1. End of Life Care in west Essex GP Audit outcomes
Dr Cemali Aksogut

2. Aim
Ongoing improvement in quality and accessibility of end of life care in keeping with the national Priorities for End of Life (EoL) Care.

3. National figures 1% of the population dies each year in the UK1
75% of deaths are from non-cancer/long-term/ frailty conditions2
85% of deaths occur in people over 652
54% die in hospital and 35% at home (18% home, 17% care home) 2
40–50% of those who died in hospital could have died at home (National Audit Office report, 2009)

4. West Essex CCG

5. Contact with Practices
Questionnaire
Telephone calls
Meetings

6. What works well Regular Gold Standard/Palliative care MDTs
Palliative care register
Good range of specialities attend MDTs
Emergency Drug box prescribing

7. What does not work so well
Not all patients have DNACPR, PPC or PPD or Advanced Care Plan (ACP)
Syringe Driver Prescribing
Lack of information in cases of suddenly deteriorating patient e.g. discharged from hospital new to care home without adequate end of life care services and support
Sharing of information e.g community/OOH
Care over night and during OOH
Different form to be completed for each service

8. Challenges Improving Palliative Care list size Syringe Driver Time
Difficulties identifying of End of Life patients
Time to have difficult conversations
Prognostic Indicators, DNACPR/MCA
Syringe Driver
Training, West Essex CCG Formulary
Time
DNACPR, PPC, PPD, ACR, other forms

9. Challenges Improving PPD
45% of deaths in Essex in over 65 years occurs in Hospital3
Continuity of care: sharing information and handover
Improve use of PPD and PPC
Time to have difficult conversations

10. Examples of good practice
End of life care templates
E.g. St Clare Hospice’s Template
Arranging meeting with DNs to discuss issues around End of Life care e.g. syringe driver prescribing
Continuity: named GP for palliative patient with regular visits

11. NEW GP Locally Enhanced Service
Post death analysis
Increase in our palliative care/end of life registers
Support the development and usage of a minimum dataset for end of life patients to support IT system to share information.
Advanced care planning
Critical Incident Analysis learning
Coming to practices in September 2017

12. References
1. The Gold Standards Framework 2. RCGP Commissioning Guidance in End of Life Care, Prof. Keri Thomas and Dr David Paynton,