Transcript Gold Standards Framework

Palliative Care Initiatives in Primary Care
The Gold Standards Framework.
Dr David Plume MBBS DRCOG MRCGP
Macmillan GP Facilitator for Central
Norfolk
The Gold Standards Framework (GSF)
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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.
GSF in Primary Care
• 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.
GSF in Primary Care
• 5 Goals
– Patients symptoms are controlled
– Preferred place of care and death established
– Security and support
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Better advance care planning
Information
Less fear
Fewer admissions
– Carers supported, informed, involved and empowered.
– Staff confidence, communication and co-working improved.
GSF in Primary Care
• 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.
C1- Communication
• 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
C2-Co-ordination
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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.
C3-Control of Symptoms
To ensure each patient has their symptoms,
problems and concerns:
• Assessed
• Recorded
holistically
• Discussed
• Action plan
C4-Continuity of Care – Out of Hours
1) OOH provider aware of the patient, their
diagnosis, current management and
particular problems, concerns and wishes.
2) Anticipation of care, equipment and drug
needs to prevent:
1) Crisis situations
2) Inappropriate/avoidable admissions to hospital
C5-Continued Learning
The primary healthcare team is committed to
staying up to date with skills and information
relevant to end of life care of their patients.
C6-Carer Support
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Emotional
Practical
Bereavement
Staff support
Carer breakdown is the key factor in prompting
institutional care for dying patients
Main Needs of Carers
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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
C7-Care of the Dying – Terminal Phase
Patients on the last days of their life are cared
for appropriately using the Liverpool Care
Pathway
GSF in Primary Care
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“complicated”
“time consuming”
“not worth the time/cost”
“we are doing well already”
“more time spent in meetings”
“we haven’t had any complaints”
GSF 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 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
GSF In Primary Care
• 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 2008;58:256-263
• “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”
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Dr G. Norwich
GSF in Primary Care-Where will I come upon it?
• 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
GSF In Primary Care-When?
LCP
GSF- 1 yr
PPoC-Never to early
GSF in Primary Care
• 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.
SCR1 Form
Summary of Palliative Care Patients
Name of patient
Name of Carer
Diagnosis
(+code)
G
P
D
N
Problems/ Concerns
Anticipated
needs
Information
given/ Carer
issues
DS
1500
date
Macmillan
Nurse/
CNS
Hospi
ce/
SPC
OOH
Handover
Form
Date
sent
Preferred
place of
Care
stated
+ date
Actual
place
death
+ date
Berea
vement
Care
Crisis Events/
Notes
SCR2 Form
SCR 2
PATIENT SUMMARY
NHS Number
Name
Address
Diagnosis / Active Current Problems
Postcode
Tel No
DOB
Patient Aware
Carer Aware
Family / Carer Contacts
Surgery
GP
SPC/ Macmillan
Case Manager
DN
Current Care Package
Tel
Personnel Involved
Consultant
Hospital
Other
Present Treatment
Base Line Obs
Current Medication
Priorities (Problems and concerns)
Other Issues (Rescue drugs held, out of hrs care, before considering admission try etc)
Risk Assessment for Home Visit (Pets, parking, access to house, local area, patient/cohabitants)
Preferred Place of Care (Dated)
Comments
Signature
Date
Modified SCR2 Solihull © Gold Standards Framework March 2006
Y/N
Y/N
The Forms
• Changes are afoot!
• Norwich PBC Consortium working on new
versions of OOH Forms, DNAR Forms etc.
• For more info speak to Dr Nick Morton
GSF In Primary Care-Central Team
• 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.
GSF in Primary Care
• 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.
GSF In Primary Care-More Information
• 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.syringedriver.co.uk
• E-Mail Elizabeth or I
• [email protected]
• [email protected]