Trinity is committed to providing accessible, high quality Specialist Palliative Care for everyone affected by an
advanced, progressive life limiting illness. Once a patient is referred to Trinity they are able to access the
Clinical Nurse Specialist team, In-patient Unit, Day Therapy Unit, Linden Centre, Lymphoedema Service and
Complementary Therapy.

As referrers, you can then ensure that your patient can access all or some of the services that they are entitled to.

Referral Criteria

Patient has a progressive, life limiting diagnosis
Has complex problems that cannot be adequately
addressed by current healthcare team
Has a reasonable understanding of their illness, where has
Accepts referral to specialist palliative care services

Patient referral form

We hope this newly designed referral form will help you refer patients easily and effectively.

Click here to complete the Specialist Palliative Care Referral Form - Microsoft
Please save and then e-mail the completed form to

Please attach any relevant documentation with the referral
i.e. list of current medication, relevant out-patient
clinic or hospital discharge letters, oncology annotations, etc.

If you have any queries regarding the referral process, please call the CNS Secretaries on 01253 359379.

If you would like to discuss a referral, please contact us on 01253 359379, and a member of the Community or Hospital
CNS Team would be happy to talk to you.

Contact details for key Palliative Care healthcare professionals

Trinity Palliative Care Clinical Nurse Specialist

Trinity Hospital CNS Team 01253 359379

Trinity Hospital CNS Team 01253 359379

Specialist Palliative Medicine Medical Advice Dr Gillian Au - Medical Director, Trinity Hospice
01253 358881

Dr Andrea Whitfield Hospital Consultant via secretary 01253 655672 Or via hospital switchboard
01253 300000

Community Consultant via secretary 01253 359203 Or via Trinity switchboard 01253 358881

Specialist Palliative Care Pharmacist Advice

Andrew Dickman via hospital switchboard 01253 300000

Out of Hours Advice for Healthcare Professionals

Trinity Hospice Advice Line 01253 359359

Brian House referral form

Please click here to download a pdf of the Brian House Referral Form
Please download and print the form.
Completed referrals
should be emailed to the Clinical Manager, Carol Wylde, at

Linden Centre referral forms

If you wish to self-refer to the Linden Centre's adult counselling services, please ring the Linden Centre on 01253

If you are a parent or carer wishing to refer a child or young person to the CASCADE counselling service at the
Linden Centre, please ring us on 01253 952582.

If you are a professional wishing to refer an adult, child or young person please complete this referral form and return it to the Linden Centre, or email it to

Lymphoedema referral form

Consultants, GPs or other health care professionals who wish to refer a cancer patient to our Lymphoedema Clinic
should complete this cancer-related referral form.

For non-cancer referrals, please complete this non-cancer-related referral form.

Admiral Nurse referral form

If you wish to refer to our Admiral Nurse for dementia support, either as a patient or a carer, please use this referral form.

Stay connected
with Trinity Hospice