Dr David Plume MBBS DRCOG MRCGP

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• Dr David Plume MBBS DRCOG MRCGP
• Macmillan GP Facilitator for Central Norfolk

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• Systematic approach
• Framework
• Optimisation
• Gold Standard care for those nearing the end of
  life in the community.
• Quality not quantity
• Any end stage disease process.
• Grass roots initiative from Primary care (Dr
  Kerri Thomas), in 2001, to improve generalist
  palliative care and collaboration with
  specialists.

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• 1, 3, 5, 7
• 1 Chance to get this right
• 3 Processes.
• IDENTIFY those in need of palliative care
  input/support
• ASSESS their needs, symptoms, preferences/issues
• PLAN the care of these patients, with these
  patients.

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• 5 Goals
• Patients symptoms are controlled
• Preferred place of care and death established
• Security and support
• Better advance care planning
• Information
• Less fear
• Fewer admissions
• Carers supported, informed, involved and
  empowered.
• Staff confidence, communication and co-working
  improved.

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• 7 Tasks
• C1 Communication
• C2 Co-ordination
• C3 Control of symptoms
• C4 Continuity including OOH
• C5 Continued learning
• C6 Carer support
• C7 Care in dying phase.

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• Multi-professional discussion around difficult
  issues e.g. preferred priorities of care, child
  bereavement, informal carer support.
• Prevents role blurring
• Critical incidents
• Avoidance of crisis intervention

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• Nominated co-ordinator
• Organise PHCT meetings
• Supportive care register.
• Documentation is complete and up to date
• Also co-ordination of MDT.

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• To ensure each patient has their symptoms,
  problems and concerns
• Assessed
• Recorded holistically
• Discussed
• Action plan

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• OOH provider aware of the patient, their
  diagnosis, current management and particular
  problems, concerns and wishes.
• Anticipation of care, equipment and drug needs
  to prevent
• Crisis situations
• Inappropriate/avoidable admissions to hospital

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• The primary healthcare team is committed to
  staying up to date with skills and information
  relevant to end of life care of their patients.

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• Emotional
• Practical
• Bereavement
• Staff support
• Carer breakdown is the key factor in prompting
  institutional care for dying patients

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• Recognising their value and importance
• Involving them
• Informing them
• Training them
• Supporting them
• Helping them to adopt coping strategies
  internal/external
• Watching for personal health problems

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• Patients on the last days of their life are cared
  for appropriately using the Liverpool Care Pathway

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• complicated
• time consuming
• not worth the time/cost
• we are doing well already
• more time spent in meetings
• we havent had any complaints

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• care for people near the end of life is a
  vitally important area of health and social care,
  a litmus test for other areas and a humanitarian
  and economic imperative. GSF Programme Position
  Summary Paper for NHS EOLC Programme Nov 07
• The college is pleased to support the Gold
  Standards Framework, which is having a huge
  impact on the quality of care at the end of
  patients' lives. The values expressed in this
  framework are central to the College ethos of
  Knowledge with Compassion.Dr Graham Archard,
  Vice Chairman Royal College of General
  Practitioners, March '05

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• I fully support the further rollout of GSF within
  primary care. I have also been impressed by the
  adaptation of GSF for use in care homes, and the
  benefits that this can bring to patient care.
  Professor Mike Richards National Cancer Director
  and Chair of the Advisory Board on End of Life
  Care Oct 17th 07
• Implementing the framework enabled processes of
  communication associated with high quality
  palliative care in general practice, but there
  was variation how this worked in individual
  teams. Interpersonal relationships and
  communication in primary palliative care. Kashifa
  Mahmood-Yousef etc al. BJGP 200858256-263
• this was probably the best thing we have done as
  a practice as long as I can remember, and
  certainly the thing that has had the greatest
  impact on the care we deliver
• Dr G. Norwich

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• 3 Threads
• GSF in Primary Care
• The focus of today
• GSF in Care Homes
• Does what it says on the tin!
• Push to get CH managers into GSF meetings
• Phase two studies showed reduced crisis
  admissions by 12 and deaths in hospital by 8
• End of life care developments.
• Advance care planning
• After Death Audit analysis tools

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• The reality when setting up can be very simple!
• 1 designated admin lead
• 1 meeting, ideally once a month, the duration of
  which will depend on the practice.
• 2 Forms, one of which even doubles up as the OOH
  handover form!
• Try to invite a MDT-DN/CSPCN/OT/Physio/SW, and
  Care Home Manager if appropriate.

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• Changes are afoot!
• Norwich PBC Consortium working on new versions of
  OOH Forms, DNAR Forms etc.
• For more info speak to Dr Nick Morton

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• Registration with the Central GSF team
• Not obligatory to get QOF monies
• Dedicated electronic support
• Access to PDA tools
• Accreditation when available
• Source for PCT/SHA when looking at uptake.

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• Quality Outcomes Framework
• PC1 Register of those in need of palliative
  care/support.
• PC2 Regular MDT case review meetings where all
  the patients on the palliative care register are
  discussed.
• Beyond QOF
• As of 2007
• 50 of practices are registered with the Central
  Team
• 2/3 of practices claim to be using GSF
• 90 of practices are claiming palliative care QOF
  points
• Push now is not for coverage but depth and
  consolidation.
• Accreditation for practices, quality assurance.

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• Gold Standards Framework Central Team Site
  http//www.goldstandardsframework.nhs.uk
• The National Council For Palliative Care
  http//www.ncpc.org.uk
• My GP Facilitator Blog Site! http//www.syringedri
  ver.co.uk
• E-Mail Elizabeth or I
• Elizabeth.Stallwood_at_norfolk-pct.nhs.uk
• dplume_at_nhs.net