The majority of support provided by St Margaret’s Hospice, is to patients who are in community settings, be that their own homes, care homes or support within community hospitals.
Referrals are on a basis on a specialist need rather than disease basis. For many patients in the late stages of illness, palliative care needs and advance care planning needs can be met by the primary care team (District Nurses’ (DN’s), General Practitioners (GP’s) , Care homes) with sometimes only advisory support needed from the hospice. However, some people will need access to hospice expertise in palliation of symptoms, psychological support, and specialist care in the dying phase.
The primary care team continue to hold overall responsibility for community patients and will request hospice involvement which may be for a period of time or continuing until death, including pre and post bereavement care for family members.
The community clinical nurse specialist team can help with:
- Symptom management which is coordinated with other primary care providers including GP’s and DN’s with whom there will be a requirement potentially to review medication and prescriptions, MAR charts or syringe pumps.
- Linking with the EOLCCC to support with ordering equipment, arranging care packages, but will again require partnership working with DNs, care agencies, equipment and continence supplies etc
- Discussion of advance care planning and treatment escalation plans.
- 24/7 specialist advice to patients, families and care professionals through advice line specialist nurses and on call consultants
- Collaboration between health care professionals for continuity of care through gold standards framework meetings GP practices and neighbourhood end of life meetings.
Reasons for referral
(Patients must consent to referral if they have mental capacity to do so or a best interest decision has been made to refer). Please ensure the referral has been discussed with the patient.
- Complex, distressing, unmanageable or rapidly deteriorating symptoms relating to the patients advanced illness that cannot be readily managed by the team responsible for their care.
- Specialist care in the dying phase, including bereavement needs of family.
- Complex psychological, emotional, social, spiritual distress relating to their advanced illness requiring a holistic approach.
- Bereavement support arising from a recent death when additional support is required to adjust to loss.
Referrals that would not meet the criteria:
- Patients with chronic stable disease or disability with a life expectancy of several years.
- Patients with chronic pain, problems not associated with progressive terminal illness.
- Patient with mental capacity who decline referral or are unaware of referral. Referrers will be asked to confirm consent with patient before a referral can be accepted.
- Principal needs are psychological requiring specialist mental health team referral.
How to refer
Via telephone, Monday- Friday 09:00-17:00 on 01823 333822 or 01935 709480. Please note that calls to and from the hospice may be recorded for training and quality purposes.
E-referral via the online portal here.
The electronic system that we use to store patient information changed in January 2024 and so may look different to what you are used to. This will not affect how we handle your data or how your care is provided.
Urgency of referrals
We are not able to offer an emergency service, and urgent referral will be responded to within two working days. Urgent referrals are usually triaged as patients with rapidly deteriorating condition who without specialist palliative care will have a heavy symptom burden, deteriorating rapidly with unstable symptoms or limited support or are likely to require urgent hospital admission.
Routine referrals will be contacted within five working days.
Who can refer?
Referrals are accepted from GP’s, consultants, CNS’s, community nurses and other clinical staff. Referrals are also considered from patients or families directly and we advise they contact their GP or other health care professionals involved and that we will confirm their referral with their GP.
Outcome of referrals
Referrals are triaged and signposted to the most appropriate care service. Intervention by the team may include:
- Triaging assessment
- Advice line support
- AccuRx virtual (video) consultation
- A clinic appointment for assessment and review by the St Margaret’s Hospice specialist nursing teams, specialist therapy teams and/or medical team.
- Referral to therapies, occupational therapy, supportive care and social care team.
- A home visit, this may be a one off or a series of visits.
- Hospice day service appointments
- An admission to our inpatient unit
Patient not on active caseload will be proactively supported by the advice line/Central referral centre if:
- There has been resolution of multiple, complex or refractory physical symptoms.
- There is no longer a need for regular Specialist Palliative Care follow up and /or the patient’s on-going needs are more appropriately met by other hospice services or health and social care agencies.
- The patient’s difficult social, psychological or spiritual issues relating to their life limiting illness have been addressed.
- The family and carer needs requiring specialist support have been addressed.
- The patient chooses not to accept further specialist hospice input.
If you have any questions about a referral to hospice services please contact our Adviceline on 01823 333822 or 01935 709480.