1. 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…

2. 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…

3. “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)

4. Spectrum of Complexity
Easiest

5. 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

6. 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

7. eFI
0-0.12
eFI >
0.36
eFI
eFI 0.25 – 0.36

8. 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

9. 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

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

11. Aim, to do away with paper

13. 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

14. 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?

15. 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

16. Working in the dark
Then when our colleagues see our patients

17. And gain consent to view

18. 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

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

20. SCRAI view
Diagnosies, PMHx, codes and associated

21. SCRAI view
Preferences and I.C.E. plans

22. 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)

23. 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

24. TEMPLATE - 1st Page: Introduction

25. 2nd Tab: Patient / NOK / Carers’ Info

26. 3rd Tab: ICE / Emergency Health Plan

27. 4th Tab: Functional Status / Observations

28. 5th Tab: Advance Care Planning

29. 1st Page: Introduction

30. 2nd Tab: Consent

31. 3rd Tab: Patient / NOK / Carers’ Info

32. 4th Tab: ICE / Emergency Health Plan

33. 5th Tab: Functional Status / Observations

34. 6th Tab: Advance Care Planning

38. Working in the dark

40. Working better with Additional information