End of Life Care LCS Event 19 th March 2014 Royal College of General Practitioners 30 Euston Square Dr. Patrick McDaid

Aim of LCS To increase identification and awareness of those in their last year of life. Optimise their care in the here and now Plan with them for their future A secondary objective is to reduce avoidable hospital admissions/deaths/spend Do this well and deaths in hospital will reduce and then plateau

Requirements of LCS The LCS reimbursed GPs practices to meet with their EoLC facilitator to review deaths and draw up their Actions Plans. This annual so the Action plan develops To start using CMC To attend an educational event.

A total of 439 people were described in the End of Life Care After Death Analysis 2013, with 217 from Camden practices and 222 from Islington practices. Of the deaths reviewed, approximately 40% were on a palliative Care register at the time of death, in both Camden and Islington. Deaths included in the audit: by area 4

Palliative care register: possibility of inclusion Could any more have been on Palliative Care registers? GPs thought so. 50% for Islington patients and 55% for Camden. …. with hindsight, eligible for inclusion on the register.

Identification leads to the opportunity for appropriate end of life discussions. Forty five percent of Islington patients and 32% of Camden patients included in this audit had an end of life care discussion with their GP prior to their death. End of life care discussion 6

Increased discussions can reasonably be expected to lead to increased recording of wishes. A third of Islington patients included in this audit had their preferred place of death recorded, just under a quarter for Camden. Place of death: preferences 7

If preferences are known they are more likely to happen. In Islington 10% less people died in hospital in comparison to Camden In keeping with recording the preferred place of death Place of death: by area 8

Feedback from carers: factors associated with positive or negative EoL experience for carers and relatives 9 Positive factors Being kept informed and involved (including regular contact with patient’s GP and secondary services and being prepared for death) Perceived “peacefulness” of the death Family presence at the death Dignity of the patient at end of life Perceived support and feeling cared for by services Good comfort and pain management Negative factors Shock and disbelief due to unanticipated / sudden death Relatives not necessarily fully aware of patient’s status (due to lack of communication)

What’s emerged from the deaths reviewed? 3 Good points Identification Camden compared well against National GSF benchmark (at or above) for proportion of deaths that were on a Palliative Care register. If preferred place of Care if dying is “Care home” it is achieved almost 100% of the time. Well done care Homes and Care Home GPs Prescribing at End of Life - GPs generally felt that this was co-ordinated well in the cases reviewed

What’s emerged from the deaths reviewed? 3 areas for improvement Identification – in the opinion of GPs reviewing these deaths, 55% of the deaths that were not on a register could have been Non Cancer Deaths – more challenges than for Cancer deaths getting these people on a register and having discussions. There is scope, with LTC management for addressing this. End of Life conversations Keep an eye out for opportunities Offer but don’t insist. Record