Background Sixty million people worldwide need palliative care annually, but only 14% receive it (World Health Organization. Palliative care: key facts. [Internet] 2020). Barriers to access include: age, sex, ethnicity, socioeconomic position, accessibility of services, and diagnosis (Allsop, Ziegler, Mulvey, et al. Palliat Med. 2018; 32(8): 1322–1333). Access to community specialist palliative care (CSPC) services may reflect this.

Aims To identify, 1) patterns in the populations accessing CSPC services, and 2) underserved populations.

Methods A retrospective evaluation of all referrals made to three CSPC services in one calendar year. Time in days calculated for: referral to discharge/death, and discharge to death in the cases discharged before death. Index of Multiple Deprivation (IMD) deciles (a surrogate for socioeconomic position) and straight-line distances between patients’ residence and hospice were obtained. Access to palliative care was considered in terms of patients receiving a referral, and the duration under care in time from referral to death (days).

Results 2579 referrals (47% female, median age 76, 59% White British). Cancer was the modal diagnosis (72%). The modal IMD decile was 10 (least deprived), and median 7. Most referrals lived 5–10km from hospice. The median time from referral to discharge or death was 20 days, and from referral to death, 46 days. Younger age groups, cancer diagnoses, higher IMD decile and White British ethnicity had longer median referral to death times.

Discussion Fewer referrals were made for those with a non-cancer diagnosis, lower socioeconomic position, non-white British ethnicity, and residence further from the hospice. Those with non-cancer diagnoses, lower socioeconomic position, and older age groups, received fewer days of CSPC. CSPC remains aligned to the needs of less deprived, older, white British patients with cancer. Introducing palliative care referral to guidelines for management of terminal conditions and education on the benefits of early referral to SPC (Aldridge, Hasselaar, Garralda, et al. Palliat Med. 2015; 30(3): 224–239), and increased collaboration with underserved communities to design services aligned with their needs is required.