Referral form for Health Professionals

St Richard’s Hospice has developed a new referral form and it is hoped that this will enable referrals to be handled more efficiently. It is important that referral is discussed with the patient and family/carers. Please provide full information and identify the service required as this helps us to respond appropriately.

Palliative Care Services in Worcestershire use an electronic patient record that enables smooth transition across care settings.


Click here to download the St Richard’s & BSSW referral form 

St Richard’s Hospice offers free care to adults with a serious progressive illness, improving their quality of life from diagnosis, during treatment and to their last days.

Most patients will have advanced, progressive disease, where the focus of care will have changed from curative to palliative and prognosis is limited. Some patients with complex needs are referred earlier in their disease journey.

Not everyone with terminal or advanced disease will need specialist palliative care or hospice services. A demonstrable need for specialist palliative care must be established. In some cases patients will be discharged from the hospice where there is not felt to be a requirement for ongoing support.

Referral is appropriate where:

• Pain or other symptoms are difficult to control despite intervention
• It is difficult to meet the psychological, social and spiritual needs of the patient, family or significant others
• Care in the last days of life where additional support is required

The hospice In-patient Unit is not able to provide rehabilitation facilities, planned respite or long term care.

Making a referral:

Patients who would like support from St Richard’s can be referred by their GP, consultant, district nurse or health care professional. Patients, or a person close to them,  can also speak to our Gateway referral team themselves for information or advice. In all cases the GP, who is the key person in charge of that patient’s care, will be informed. We will then phone the patient to discuss any concerns and, if needed, we can arrange a convenient date and time to visit to plan the support and  care we can offer.

At all stages we will work in partnership with the community teams and acute hospital services involved in the patient’s care. If you would like more information about referral please contact the Gateway Team on 01905 763963.

The referrer should state clearly the purpose of the referral. A completed referral form should be emailed to the hospice at the address on the referral form. The form should be accompanied by supporting documentation eg hospital letters, reports or GP summary and a list of the patient’s current medication. Failure to do so will result in a delay in processing the referral.

For patients with decision making capacity, referral must be discussed with them and made with their consent. On receipt of the referral form, details will be entered on SystmOne, the Palliative care Database in use across Worcestershire.


Referrals for St Richard’s Nurse Specialist Team or Living Well Centre

Patients must be registered with a GP in South Worcestershire

Non urgent

Non-urgent referrals may be emailed to the hospice at the address on the referral form. All referrals will be entered onto SystmOne (electronic patient record) within 1 working day. A member of the Gateway Team will make contact with the patient or family within a maximum of two weeks in order to determine support required. Provision of comprehensive clinical information at point of referral will help to ensure first contact is timely.


If contact with the patient is required within 48hrs, the referral should be marked as urgent and emailed to the hospice and the referrer should telephone the Gateway Team on 01905 763963 to provide immediate advice – failure to do so may result in delays in contacting the patient.

Out-patient assessment

Referrals should be made as above, stating that out-patient clinic assessment by a CNS or Doctor is required.

Referral for Admission to the In-patient Unit

The multidisciplinary team meets daily on Monday – Friday at 9.30am to review and prioritise those patients on the waiting list. In order for the team to make decisions appropriately they must have a clear picture of the patient’s medical condition and the need for specialist palliative in-patient care. The capacity to admit will depend on bed availability, and medical/nursing staffing capacity and should not compromise the care given to patients already on the unit.

Admission will normally be arranged before 2pm to allow time for adequate assessment and treatment. A request for more urgent admission should be discussed with the Unit manager, senior Ward Sister or senior Doctor on IPU.

Admission at weekends and public holidays may be possible and can be arranged through the on-call CNS and first on-call doctor at the hospice. Priority will be given to patients in the community to prevent inappropriate admission to an acute hospital bed, but in the event of capacity to do so, transfer from hospital may be possible. In-patient accommodation comprises 13 single en-suite rooms and two 2-bedded rooms with shared bathroom.

A patient’s length of stay in the In-patient Unit will be determined by the multiprofessional team. Planning for discharge will start soon after admission unless this is clearly inappropriate.

To find out more about Advance Care Planning and the Worcestershire Advance Statement visit the South Worcestershire Clinical Commissioning Group website