Living and Dying Well A perspective from Primary Care.

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Presentation transcript:

Living and Dying Well A perspective from Primary Care

NHS Grampian Palliative Care Strategy Group

Christopher Columbus

Tools/Triggers Palliative Care RegisterN=72 Cancer 100% Non-Cancer 79% Gold Standards Framework Scotland85% Directed Enhanced Services88% Integrated Care Pathway Liverpool Care Pathway 10% Alternative 3% Assessment tools32%

Model of Care Centred on Palliative Care Register and GSFS Extend these to –Non cancer patients –All care settings Link with DES and ePCS

Model of Care (2) Incorporate assessment and prognostication Start ‘up-stream’ but include ‘end of life’ Facilitate advance care planning Integrate recommendations from short life working groups

Prognostic tools Palliative Performance Scale (PPS) Palliative Prognostic Index (PPI) Biological markers

Symptom Checklist

Symptom Checklist (2)

Symptom Control algorithm

Nursing Dependencies

Core Model

Concurrent activities ‘Just in Case’ box pilot in Banff and Buchan The Grampian Palliative Care Network of Community Pharmacists Out of Hours Care in the home environment – 2 pilots

Consultation Numerous primary care teams GP cancer and palliative care leads RCGP study day Care Home/Home care professionals (nursing and social care) Care Home Managers Dementia Study Day LTC Collaborative Marie Curie Out of Hours Service

Challenges Roll out and embed the programme Electronic format Maintain impetus

Negative Factors Time H 1 N 1

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