Presentation on theme: "Dr David Plume MBBS DRCOG MRCGP"— Presentation transcript:
1Dr David Plume MBBS DRCOG MRCGP Palliative Care Initiatives in Primary CareThe Gold Standards Framework.Dr David Plume MBBS DRCOG MRCGPMacmillan GP Facilitator for Central Norfolk
2“Systematic approach” “Framework” “Optimisation” The Gold Standards Framework (GSF)“Systematic approach”“Framework”“Optimisation”“Gold Standard” care for those nearing the end of life in the community.Quality not quantityAny end stage disease process.Grass roots initiative from Primary care (Dr Kerri Thomas), in 2001, to improve generalist palliative care and collaboration with specialists.
31 Chance to get this right 3 Processes. GSF in Primary Care1, 3, 5, 71 Chance to get this right3 Processes.IDENTIFY those in need of palliative care input/supportASSESS their needs, symptoms, preferences/issuesPLAN the care of these patients, with these patients.
45 Goals Patients symptoms are controlled GSF in Primary Care5 GoalsPatients symptoms are controlledPreferred place of care and death establishedSecurity and supportBetter advance care planningInformationLess fearFewer admissionsCarers supported, informed, involved and empowered.Staff confidence, communication and co-working improved.
57 Tasks C1 Communication C2 Co-ordination C3 Control of symptoms GSF in Primary Care7 TasksC1 CommunicationC2 Co-ordinationC3 Control of symptomsC4 Continuity including OOHC5 Continued learningC6 Carer supportC7 Care in dying phase.
6Prevents role blurring Critical incidents C1- CommunicationMulti-professional discussion around difficult issues e.g. preferred priorities of care, child bereavement, informal carer support.Prevents role blurringCritical incidentsAvoidance of crisis intervention
7Nominated co-ordinator Organise PHCT meetings C2-Co-ordinationNominated co-ordinatorOrganise PHCT meetingsSupportive care register.Documentation is complete and up to dateAlso co-ordination of MDT.
8To ensure each patient has their symptoms, problems and concerns: C3-Control of SymptomsTo ensure each patient has their symptoms, problems and concerns:AssessedRecorded holisticallyDiscussedAction plan
9Anticipation of care, equipment and drug needs to prevent: C4-Continuity of Care – Out of HoursOOH 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 situationsInappropriate/avoidable admissions to hospital
10C5-Continued LearningThe primary healthcare team is committed to staying up to date with skills and information relevant to end of life care of their patients.
11Emotional Practical Bereavement Staff support C6-Carer SupportEmotionalPracticalBereavementStaff supportCarer breakdown is the key factor in prompting institutional care for dying patients
12Recognising their value and importance Involving them Informing them Main Needs of CarersRecognising their value and importanceInvolving themInforming themTraining themSupporting themHelping them to adopt coping strategies – internal/externalWatching for personal health problems
13C7-Care of the Dying – Terminal Phase Patients on the last days of their life are cared for appropriately using the Liverpool Care Pathway
14“not worth the time/cost” “we are doing well already” GSF in Primary Care“complicated”“time consuming”“not worth the time/cost”“we are doing well already”“more time spent in meetings”“we haven’t had any complaints”
15GSF In Primary Care“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 07The 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
16GSF In Primary CareI 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 07Implementing 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 2008;58:“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
17End of life care developments. GSF in Primary Care-Where will I come upon it?3 ThreadsGSF in Primary CareThe focus of todayGSF in Care HomesDoes what it says on the tin!Push to get CH managers into GSF meetingsPhase two studies showed reduced crisis admissions by 12% and deaths in hospital by 8%End of life care developments.Advance care planningAfter Death Audit analysis tools
18GSF In Primary Care-When? LCPGSF- 1 yrPPoC-Never to early
19The reality when setting up can be very simple! GSF in Primary CareThe reality when setting up can be very simple!1 designated admin lead1 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.
22For more info speak to Dr Nick Morton The FormsChanges are afoot!Norwich PBC Consortium working on new versions of OOH Forms, DNAR Forms etc.For more info speak to Dr Nick Morton
23Registration with the Central GSF team GSF In Primary Care-Central TeamRegistration with the Central GSF teamNot obligatory to get QOF moniesDedicated electronic supportAccess to PDA toolsAccreditation when availableSource for PCT/SHA when looking at uptake.
24Quality Outcomes Framework GSF in Primary CareQuality Outcomes FrameworkPC1 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 QOFAs of 200750% of practices are registered with the Central Team2/3 of practices claim to be using GSF90% of practices are claiming palliative care QOF pointsPush now is not for coverage but depth and consolidation.Accreditation for practices, quality assurance.
25The National Council For Palliative Care: http://www.ncpc.org.uk GSF In Primary Care-More InformationGold Standards Framework Central Team Site:The National Council For Palliative Care:My GP Facilitator Blog Site!Elizabeth or I