Why contingency planning? & what to consider Patient care Any patients I see, who may need the support of other services: OOHs, 111, A&E, Amb & Community GMS contract Frailty reviews SCR & SCRAI (Additional Information) Maintain the GP record ready for DCR (Detailed Care Record) sharing Open to further suggestions once familiar…

Wide range of contingency planning GMS – K.I.S.S. Any patients I see, who could deteriorate OOHs/over the weekend Frailty/LTCs with an I.C.E. (In Case of Emergency) plan Patients with communication problems Palliative Care Beyond GMS ...Geriatric assessment… -> Dr Esme Gates At it’s simplest… could be any patient…. ESME then How…

“In an ideal world DNACPR will be discussed earlier “In an ideal world DNACPR will be discussed earlier. In my DNACPR utopia, patents will be bringing the subject up with their doctor! That takes confidence and knowledge, and a change in attitude of talking about death in us all. I'm working on it.” Kate Masters (daughter of Janet Tracey)

Spectrum of Complexity Easiest

Frailty “Homeostenosis” eFI/Rockwood/Edmonton Inability to withstand stressor owing to cumulative deficits and restricted physiology of ageing. Stressor could be illness, fall, inadequate POC eFI/Rockwood/Edmonton Think frailty score not age

How does frailty present? Frail but not sick Frail Fallers Frail and sick but can be managed at home Frail and sick and clinically needs to be in hospital (for investigation/treatment) In the terminal stages of frailty and probably should never have been sent to hospital Dying patients. Dr John Butler, consultant geriatrician, University Hospital Wales

eFI 0-0.12 eFI > 0.36 eFI 0.13-0.24 eFI 0.25 – 0.36

Helpful questions What matters most to you day to day? What are your priorities if you get unwell? Have you considered how you would manage at home if you weren’t able to care for yourself? Would you ever consider living elsewhere ? Have you discussed resuscitation with anyone before? Would you like to tell me how you feel

Contingency planning Why? How? SCRAI (SCR & Additional Information) dataset Show SCR & SCRAI view Training & Communications to follow Local template (S1 & EMIS) developed If contingency planning then how? Making best use of SCRAI dataset

I showed this last year, the Old way, visit, consent, record in GP system, template, tidy notes, printed paper/fax/email

Aim, to do away with paper

If sharing contingency plans, then How? Consent clear, simple & explicit Template - easy to use & clinically sensible Record the review into GP record No double-entry Some house-keeping Shared electronically Subsequent reviews kept up to date Fulfils the contract As the last slides showed

SCRAI dataset meds and allergies + reason significant medical history (past & present) anticipatory care information (such as I.C.E. plans) end of life care information Immunisations Contains all the information needed for contingency planning: With consent, additional info shared from the GP record: Why would we use any other system?

SCRAI dataset for contingency planning Easy of use Bonus DCR prep: using SCRAI will train GPs (incl. locums) to maintain the record fit for DCR sharing integrated within GP system, national dataset, local template : National system, contracted with providers

Working in the dark Then when our colleagues see our patients

And gain consent to view

Working better with additional information Meds and allergies + Significant medical hx Anticipatory care info (such as I.C.E. plans) EoL care info Working better with additional information It should be safer

SCR view S1 (but also EMIS) What do it look like? Allergies and Meds

SCRAI view Diagnosies, PMHx, codes and associated

SCRAI view Preferences and I.C.E. plans

Training required Use of the template Check associated text esp for 3rd party info Edit this as appropriate Easy, but needs some training Training now, will help with DCR (now & future)

Universal template - to cover all uses SECTIONS (designed for clarity & flow) Introduction/Consent Patient / NOK / Carers’ Info I.C.E. / Emergency Health Plan Functional Status / Observations Advance Care Planning with SCRAI consent: when you use the template, the info is recorded in the GP record & shared. Communications about training to following I am also happy to come out to practices to help

TEMPLATE - 1st Page: Introduction

2nd Tab: Patient / NOK / Carers’ Info

3rd Tab: ICE / Emergency Health Plan

4th Tab: Functional Status / Observations

5th Tab: Advance Care Planning

1st Page: Introduction

2nd Tab: Consent

3rd Tab: Patient / NOK / Carers’ Info

4th Tab: ICE / Emergency Health Plan

5th Tab: Functional Status / Observations

6th Tab: Advance Care Planning

Working in the dark

Working better with Additional information