
Who is the service available to?
BMAAS will be available to all adults who are registered with a Birmingham GP.
Who can refer?
For the first year of operation, referrals will only be accepted direct from Primary Care.
How to refer:
BMAAS is the single point of access to specialist dementia assessment across Birmingham.
Referrals should be accompanied by the relevant “dementia screening” blood tests and cognitive
screening results (referral form on reverse).
What are the referral criteria?
1. Evidence of age related memory or other cognitive impairments with at least
6 months duration
2. No established diagnosis of dementia
3. Cognitive decline that cannot be accounted for by other causes e.g. physical
disorder, head injury, single stroke, alcohol problems (dementia screening in primary care
is required).
Referrals will be screened by BMAAS and using clinical judgement, those assessed as requiring
specialist intervention and care coordination will be passed on to the appropriate Community
Mental Health Team.
If you have any questions please contact the Team on
0121 301 5440
or speak to the Duty Worker on
0121 301 5441
Referral form on reverse
Birmingham Memory Assessment and Advisory Service Referral Form
Please Fax referral to 0121 301 5940
Is the patient aware of this referral? Yes
No
Date of referral: _______________
In your opinion, does the patient have the capacity to consent to an
assessment of their memory?
Yes
No
Patient
Name
Address
D.O.B.
Gender
Age
NHS Number
Ethnicity
Interpreter
Needed?
If yes, which
language spoken?
Contact details of
next of kin
Referring GP
Yes
No
Tel no
(home)
Tel no
(mobile)
ePEX no (if
app)
Practice
Address
Tel No.
Fax No.
Details of referral:
There is evidence of memory and/or other cognitive impairments with at
least 6 months duration?
The memory or cognitive decline cannot be accounted for by any other
causes, e.g. physical disorder, head injury, single stroke, alcohol problems?
There are no risks/safety issues that need the intervention from a CMHT
(e.g. Paranoia, suicidal thoughts, wandering, leaving appliances on)?
There is no additional complexity such as substance misuse?
There is no evidence of an established dementia such as scan results,
diagnosis, low scores on memory tests (e.g. mmse score less than 20) etc.?
There is no urgent intervention required?
TRUE
FALSE
Please tick
Please tick
BMAAS
BMAAS
BMAAS
CMHT
BMAAS
CMHT
BMAAS
CMHT
BMAAS
CMHT
For patients where there ARE ticks in the FALSE box please pass the referral directly to
your local Community Mental Health Team. For patients with ticks in all of the TRUE
boxes please pass the referral to BMAAS
All referrals to BMAAS require that physical examinations have been completed to
eliminate any other cause of the memory or cognitive difficulties.
Relevant medical history:
Current medications: please attach list of medications with this referral.
Scores from any memory tests undertaken such as 6-CIT or MMSE:
Recent Dementia Screening blood test completed in last 3 months as detailed below:
Bloods taken and no abnormalities found
Full Bloods
Thyroid
Urea and Electrolytes
LFTs,
TFTs,
B12
Folate
HBAIC
YES
Have all physical examinations, including the blood tests detailed above been completed
and cannot explain the reason for the memory or cognitive changes:
(please tick)
Please include any other significant information that will assist BMAAS in undertaking the
assessment of your patient: (please feel free to attach further information to this referral)
[If you wish to discuss this referral with the team please contact us on 0121 301 5440]