Resources for GPs and professionals

Resources for GPs and professionals

Resources and guides for healthcare professionals

Advice and support

If you need advice or support please call us on 02087684582

Your call and brief details will be taken by a member of our admin team and forwarded to the appropriate team. A member of the team will ring you back on the same day. Please leave a number that we can easily contact you on.


Anticipatory prescribing refers to charts and, where appropriate, medications that are left in a person’s usual place of residence for use by visiting clinicians should problems arise with uncontrolled symptoms.

  • Patients are most vulnerable to these in the last days of life and when they are no longer able to swallow
  • The common ones are pain, nausea and vomiting, distress and agitation and respiratory secretions
  • The guidance below covers these.

There has been controversy over the best practice for clinicians to adopt following the widely publicised Gosport Enquiry.

  • General, national guidance and policies are currently under development and several members of the clinical team at St Christopher’s are closely involved with this work
  • Our current guidance reflects the developing thinking, is subject to regular review and scrutiny and will be modified as further evidence emerges around the best and safest practice to adopt
  • Our 24 hour specialist advice and support is there to back up this general guidance to ensure, as far as possible, that clinical decisions are individualised and safe.


Anticipatory Prescribing Guidance for Frail Elderly Patients (PDF) Anticipatory Prescribing Guidance for Adults (PDF) Pan London Symptom Control Medication Authorisation and Administration Record (MAAR) (PDF)


  • Support for symptoms including breathlessness, fatigue, and fluid build-up. A full holistic assessment will be carried out, and referrals on to other services including rehab where appropriate
  • Support for psychological wellbeing- an assessment will be carried out and linking with other services including emotional support, complimentary therapies, spiritual support, carer assessment and support
  • Welfare support
  • Assessment for equipment and care
  • Advance care planning and creation of Universal Care Plan
  • Assessment for and guidance around use of sub-cutaneous furosemide to aid hospital avoidance
  • Coordination of care and close working alongside GP’s / DN’s and cardiology/ heart failure services to optimise treatment.
  • Support and coordination around deactivation of internal defibrillators as appropriate

Patients who are registered with either a Bromley or Croydon GP- including those in nursing homes:

Confirm that the patient meets at least one of the following referral criteria- if unsure please call to discuss:

  • Symptomatic (e.g. breathless at rest or minimal exertion) despite optimal treatment (NYHA III or IV)
  • Heart failure patients when hospital admission may not be the best/ only/ preferred option, or for whom palliative care (Hospice, hospital inpatient or community care) may be of benefit, either immediately or in the future
  • Optimal therapy but continuing or deteriorating physical and/or psychological symptoms.  Where only psychological issues are present consider referral to clinical psychology
  • Patient has advanced heart failure and their family or carer(s) would benefit from support, either immediately or in the future (including bereavement)
  • The patient has had two or more previous admissions for heart failure within the last 6 months.

GP referrals

For routine referrals to the palliative heart failure service please use the standard pan london form clearly highlighting it is for this service

For urgent referrals please mark it as urgent and it will be triaged by our spoc team accordingly.

GPs in Bromley: If you are not certain about a Heart Failure diagnosis and treatment options and whether someone is suitable for palliative care input you can refer in to the monthly palliative heart failure MDM for discussion with a heart failure consultant and the palliative care team – see link above.

Heart failure team referrals

Referrals will also be taken direct from the relevant heart failure teams.

Routine referrals:

The GP sends the referral form via EMIS

The referrals team will contact the patient/carer and discuss the referral and aims of our input- highlighting any issues that need addressing

The heart failure service will book in to see the patient/ carer at home or in the hospice as an outpatient if able.

The patient will either stay under the heart failure service depending on the level of complexity or be handed over to the community team for ongoing support if appropriate.

For urgent referrals:

The GP should use the standard referral form – these will be triaged by the team and contacted.

The community team will be the first team to see the patient and will refer into the heart failure service if needed

The heart failure service can also be contacted for advice.

When a patient is nearing the end of their life, health care professionals should be aware of those who have internal cardiac defibrillators and should be considering deactivation in a timely manner to prevent inappropriate shocks at the end of someone’s life, which are painful and distressing for the individual and those close to them. 

Palliative care can help with starting these conversations and coordinating the process. If someone is too unwell to attend the hospital for formal deactivation we have magnets available to take out for those who are dying and have an active device. 

If you have a patient with an active internal defibrillator ( either an ICD or a CRT-D) in situ and you are concerned they are approaching end of life- please consider referring to palliative care for support with conversations around deactivation. If the patient has a Bromley or Croydon GP please consider referral to the Palliative heart failure service at St Christopher’s.  Please see the guidance that we follow and if you have questions or are unsure whether to refer someone please call the hospice for advice.

Guidelines for deactivating implantable cardioverter defibrillators (ICDs) in people nearing the end of their life

This website hosts the PANG Palliative Care Guidelines developed by a collaboration of UK Health organisations. Additional material is provided by Dr Ian Back.

GPs in Bromley can refer into the monthly palliative heart failure MDM if they’re uncertain about a patient’s diagnosis and whether there is a need for sub cut furosemide to help direct correct treatment.

Email and the referral will get processed by the MDT co-ordinator for discussion.

You might also be interested in:

Palliative and End of Life Care Update for GPs

How to refer

Information and guidance on how to refer patients to St Christopher's

Hospice Care

What we offer

We’re here to help you live well, however that looks for you

Welcome to St Christopher's


A warm welcome to St Christopher's

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