1. Living and Dying Well A perspective from Primary Care

2. NHS Grampian Palliative Care Strategy Group

3. Christopher Columbus

4. 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%

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

7. 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

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

9. Symptom Checklist

10. Symptom Checklist (2)

11. Symptom Control algorithm

12. Nursing Dependencies

13. Core Model

14. 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

15. 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

16. Challenges Roll out and embed the programme Electronic format Maintain impetus

17. Negative Factors Time H 1 N 1