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<h3>Introduction</h3> Residents with advanced frailty living in care homes often have significant palliative care needs. While most are managed effectively by care home staff and primary care, complex cases require specialist input and closer collaboration across services. The Midhurst Palliative Care Frailty and Nursing Home Project was established to improve integration between specialist palliative care, primary care, community nursing, and care home teams in rural West Sussex. The project also aimed to strengthen advance care planning, improve symptom control, and deliver an education programme to enhance staff confidence and capability. <h3>Methods</h3> Following an initial six-month pilot, the project expanded to seven care homes supported by three GP surgeries. Weekly multidisciplinary team (MDT) meetings are held remotely as part of the Enhanced Health in Care Homes (EHCH) framework. Residents are registered on either an MDT advice caseload and those with specialist palliative needs receive face-to-face input. Data collection includes diagnosis, medication review, advance care planning (ACP), preferred place of death (PPOD), hospital admissions, and patient reported outcome measures using the Integrated Palliative care Outcome Scale (IPOS). Macmillan staff deliver regular educational sessions covering symptom management, communication, and end-of-life care. <h3>Results</h3> A total of 184 residents has so far been supported (40% advice; 60% face-to-face). Medication reviews have been completed in 97% of cases, and ACP discussions have taken place in 88%. In 16 cases of acute deterioration MDT intervention has directly avoided admission. IPOS scores demonstrate a reduction in symptom burden following intervention. Feedback from patients, families, GPs, and care home staff (using the Friends & Family Test) indicates improved communication, symptom management, and staff confidence following the education programme. <h3>Conclusion</h3> The project demonstrates that structured collaboration between specialist palliative, primary care, community and care home teams, supported by targeted education, improves patient outcomes, reduces hospital admissions, and enhances workforce skills.