Extra Support Service (ESS)

The Extra Support Service (ESS) is what OHL has chosen to name the commissioned High Intensity User (HIU) Service.

The role of ESS is to try and reduce the attendance to Lewisham A&E of the most frequent attenders (those attending 6 or more times in one year). We try to address their underlying issues, in order to protect the scarce resources provided by A&E.

The service is trying to be involved with 75 of the top 100 attenders.

The current service model is that the ESS nurse will contact the patient by phone to try to determine their needs and reasons for attending A&E and put interventions in place in the community to try to deal with the patient’s problems. We also have a health coach (organised by Community Connections) who can provide signposting to other agencies and offer support about self-management where appropriate.

The ESS nurse has a mobile which is accessible 9-5pm Mon to Fri when the patient is in crisis so that the nurse can hopefully prevent an inappropriate A&E attendance.

Referral Criteria

At the moment, it is not possible to be referred into ESS we only accept referrals based on a list provided by Lewisham Hospital A&E department.


How will patients be identified? – Patients cannot be directly referred via a GP or self-referral, but are identified by Lewisham Hospital.

Are there any exclusion to who ESS can work with? –The current ESS exclusion criteria are:

  • any patient not registered with a Lewisham GP surgery
  • sickle cell disease
  • age less than 18
  • age above 70
  • care home/nursing home residents
  • pregnant patients
  • those under the care of a frequent attender team (e.g. SLAM Crisis+

How long will patients remain with the ESS? – We follow a multidisciplinary team (MDT) approach and hold regular MDTs once a month to review the patients on our list. We have other professionals attending the MDT to provide input on these patients, such as Fulfilling lives of Lambeth Southwark Lewisham, SLAM, Lewisham Social Services, Lewisham Drug and Alcohol Team, and Lewisham Council Prevention Team.

Contact Information

Cynthia LynchESS Admininstrator
E: cynthia.lynch@onehealthlewisham.co.uk
One Health Lewisham

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