Case study:

24 February 2009

Community based Nurse led Palliative Care Clinics in Luton

Key points

Community-based, nurse-led palliative care clinics in Luton are proving popular with patients who say they give them choice and address their needs earlier in their disease. The clinics, which are held from Monday to Friday in various community locations, can be accessed by any patient with a palliative care diagnosis who is either working or remains independent in their home. Previously they had no choice of support other than home care.

Patients can re-refer themselves as any new problems arise. As their disease progresses and they are no longer able to attend a clinic, home support is then given via the district nurses working in partnership with the aligned specialist palliative care nurse.

Since the clinics started in 2006 over 250 new patients have accessed the service with over 600 follow up appointments. The total number of referrals has increased by 30% compared to the previous arrangement.

It has also given specialist palliative care nurses more capacity in their working week because they can see more patients in a clinic setting than through individual home visits.

The clinics began as a six-month pilot in 2006 after a mapping of service provision identified gaps in support for patients.

Patients are referred from clinicians working in cancer and occasionally other diseases at the time of palliative diagnosis for a holistic assessment of their needs by a specialist palliative care nurse. The initial appointment is an hour with follow-up appointments usually lasting 30 minutes. Following a clinic visit, a communication proforma is completed and faxed to the referrer and primary health care team to let them know the level and type of support the patient and carer are receiving.

There has inevitably been some resistance to the new arrangements. District nurses were initially concerned they would not know about patients at an early stage of their disease and therefore could not build relationships. Team members were concerned about capacity issues and felt that visiting patients at home enhanced the support they could offer. They were also worried their clinical skills such as phlebotomy and examination skills would not be adequate.

These issues have now been resolved as has the concern raised by oncology professionals that because patients were now being referred at the time of their palliative diagnosis and not later as their disease progressed they might not be able to understand the implications of their condition. Colleagues are now invited to sit in on clinics to gain a greater understanding of how the clinics operate and how patients can benefit.

Those who take the clinics are also attempting to work more closely with other nurses specialising in long-term conditions to see how patients may benefit from cross- boundary working. It is hoped that some of these patients may be supported within the clinics. But even where they are not, the clinics are helping to foster better coordinated care for patients who subsequently require home support in the last few months of life.

The clinics will undergo yearly evaluation. It is also hoped to find more venues so that in future they can run seven days a week at different times of the day.