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Dr David Plume MBBS DRCOG MRCGP

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Dr David Plume MBBS DRCOG MRCGP Macmillan GP Facilitator for Central Norfolk Quality Outcomes Framework PC1 Register of those in need of palliative care/support. – PowerPoint PPT presentation

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Title: Dr David Plume MBBS DRCOG MRCGP


1
  • Dr David Plume MBBS DRCOG MRCGP
  • Macmillan GP Facilitator for Central Norfolk

2
  • What is the GSF and why is it important?
  • When should we be using the GSF and where will I
    come across it?
  • What do we practically need to be doing to set up
    a good meeting?
  • What benefits are there for me or my practice?
  • Where is GSF heading?
  • Where can I get more information?

3
  • 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.

4
  • 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.

5
  • 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.

6
  • 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.

7
  • 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

8
  • Nominated co-ordinator
  • Organise PHCT meetings
  • Supportive care register.
  • Documentation is complete and up to date
  • Also co-ordination of MDT.

9
  • To ensure each patient has their symptoms,
    problems and concerns
  • Assessed
  • Recorded holistically
  • Discussed
  • Action plan

10
  • 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

11
  • The primary healthcare team is committed to
    staying up to date with skills and information
    relevant to end of life care of their patients.

12
  • Emotional
  • Practical
  • Bereavement
  • Staff support
  • Carer breakdown is the key factor in prompting
    institutional care for dying patients

13
  • 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

14
  • Patients on the last days of their life are cared
    for appropriately using the Liverpool Care Pathway

15
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16
  • complicated
  • time consuming
  • not worth the time/cost
  • we are doing well already
  • more time spent in meetings
  • we havent had any complaints

17
  • 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
  • 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
  • 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

18
  • 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

19
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20
  • No one expects this to happen overnight!
  • This should be an organic process which works
    with what you are already doing, at a pace which
    is appropriate for you and your practice.

21
  • 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.

22
  • Ideally Practice Manager/Deputy.
  • Logistics of setting up the meeting
    infrastructure, and inviting everyone.
  • Completing/updating the forms

23
  • Aim to improve the flow of information
  • Advance Care Planning/proactive care/post death
    analysis
  • Measurement and audit, to clarify areas for
    future improvement at patient, practice PCT and
    network level.
  • Single GP Meetings

24
  • SCR1-Summary sheet
  • SCR2-Front Sheet and OOH Handover

25
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26
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27
  • Changes are afoot!
  • Norwich PBC Consortium working on new versions of
    OOH Forms, DNAR Forms etc.
  • For more info speak to Dr Nick Morton

28
  • 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.

29
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30
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31
Dr G. Norwich- 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
32
  • If you reduce inappropriate admissions then
    hopefully there would be an financial benefit
    from this!

33
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34
  • 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.

35
  • First Gear (C1/C2)
  • QOF
  • Second Gear (C3,C4,C5)
  • Beyond QOF
  • Third Gear (C6,C7)
  • Fourth Gear (Sustain, Embed, Extend)

36
  • 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

37
  • What is the GSF and why is it important?
  • When should we be using the GSF and where will I
    come across it?
  • What do we practically need to be doing to set up
    a good meeting?
  • What benefits are there for me or my practice?
  • Where is GSF heading?
  • Where can I get more information?

38
(No Transcript)
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