Updated palliative care referral form version 4.2

What's changed

The specialist palliative care teams across North West London now work together to redirect referrals between providers rather than sending them back to the GP. Once you submit a referral, it becomes the responsibility of the receiving team to find the best service for the patient based on their needs, provided the patient meets the core criteria for specialist palliative care.

How it works

Complete the pan-London referral form and send it using the contact details provided. The receiving team will triage, redirect if needed, and coordinate services - including arranging multiple providers if required.

What services does this cover?

Services include community specialist palliative care teams, 24/7 advice lines, hospice at home, inpatient units, outpatient clinics, lymphoedema services, and psychological and bereavement support.

Eligibility

  • Living in NWL and registered with an NWL GP
  • aged 18+
  • Advanced, progressive, life-limiting illness (including cancer, frailty, organ failure, neurological conditions, dementia)
  • Complex symptoms or circumstances requiring specialist palliative care input 
  • Patient consent obtained or best interest decision made

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Related Services

24 hour Advice Line Pembridge Hospice
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Pembridge Hospice provides palliative care services and advice to the residents of Brent, Central London, West London and Hammermith and Fulham.

This is a 24 hour, 7 days a week telephone advice line.

Referral form for clinician use only.

 

Community Specialist Palliative Care Referral Form V4.2 (DOCX)
24 hour Helpline Pall24 for North Brent and Harrow
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24 hour Helpline Pall24 for North Brent and Harrow

T. 03000 200 224

This service was formerly known as Single Point of Access (SPA)

This is a 24 hour 7 days a week helpline providing advice for patients, families and professionals, hosted by St Luke's Hospice for residents of Harrow and North Brent.

Urgent rapid response visits can be made to patients registered with a Harrow GP

 

Brent North Community Palliative Care Team - based at St Luke's
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Brent North Community Palliative Care Team - based at St Luke's

T. 020 8382 8013

North Brent Community Specialist Palliative Care Nurse team provides advice and visiting to palliative care patients in North Brent. The team is based at St Lukes Hospice.

Areas: Queensbury, Fryent, Welsh Harp, Barnhill, Kenton, Northwick Park, Preston, Sudbury, Wembley Central, Alperton, Tokyngton

The team can be contacted for referrals Monday to Sunday 8.30am to 4.30pm. 

After 4.30pm the Out of Hours Telephone Advice line 020 8382 8000 operates and calls will be taken by a nurse on St Lukes inpatient unit

Referral form for clinician use only.

Community Specialist Palliative Care Referral Form V4.2 (DOCX)
Brent South Community Palliative Care Team - based at Pembridge Hospice
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Brent South Community Palliative Care Team - based at Pembridge Hospice

T. 020 8102 5000

South Brent Community Specialist Palliative Care Nurse Team provides advice and visiting to palliative care patients in South Brent. The team are based at Pembridge Hospice

Areas: Harlesden, Willesden, Kilburn, Neasden (south of north circular Brent, except the St Raphael's Estate) 

All referrals to be made via the CLCH Single Point of Access Service (SPA) email address and will be processed during working hours of Monday to Friday 9.00am to 4:30pm. Any referrals sent outside of this time period will be processed on the next working day.

For ALL urgent referrals, both in and out of working hours, please also call Pembridge (as per current process) on the 24 hour number above.

For any other email correspondence. clcht.pembridgeunit@nhs.net.

Referral form for clinician use only.

Community Specialist Palliative Care Referral Form V4.2 (DOCX)
St John's Hospice at Home
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St. John's Hospice provides palliative care services to the residents of Brent and Westminster.

Telephone response will be received within 2 hours.

Inclusions are: Terminal care last 2 weeks of life, 24 hour, admission avoidance, facilitated discharge and respite care escorting a patient.

Referral form for clinician use only.

Community Specialist Palliative Care Referral Form V4.2 (DOCX)
St John's Hospice Inpatient unit
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St. John's Hospice provides inpatient palliative care services to the residents of Brent, Central London and West London.

This is an inpatient unit with 18 beds

Please contact for admissions for advice and Community Specialist Palliative Care.

The office hours are Monday to Friday 8.30am to 4.30pm. Referrals received in the morning are triaged the same afternoon, and those received in the afternoon are triaged the following working day.

If urgent, please follow up the referral by calling us on 020 7806 4040. Out of hours, urgent referrals will be discussed with the consultant on call.

Referral form for clinician use only.

Community Specialist Palliative Care Referral Form V4.2 (DOCX)
St Luke's Hospice at Home
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St Luke's Hospice at Home

T. 0208 382 8020 / 8050

St. Lukes Hospice@Home provides palliative care services to the residents of North Brent and Harrow. Respite and bridging packages of care are available for end of life patients.

Please contact the team between Monday to Saturday 9.00am to 5.00pm.

The email can be used for fast track referrals.

Referral form for clinician use only.

Community Specialist Palliative Care Referral Form V4.2 (DOCX)
St Luke's Hospice Inpatient Unit
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St Luke's Hospice provides inpatient palliative care services to the residents of Brent.

This is an inpatient unit with 12 beds. Please contact for admissions and advice.

Referrals can be made Monday to Sunday 9.00am to 4.00pm. 

Referral form for clinician use only.

Community Specialist Palliative Care Referral Form V4.2 (DOCX)

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