Background Nearly a quarter of all deaths in England occur in care homes (Office for Health Improvement & Disparities. Palliative and end of life care factsheet: Recent trends of deaths in care homes and provision of care. 2024). Care home staff increasingly look after patients with significant frailty and multiple co-morbidities (NHS England. FRAIL strategy. 2024). Despite national strategies, end-of-life-care (EOLC) in care homes remains challenging (NHS England. Palliative and end of life care: statutory guidance for Integrated Care Boards (ICBs). 2022; Macgregor, Rutherford, McCormack, et al. BMJ Open. 2021;11(2):e049486). Little was known about the events that preceded referral to the local specialist palliative care service (SPCS) from care homes.

Aim To identify the factors contributing to referrals from care homes to a local SPCS with the aim of identifying measures to improve end of life care for care home residents.

Method SystmOne records for 36 patients between January and May 2023 were reviewed. Data was collated specifically looking at interventions that preceded referral.

Results Of the 36 records reviewed, 71% had frailty and/or dementia and 60% had five or more co-morbidities. 29% had a diagnosis of malignancy. 78% had been referred directly by the care home. 19% patients were included in the GSF register, however, only 14% had had this updated in the preceding 12 months. In contrast, 75% had a documented clinical frailty score. Only 22% had a completed advance care plan (ACP) document (PEACE) available on SystmOne for clinicians to view. 39% had been seen by their GP in person in the month prior to referral. 19% had been reviewed virtually. The median number of days between a GP in-person review and referral was 35 (range 0–953). 42% had been seen by another clinician from primary care (e.g. practice nurse, pharmacist, GP paramedic) in the month prior to referral.

Conclusion Uptake of GSF and the locally recognised ACP document (PEACE) was low in this cohort. Although practice varied hugely, many were seen in the month prior to referral by their GP as well as by other primary care clinicians. This offers an opportunity in involving wider members of the GP practice in improving end of life care in care homes.