Background MYSPC community team consists of six WTE CNSs supported by three consultants, covering a population of 360, 000. Long term sickness in the team and difficulties recruiting became an acute crisis with additional sickness in spring 2011. At most times from May 2011 we had less than 1/3 of our nurses. After discussion within the team a difficult decision was reached and we issued the following: It is with regret that the Mid Yorkshire Macmillan specialist palliative care team have to inform you that we are unable at this time to accept referrals for face to face consultations/domiciliary visits for community patients in Wakefield and North Kirklees. This is due to unprecedented sickness in the team and the decision has not been taken lightly. Please continue to send in referral forms and these will be reviewed each day by a consultant who will liaise with you by telephone to offer advice. Please accept our apologies for any inconvenience this causes and we will return to normal service as soon as we are able.

Aims The authors compare a 3 month period of staffing shortage with 3 months in the previous year demonstrating impact on the clinical service. Areas: • Referral numbers • Level of intervention • Face-to-face contacts • Re-referrals • Triage methods • Use of other services • Impact on non-clinical work • Emotional impact on the team.

Conclusion The impact has been significant and has resulted in changes in the way the team responds to referrals. Although this has been a difficult time it has ensured we reflect on the way we work with primary care colleagues. The authors have to utilise our skills and time to maximise effectiveness. The authors will be able to make recommendations for future models of working, not just at times of crisis.