Introduction The community nursing service was restructured to ensure that all adult people, regardless of their diagnosis, have choices and access to specialist palliative and end of life care; to strengthen the integration with our community colleagues; to improve anticipatory and advanced care planning; to reduce unplanned hospital admissions; and to ensure a timely response during episodes of palliative care crises.

Method To evidence a proposal for change an activity audit was completed, a triage system was tested, and views sought from GPs and community nursing leads. The team was changed and became comprised of two tiers of specialist nurse - Outreach Nurses and Outreach Practitioners who have extended skills of physical assessment and prescribing as well as overall responsibility for the wider caseload and the team. The service aimed to support GP’s and District Nursing teams within cluster locations. The telephone triage facility was used to determine the appropriateness of referrals and the location for the first assessment, allowing care to be prioritised and the team to offer a responsive service to complex and urgent cases.

Results By managing complex, individual and changing information and supporting patients in choices around treatment and care we have demonstrating improvement in quality and experience along with an increase in referrals. Using and applying clinical knowledge to oversee and coordinate services, we can personalise the palliative pathway for individual patients and support the needs of their families. Additionally, we can act as the key accessible professional for the multidisciplinary team, undertaking proactive case management and using clinical acumen to reduce risk.

Typical 4-month stats (April – July 2019):

Referrals - 695

Home visits - 748

Triage calls – 1307