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)
Community Palliative Care Team (South) - Royal Trinity
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Community Palliative Care Team (South) - Royal Trinity

T. 020 7787 1062

Royal Trinity Hospice (South) provides advice and visiting palliative care patients of Hammersmith and Fulham, Central London and West London.

They can be contacted 8am -8pm  7 days a week.

Referral form for clinician use only.

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

T. 0208 102 5383 / 0208 102 5000 (out of hours)

Pembridge Community Palliative Nurse Team (North) provides advice and visiting palliative care patients of Hammersmith and Fulham, Central London and West London.

They can be contacted Monday to Friday 8.30am to 5.00pm.

Referral form for clinician use only.

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

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