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This area's hospital death rate is higher than the national average; in 2019, 49% of all deaths were in hospital (compared to 22% at home, 21% in a care home, and 7% in a hospice setting). Plans to reduce hospital admissions/ deaths evolved as an Out of Hospital (OOH) model in partnership between the hospice, CCG and community health provider.The model aims to strengthen community-based care pathways through proactive multi-disciplinary case management at a Primary Care Network (PCN) level that anticipates additional health and social care needs to reduce crisis. Additionally, work has started on the development of a Care Coordination Centre for specialist/complex cases that can no longer be dealt with at PCN level.The model required a new way of working for the hospice Clinical Nurse Specialist (CNS) Service. The hospice developed a detailed leadership programme to equip the CNSs to have the confidence and skills to be assigned to a Primary Care Network and attend MDT meetings in their locality. In particular, the proposed OOH model was shared with the team, and they were asked to present the model (and their role in it) back to the Senior Leadership Team (SLT). Results This has resulted in the CNS team developing their presentation skills and confidence levels before moving to the PCN aligned model. The CNS team showed their understanding of the model, and SLT were able to 'correct' where appropriate; it has been noted by the CCG that hospice staff have grasped the model and adapted quicker than non-hospice colleagues. ConclusionThe OOH model is a long-term project, but progress has helped the hospice to free up hospital beds and lower the numbers of people aged 65+ from dying in hospital [974 (18/19), 1,052 (19/20), 843 (20/21), 822 (21/22)].

plans are only useful if accessed at times of crisis when CH staff feel challenged to avoid risk. Aim To introduce a system to improve communication of TEPs between GP, Hospice, Hospital, CH teams avoiding repetition and dependency on electronic systems. Methods Palliative care consultants worked with the Lead GP for CHs in one London borough to 1) integrate electronic record systems; 2) capture key data from conversations; 3) translate information to a patient specific colour coded format; and 4) ensure display and access of TEP by the CH staff in real time. This solution is being trialled over 3 months with the intention that people will receive care in the place they have requested and staff feel more supported. Results TEP generation through EMIS shows a large deficit in the current number of recorded TEPs: 69% of CH residents had TEPs, 32% were patients on the Gold Standards Framework with death anticipated <1yr. Working as part of a pilot project to facilitate excellent end-of-life care in CHs, data showed that the majority of residents/patients and their families are realistic about long-term future when given opportunity to engage in discussions about TEPs. Patients and families were keen to avoid hospital, but importantly wanted reassurance they would receive care that would maintain comfort and dignity. Case studies during this time indicated that TEPs were less likely to be adhered to out-of-hours with poor access to agreed TEPs in CH setting. Conclusion We believe a simple TEP chart generated by the GP, with information shared by the hospice, can be accessed by the CH team to help advocate for CH residents to receive the care and treatment they want.