Community Specialist Palliative Care Services

Generalist palliative care

Palliative care is the care of patients with advanced progressive illness, providing pain management and psychological, social and spiritual support. All health and social care professionals should provide generalist palliative care within the limits of their knowledge, skill and competence.

Specialist palliative care

This focuses on quality of life for people with progressive life-limiting illness from which they will die, and meeting needs that cannot be met by their core care team. These needs may be physical, psychological, social and/or religious or spiritual. Examples include complex symptoms, rehabilitation or family situations and ethical dilemmas regarding treatment and other decisions. This care is provided at expert level by a trained multi-professional team to manage persisting severe or complex issues. It also provides specialist education to other professionals. The community Macmillan specialist palliative care team includes clinical nurse specialists who are aligned to each neighbourhood. Care homes and the community hospital are supported by dedicated clinical nurse specialists in palliative care. The team also has specialist allied health professionals (AHPs) consisting of a physiotherapist, specialist social worker, an occupational therapist, and a dietician. These are standalone posts and cover the whole of Barnsley. Outpatient appointments and home visits with palliative medicine consultants can be arranged on an individual basis where required.

Accessing the service

• Tel: 01226 644575
• Web: https://www.southwestyorkshire.nhs.uk/services/macmillan-community-specialist-palliative-care/

All referrals are reviewed the next working day and triaged. We currently work to the following response times:

Crisis (within 2 hours) - Firstly, contact the Macmillan CNS covering the Duty Line to seek advice and discuss.

Urgent – contact within 24 hours (usually telephone consultation initially)

Planned – contact within 7 days

Provision of proactive care – 7 days plus Please indicate the most appropriate response time on the referral form. If you’re unsure, please contact the duty line to discuss before sending the referral.

If you are making an urgent referral this should be discussed with the duty Macmillan community nurse specialist (CNS) prior to sending. Please call 01226 644575 and ask to be put through to the duty Macmillan CNS.

The community Macmillan specialist palliative care team is a multi-professional team and as such referrals will be allocated to the most appropriate member / members of the team. This may not always be a clinical nurse specialist. The service offers different levels of intervention.

Level 1: Signposting, education or telephone / written advice for professionals

Level 2: Support and education for other professionals, often includes a one-off joint visit

Level 3: Complex needs – short term specialist management

Level 4: Complex needs – ongoing specialist involvement

Discharge from the service

A person is usually discharged from the service when they meet the following criteria:

• Their and their family’s needs can be met by their usual care team who have access to specialist support if required

• They no longer wish to have input from the service

• They move area. Accessing their new local service will have been discussed and enabled if required, and any necessary handover arrangements made.

We have a discharge process in place, and if a patient is discharged, they will receive a letter along with a card containing contact details.

Referral guidelines

Who can make a referral?

Referrals to the community Macmillan specialist palliative care team can be made by any appropriately trained health or social care professional.

When to refer?

Referral to the community Macmillan specialist palliative care team can be considered for any patient with a life-limiting illness with complex need or whose level of needs is considered to be beyond the scope of the current care team. The service can be offered alongside treatment as determined by the treating team if appropriate.

The service is accessible to adults (aged 18 or over) with advanced, progressive, incurable conditions. This includes people who are palliative and need our services at any point in their palliative journey, as well as those who are likely to die within 12 months and who are approaching the end of their life. The service also supports their families, carers and other people important to them.

The patient must have consented to the referral with an understanding of the role of the community Macmillan specialist palliative care team, or a best interest decision made in the absence of capacity.

Some examples of referrals would include:

• Uncontrolled complicated symptoms

• Complex emotional issues involving family, children and carers

• Difficult decisions around withholding or withdrawing care – this may include advance decisions to refuse treatment, complex best interest discussions

• Difficult and complex last days of life care

Who should be referred

Email your completed referral form to the single point of access team: rightcarebarnsleyintegratedspa@swyt.nhs.uk

For Trust community services, referrals can be made to the service via an internal corridor referral on the NNS unit or via e-referral for services not on the NNS unit. To enable the service to process and prioritise referrals, all referrals should include all appropriate information to help the team to triage.

Updated:  July 2026