Background In September 2012 the increasing number of patients referred to St Catherine’s Hospice Clinical Nurse Specialist (CNS) service, gave the opportunity to explore another option for patients to receive an assessment other than at home. An outpatient clinic service was commenced.

Aims To enable the CNS team to be more responsive to patient referrals. Assessing patients who are well enough in clinic will allow more time for those patients who need to be seen in their own home. A range of other benefits and also some challenges were identified:

• Maintain patient independence

• To optimise patient choice

• It supports the first introduction to a hospice

• Reduce travel costs for CNS team

• Patient may not have transport

• The patient may not feel emotionally able to attend a hospice

• Patients have so many appointments it may be more comfortable for them to be seen at home

• Precedents set by other health professionals that the CNS visits all patients at home

• A change of culture for community nurses who are accustomed to seeing patients at home.

Methods Initially the clinic idea was quite simple in its design; a weekly clinic at the hospice providing four appointment slots.

Results There have been regular audits since 2012 which resulted in further development of the CNS clinics; leading to the current service of two clinics per week. One held at the hospice and a second clinic at the premises of a local cancer charity; providing ten appointment slots per week.

Conclusion It is recognised that patients assessed in clinic are a small percentage of the CNS clinical workload. The aim is now for each CNS to have their own caseload clinic in the community. This is currently being piloted by one CNS having a fortnightly clinic in a GP practice (February 2016).