How to refer

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

Clinicians may refer using the form below or by phoning 020 8768 4582 (9am to 5pm Monday to Friday) or 020 8768 4500 (24 hours). Please telephone for all emergency referrals.

Downloads

• All age Pan-London Specialist Palliative Care Referral form (Word)
• For completing digitally and emailed via NHS Mail
• All age Pan-London Specialist Palliative Care Referral form (PDF)

Once completed please email to st.christophers@nhs.net.

Please make sure that you send this form using a secure email account such as NHS email.

All referrals to St Christophers will require the following information to be completed with the following:

ESSENTIAL CRITERIA:

• Referrer’s name and contact details
• Demographics (Essential Patient Details)
• GP Details (Name/Surgery Address)
• Consent (Has this referral been discussed with the patient?)
• Reason for referral
• Further details of current palliative care problems
• Primary Diagnosis
• Brief history of Diagnosis(es)/key treatments
• Other Past Medical and Psychiatric history

DESIRABLE CRITERIA:

• Prognosis
• Allergies
• NHS number
• Protected characteristics (Ethnicity, Sexual orientation, Gender, Disability)
• NOK / main contact
• Up to date medication list

Please note:

• If any of the essential criteria boxes on the form are left blank or state “see attached” our admin team will return this and request that the form be completed to our minimum requirements
• If any of the desirable criteria boxes on the form are left blank – we shall process the referral but also write back and request that you send this information to us
• The form WILL NOT be reviewed by a clinical member of the team before it is returned
• Please do not cut and paste from hospital records and please summarise on the referral form any attached information

If you would like to integrate our referral form into your electronic patient record system, please email communications@stchristophers.org.uk

We welcome discussion with community or hospital colleagues about cases where they need urgent advice, are uncertain whether to refer or need help signposting to other services. Advice for professionals from senior medical and nursing staff is available 24 hours a day (020 8768 4500). Anticipatory prescribing for end of life guidance can be found here.