1. West Essex End of Life Care Thursday 13th July 2017 Dr Christine Moss and Dr Andy Morris

2. What do we want to achieve?
People who are approaching EoL are identified early
Access to support 24 hours a day, 7 days a week
People die in their preferred place of death and have a positive experience of palliative and end of life care
People only admitted to hospital when appropriate and their stay in hospital is for the shortest time possible
All providers work collaboratively with each other to provide palliative and end of life care that is personalised, integrated, and according to their preferences
Staff feel confident and capable of delivering high quality palliative and end of life care, and are trained to do so

3. Palliative and End of Life National Ambitions

4. PAH’s progress
PAH update:
Strategy sign off
Immediate CQC recovery plan
Staffing: medical, nursing
NHSI collaborative
Ceilings of care
Oversight meetings

5. Where are we now? Building trust
Moving towards an agreed programme of work
Different conversation
Equal status
Honest consideration
Team thinking
Thinking as joint stakeholders
Optimistic

6. The Challenges Locally and strategic direction
West Essex GP Practice EOL Register sizes:
Year
West Essex Practices average
UK practice average
2014/15
0.31%
2015/16
0.34%

7. The Challenges Locally and strategic direction

8. The Challenges Locally and strategic direction
Advanced Care Planning
How to start earlier
The role of ceilings of treatment
NICE multi morbidity guidance
2. Correct completion of DNACPR
3. How can we all work more effectively together

9. The Challenges Locally and strategic direction
Medicines Management
Injectable opiates first line is Morphine (not diamorphine)
Do not use fentanyl patches on opiate naive patients
Choose quantities with care… Beware too much or too little!
Future developments
Work with STP partners
Development of a read/write real time electronic record easy to access and use by any provider with access to patients - improved education and training opportunities
Public involvement and awareness using wider Comms strategy
Medicines - (Not even 12 mcg. Start with buprenorphine. Beware of the change from patch to injectable as fentanyl has a long half life)
IT system - (This will also allow us to track where we are doing well or not so well)

10. The Challenges Locally and strategic direction
Local vs STP
Local
Integration (Acute, Primary Care, Hospice, Community)
Wrapping services (Community, OOH, Social care)
STP
Single electronic record
Communications and training; up skilling the workforce
Moving to seamless moderate frailty to EoL
Managing confidence of the patient, the family and the professionals