The request for referral to Community Specialist Palliative Care can be made by any Health Care Professional by emailing the referral form below. Please inform the GP of referral.

Referral Criteria

• Over 16 years of age
• Have active progressive life limiting disease
• Have complex specialist palliative care needs
• For professional advice
• Where the focus of care is on quality of life and who have unresolved complex needs that cannot be met by the capability of their current care team (NHS England Specialist Level Palliative Care: Information for commissioners, April 2016)

Response Times

• Category A – Patients that require contact from CPCT within 48 hours
• Category B – Patients that require contact within a week
• Category C – Patients that require contact in more than a week but within a month

On occasion, for category B & C patients, these time scales may not be achievable resulting in the patient being put on a waiting list. The referrer will be informed of this by letter.

Prompts prior to completing referral form

• Referrer has discussed the referral with the patient to ensure patient consent
• Referrer has considered whether face-to-face clinical review of patient is necessary prior to referral
• Referrer has checked The Palliative Care Handbook (Green Book) for additional advice on symptom management
• Referrer has checked that appropriate information is entered into Future Planning Template and updated where necessary.
• Referrer has considered discussing patient with the Community Nursing team for assessment of care, equipment and support.

Acceptance of Referral

If referral form is incomplete or indicating that Specialist Palliative Care is not required then CMH staff will contact referrer before progressing.