Background As referral numbers rise and hospice community teams face the challenges presented by the recent pandemic, with periods of unprecedented staff shortage, models of community working have required careful consideration.

Aims This service evaluation aims to track the evolution from individual, to team, to locality caseloads, whilst considering the advantages and disadvantages presented by these different approaches to caseload management.

Method The hospice community manager, consultant team and clinical director reviewed the model of community working prompted by themes identified through mortality reviews, reflection following complaints and staff feedback. Team meetings were held using the Grow Model (Grant, 2011. The Coaching Psychologist. 7: 118) to identify current challenges and options for change putting the team at the centre of plans for transition. Individual caseload models of working were considered in keeping with the hospice’s previous approach and the current predominant model across hospice community teams.

Results Whole team communication allowed a successful transition from the one team caseload to smaller locality caseloads of 4-5 practitioners, looking after approximately 100 patients. Each locality is led by a team leader who co-ordinates monthly caseload reviews, joined by a consultant. This has resulted in improved work satisfaction, continuity of care for patients and families, and a more manageable telephone follow-up list. Regular caseload review has prompted the identification of stable patients for discharge, as well as creating the opportunity to invite external community practitioners to join the team for collaborative learning.

Conclusion Considering different models of caseload management allows community teams to manage fluctuating referral numbers alongside unpredictable workforce numbers, whilst providing the best care possible for patients and families. During the height of the COVID-19 pandemic a one team caseload allowed the team to operate with restricted team numbers. Once the team had stabilised transition to a locality caseload has seen an improvement in continuity of care and staff satisfaction.