Background In palliative care, objective measurement of our clinical effectiveness has always been an area of concern. An ongoing, ever increasing demand for specialist palliative care community services means that managing caseloads can be a challenge. We therefore need to ensure that patients with specialist palliative needs can access the service in an appropriate and timely manner. There is very little literature or evidence of good practice around this important part of specialist community palliative care.

Method The suite of OACC (Outcome Assessment and Complexity Collaborative) measures were introduced to a hospice community team service in the summer of 2015, and by April 2016 we have demonstrated that the average CNS caseload has reduced in size by 28%. CNSs were delivering more short term interventions, or spells of care, to a patient and their family with the aim of resolving particular problems, rather than keeping patients on caseloads for several months. A telephone caseload was initiated and this allowed the CNSs to maintain contact with patients with stable symptoms but with the potential to deteriorate, who would have otherwise been discharged. This allows earlier identification of further needs and an easy re-referral system for the patient or their family when the needs arise. Use of IPOS (Integrated Palliative care Outcome Scale) has defined these spells of care enabling discharge either back to primary care team, other supportive hospice services or to the telephone caseload. CNSs embraced this way of working and saw the benefits which include improved satisfaction and work/life balance.

Conclusion We expect that using spells of care to define caseload size will be a more sustainable way to maintain manageable caseloads in the future. We aim to produce guidelines of good practice in caseload management using the OACC measures.