Introduction The National Cancer Programme (DH 2000) aims to improve access to specialist nursing advice and improve pathways. Our team of four Clinical Nurse Specialists (CNS) are in a unique position of being employed by a Hospice, yet work exclusively at a NHS Foundation Trust.

The integrated modules of care across organisations allows for a seamless service for patients who have a life limiting illness. NICE (2004) recommend patients with cancer are given a choice of services.

The Nurse Led Clinic (NLC) would offer a wider choice to patients, who can be seen as a one off assessment or for ongoing assessment and support.

Aims Develop a Nurse Led Service providing patients with more flexible options for follow up care.

Increased autonomy and scope for decision making for the CNS team.

Methods Over a three month period the CNS team assessed which of the patients, attending the Palliative Care Medical Outpatient Clinic, could potentially be seen in a NLC, running alongside the Medical Clinic.

We identified patients with psychosocial needs, those requiring liaison with CNS teams, on going blood tests, support for family.

Results The majority of palliative care inpatients, approximately 1000 per year, are managed clinically by the CNS team, with support from Medical colleagues, some of these patients would be suitable for NLC on discharge from hospital.

A third of patients attending the Medical clinic would be more appropriate for the NLC.

Conclusion The NLC allows patients choice

Patients we have previously met on the wards, find particular benefit from continuity of care

The CNS team can develop their clinical skills

Shorter waiting times for appointments

Setting up the clinic has not been without its problems, but the benefit to patients outweighed any difficulties