Background Two hospice organisations, serving the majority of the population of a major UK city (Hospice A and B). Hospice B has been unsuccessful over several years, at recruiting into a substantive Consultant role. Medical staffing, was therefore identified as a potential area for joint working, that would improve patient experience and promote collaboration.

Aim Both organisations agreed that the Medical Director at Hospice A, would provide some clinical leadership to Hospice B.

Methods Medical Director job plan split between the two units (with backfill funded by Hospice B)

Initial objectives agreed:

• Review existing medical staffing and make recommendations around future workforce planning, including how to optimise chances of recruitment into consultant post(s)

• Identify opportunities for the hospices to work together more, especially around shared job roles and clinical redesign projects

• Lead a joint hospice initiative, to effect system -wide change for EOLC across the city.

Achievement against these objectives will be assessed at appraisal.

Results Recommendations around Hospice B medical staffing, included formally linking the Consultant post with Hospice A, making optimal use of peer support and existing CPD opportunities. Consultant body agreed to amalgamate second on-call services, for more efficient out of hours working. Revised job description approved by RCP – recruitment pending. Joint clinical working provoked wider sharing of resources such as policies, guidelines, education material etc and heightened efficiency around clinical governance. Both organisations are now scoping joint working around support functions such as IT. Combined senior clinical staff away day, identified priorities for influencing at regional and national level. Future EOLC stakeholder events scheduled.

Conclusions Good example of a joint clinical role, becoming a conduit for greater cooperation between neighbouring organisations. There have been benefits to both, including reputational. Most notably, however, patient care has been positively impacted, with less staff time being expended on duplicating efforts.