Background In 2016 St Giles Hospice undertook a review of its community palliative care services to ensure the service would be fit for the future. This entailed a review of team caseloads and how and who they were managed by.

Aims Community palliative care services have been historically very linear in their approach, mainly compromising of clinical nurse specialists. The aim of the review was to identify the numbers and complexities of patients on the caseloads and produce recommendations for how caseloads could be managed more efficiently ensuring patients were seen by the right professional or person at the right time.

Methods We reviewed the number of patients on the caseloads (approximately 550 at any one time) and identified if their needs were stable, deteriorating or unstable. We then reviewed which nurse was allocated to patients and identified whether patients were moved through the team or whether they stayed with one nurse throughout their journey.

Results After reviewing the case loads it was realised our structure needed adjusting. As a result, we now have a tiered approach to our community team. Our staff nurses will see the most stable patients or patients at the beginning of their journey with us, clinical nurse specialists will see patients whose condition is changing and our advanced CNSs will see our most complex patients. This means that patients are seen by the right person at the right time via step up or step down approach and has enabled us to see 1300 extra patients in 2016–2017.

Conclusion Service review continues and as a result we will be adding lead advanced nurse practitioners to the team and community care volunteers as we continue to evolve our service to ensure we can be responsive to the needs of the communities we serve.