Palliative Care

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Palliative Care

• Lynn Hopwood
• Macmillan /Specialist Palliative Care Nurse Team
  Leader

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• It is the right of every person with a life
  threatening illness to receive appropriate
  palliative care wherever they are

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QOF

• The practice has a complete register available of
  all patients in need of palliative care /support
• The practice has regular (at least 3 monthly)
  multidisciplinary case review meetings where all
  patients on the palliative care register are
  discussed
• 3 points each

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Gold Standards Framework(GSF)

• Aims to develop a practice based system to
  improve the organisation and quality of care for
  patients in the last stages of life in the
  community, so that more live and die well in
  their preferred place of care(PPC)

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GSF

• An evidence based programme to help improve
  planning of palliative care in the community
• Developed from primary care for primary care
• Currently covers approx ¼ of the population
  across the UK as a means to improve care for
  dying people with any advanced illness in the
  community
• Prevention of unnecessary hospital admissions
• Audit will enable the commissioning of better
  local services

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• Previous experiences elsewhere, have shown easier
  to start with cancer patients then spread across
  other diagnoses
• Improve outcomes for all patients with a
  life-limiting illness
• Cost effective

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GSF Toolbox

• Register of palliative care patients
• LCP
• PPC
• OOH proforma
• Supportive network

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LCP

• Developed in Liverpool by John Ellershaw and team
• Evaluated well
• Slowly introduced into Bury over approx. 4yrs
• To be introduced into nursing homes
• National evaluation scheme

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PPC

• PPC tool developed in Lancs and S.Cumbria cancer
  network
• Concept good
• Needs more robust evaluation

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Basic principles

• Identify patients
• Assess their needs, preferences and address
  patient issues
• Plan of care involving patient and those who are
  caring for them

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Goals

• Symptom control
• PPC
• Security/support
• Carer support
• Staff confidence

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Key Tasks 7 Cs

• Communication
• Co-ordination
• Control of symptoms
• Continuity (OOH)
• Continued learning
• Carer support
• Care in the dying phase

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Benefits

• Consistency of approach to management of
  palliative care patients in all practices
• Improving patient/carer experience/ satisfaction
• Improved communication
• Choice where possible
• Delivering evidence based high quality care
• Partnership working
• Proactive planning
• Patient focused

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Live with diagnosis /- supportive care
Cure
Death
Treatment
Remission
Diagnosis
Bereavement
Live with diagnosis supportive/ palliative care
Palliation
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SPCNT involvement

• At any point from diagnosis through to dying
  phase where the patient has complex specialist
  palliative care needs that cannot be managed by
  the generic team
• Telephone advice to health and social care
  professionals
• Brief interventions
• Longer term interventions

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Current situation

• Slippage monies from GMCCN for GSF co-ordinator
  one year
• NE sector team to work with Nursing homes to
  provide palliative care education and introduce
  LCP (one year funding)
• Preparation for the above roles are ongoing
• OOH proforma
• Time and resources

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Potential pitfalls

• Resources
• 4 SPCN/Macmillan Nurses
• GSF co-ordinator
• Complexity of number of tools
• Identifying keyworker
• Access to palliative care inpatient /day patient
  care for patients with non-malignant disease
• Access to specialist palliative care beds
• Bereavement support
• When to add patients to register

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Suggested criteria for inclusion on register

• Need for supportive and palliative care
• DS1500
• Clinical indicators eg stage 3-4 heart failure,
  multiple secondaries in cancer

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Next steps

• Appoint GSF co-ordinator
• Contact GP surgeries to ascertain interest
• Plan, implement and support practices

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Phased approach to implementation

• Meet with co-ordinator, plan meeting, register
• Review assessment tools, OOH handover form,
  education audit, reflective practice
• Implementation of care and support with
  patient/families
• Sustain, embed, extend

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Future developments

• Addressing Nice supportive and palliative
• care guidance
• NE sector OOH specialist palliative care advice
  line
• Availability of Specialist palliative care
  face-face contact Mon-Sun 9-5
• Bury Cancer patient/carer partnership

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Thank you for listening.