Palliative care delivery in rural settings requires a flexible multidisciplinary team approach, drawing on various levels of knowledge and expertise to optimally support the patient, and their relatives/carers. The model evolved and successfully implemented across a wide rural area in North Wales, consists of palliative care consultants, Macmillan nurses, hospice at home nurses and allied health professionals, all providing input into the care of terminally ill patients. Linking with healthcare professionals in acute and primary care settings including residential care, the team deliver clinical and non-clinical care 7 days a week. Clinical work entails direct patient contact involving assessment, planning, implementation, evaluation and review of care. This involves liaison between palliative care consultants, GP's, pharmacy, district nursing teams, allied health professionals, private/charitable agencies and travelling time. The provision of specialist palliative care education is tailored according to need, and delivered locally also, a wider concurrent programme of educational sessions is systematically delivered to enhance continuing professional development. Operating in the West of a large NHS organisation the multidisciplinary team funding is four-fold and includes contributions from statutory and voluntary sectors. These factors, introduce specific management challenges shaping the model of service provision. This model has been 10 years in development, a time of change within the NHS. Lessons learnt highlight communication, forward planning and an entrepreneurial approach. The model reflects best-practice and as it continues to mature the authors are confident in offering our experiences to others wishing to explore exemplary models of palliative care service provision in a rural setting.
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