How to access Client Services

1. How to Refer

2. Referral Criteria

SMART London

1. Referrals to SMART London case working must be completed via the RBKC Adult Social Care Pathway so must be referred to their service first for a Social Care Needs Assessment.

2. After completing a Care Needs Assessment, it will be determined whether SMART London's keyworking service is the right fit. A referral will then be submitted to our team for review.

Community Living Well employment services

1. Referral is by GP, Talking Therapies, self-referral, internal partners and other voluntary sector/community organisations.

For more information, please see Employment Support | Community Living Well

2. CLW Employment teams work with people over 16 + years old who have common, complex or long-term mental health needs, and are registered with one of our GP practices in K&C and QPP, ideally living in the borough.

We may signpost those who have moved to other areas of London.

Wellness in Work

1. Referral is by internal Talking Therapies teams only.

For more information, please see Wellness in Work - Shaw Trust

2. Wellness in Work with people 16 + years old who are accessing Talking Therapies in Kensington & Chelsea, and Westminster.

Primary Care Navigator Services

1. Referral is by GP, Talking Therapies, self referral, internal partners and other voluntary sector/community organisations. 

For more information, please see Navigators | Community Living Well

2. Primary Care Navigators work with people over 16 + years old who experience mental health problems whilst under the care of their GP, and their carers.

Clients must be registered with one of our GP practices in K&C and QPP, and ideally living in the borough.

Community Navigators

1. Referral is internal within the hubs only.

2. Community Navigators work with people 16 + years old who have serious mental illness and are under the care of the Community Mental Health Hubs.

Forever Care

1. Information required for Forever Care pre-referral

Please provide:

  • An anonymised identifier (e.g. initials)

  • A brief case history outlining the person’s circumstances and current challenges

  • A short explanation of why Forever Care may be appropriate

  • Confirmation of any current safeguarding concerns (without identifiable details)

Once the pilot is ready to move forward, selected cases will be followed up through a full referral process with consent.

Email referral to: kara.kyle@smartlondon.org.uk

2. Forever Care is intended for individuals with complex and multiple needs, who have a pattern of repeated referrals or frequent service use without sustained improvement, and who face barriers such as health inequalities, social exclusion, or fragmented care pathways. It is designed for those who would benefit from longer-term, coordinated, and person-centred support through a multi-disciplinary approach, rather than those whose needs can be met through short-term interventions or who are currently receiving intensive statutory or crisis services.