1. Hospice Palliative Care – Tips for Primary care
A Babber
GPST - Windsor VTS
3rd July 2018

2. 1. Hospice Palliative care support
Inpatient unit
End of Life Care (EoLC)
Symptomatic Control (SC)
Respite Care (RC) - support for family and carers
Day therapy unit (DTU)
Weekly activities – 6 week program
Respite for carer, symptom review by specialists and sign-posting
Complementary therapies
Physiotherapy

3. 2. Community Palliative care support
District nurse
Clinical Nurse Specialist (CNS)
Macmillan Cancer Support Services
Marie Curie Cancer Care
Rapid Response Team (RRT)
Help the Hospices
Hospice UK

4. 3. Proactive Indicator Guidance – GSF PC
1% population die/yr (30% hospital pts, 80% care home pts)
Unexpected deaths: 10%
Tool for early identification of patients nearing end of life (EoL)
Surprise question – prognosis likely death within 12 months
If unsure - General/Specific indicators of decline
Cancer and non-cancer diseases
GSF Process
Identfy – Assess – Plan
Advance Care Planning (ACP)
GSF PIG 2016 online link

5. 4. Common Symptoms Pain Nausea and vomiting Shortness of breath
Agitation/anxiety or Confusion
Constipation
dysphagia
Disease progression, treatment or medication side effects related
Refer difficult to control symptoms for specialist palliative input

6. 5. Palliative Emergencies
Likely to need hospital specialist and/or palliative care input
Spinal cord compression
Neutropenic sepsis / Pancytopenic crisis
Bone fractures
Hypercalceamia
Superior Vena Cava Obstruction (SVCO)
Major Haemorrhage

7. 6. Complementary therapies
Holistic approach to patient-centred care
Massage – pain, lymphoedema, anxiety,
Acupuncture – emotional/physical stress, pain, N&V, breathlessness
Reiki – energy healing
Reflexology – pain, N&V, anxiety, constipation

8. 7. DS1500 and continuing care DS 1500 Continuing care
Doctors report for Disability Allowance, Attendance Allowance or Incapacity Benefit under special rules
Prognosis <6 months
Fast track - override qualifying periods
tax free benefits due to terminal illness at higher rates
Continuing care
Application requires doctors report on disease and expected progression
Package of care arranged/funded by NHS for adults NOT Local Authority
For priority patients (terminal phase of illness)
Initial screening process and full assessment
Fast track process preventing delay

9. 8. Useful guidance - links
Gold Standards Framework in Palliative Care Proactive Identification Guidance 2016 – RCGP supported document
Advanced Care Planning Discussion from – GSF
GMC Guidance on End of Life Care
NICE quality standards for End of Life Care
Palliative Care Assessment Tools – CAGE, MMSE, Performance Status, Constipation score
GMC Mental Capacity Aseessment Online Tool