Community Macmillan Specialist Palliative Care Service

Why a professional should choose the service

• The team is a multi-professional team, ensuring a holistic and person-centred approach.
• All members of the team have specialist training, including advanced communication skills, and possess expert knowledge and skills in palliative care, including pain and symptom management.
• The team has established networks and relationships with health and social care providers in Barnsley, supporting a consistent approach to both generalist and specialist palliative care.
• People referred to the service via the team’s referral form will be contacted according to the referrer’s assessment of need, for example: urgent referrals within 24 hours of receipt, planned referrals within seven days, and proactive referrals after seven days. The duty Macmillan Clinical Nurse Specialist welcomes discussions regarding urgent referrals, as they may be able to provide advice or signposting (Monday to Friday, 9.15am to 4.45pm).
• When the team is involved, an individualised care plan will be developed in partnership with the person and, where appropriate, those important to them. The plan will address preferences for future care, including preferred place of care, preferred place of death, ReSPECT conversations, and completion of ReSPECT plans where required.
• The service is compliant with relevant NICE guidance and applicable local and national policies.
• The team provides a seven day service, 365 days a year.
• The Clinical Nurse Specialists within the team are independent non-medical prescribers.
• Team members attend a weekly specialist palliative care meeting with a Consultant in Palliative Medicine from Barnsley Hospice.
• The team provides leadership for palliative care within its neighbourhoods and across wider teams in Barnsley, promoting best practice and collaborative working.

Support offered

Consent from the person for the service to be involved is required. Where a person lacks the mental capacity to make this decision, a referral may be made following a best interests decision if there is an identified need for the service.

• Following an assessment, a care plan will be developed in partnership with the person and, where appropriate, their family.

Outcomes

• Optimising a person’s quality of life when they have an advancing, progressive and life-limiting illness.
• Helping the person and their family adapt to and live with their illness and treatment.
• Supporting a person to die in their preferred place of care.
• Providing the highest possible quality of palliative and end of life care.
• Providing support and education to the wider generalist team, both formally and informally.

Referrals accepted from:

A & E, AHPs, Consultants, GP staff, GPs, Hospice staff, Hospital staff, Nurse, Other NHS services, Other Trust services

Referral criteria:

Referrals to the community Macmillan specialist palliative care team can be made by any appropriately trained health or social care professional.  A written referral is required with all relevant information as this will enable the team to triage accordingly.

Referral to the Community Macmillan Specialist Palliative Care Team should be considered for any patient with a life-limiting illness who has complex needs, or whose level of need is considered to be beyond the scope of the current care team. The service can be provided alongside active treatment for an underlying palliative condition.