GP Practice identification of end of life patients

1. GP Practice identification of end of life patients

2. GP identification QOF guidance states: a patient should be included on the end of life register if any of the following apply: Their death in the next 12 months can be reasonably predicted using ‘the surprise question’ They have one core and one disease specific indicator in accordance with the GSF Prognostic Indicators Guidance They are entitled to a DS 1500 form (the DS 1500 form can be issued when a patient is considered as terminally ill if they are suffering from a progressive disease and are not expected to live longer than six months)

3. Prognostic Indicators Please review and make use of the simple prognostic indicator sheet provided with this presentation This has been tailored using the GSF prognostic indicator guidance

4. Find out what the patient knows Find out what more information the patient wants Find out what the patient needs to help them adjust to the news Communication Key Principles in the Communication of Significant News • Is not a one off event; is a process to support patients to adjust to their condition • Is a two way process, delivered at a pace suited to the patient • Communication needs to occur throughout the patients’ care pathway • Patients have a right not to know to know about their illness

5. Communication Key Principles in the Communication of Significant News • Pre-diagnosis - Whenever ordering tests it is helpful to discuss with the patient how the results will be given. With any investigation there is a risk that the result may be worrying. Think ahead and consider asking the patient how they want to receive the results. • New Diagnosis - If over the course of doing investigations serious illness is expected it is important to prepare the patient that the news may be bad so that they are forewarned of possible outcomes. • Recurrence - This is often more devastating than receiving an initial diagnosis and can be catastrophic news for the patient.

6. Communication Key Principles in the Communication of Significant News • Complications of disease - Any changes to a patient’s lifestyle/function e.g. ability to drive, whether they can return home, becoming incontinent can also be devastating and communication of this also needs sensitive handling. • Deterioration - When a patient’s condition deteriorates indicated by situations such as increasing weakness or lack of response to treatment, often there is opportunity to offer further discussion about their condition and what will happen in the future. Always remember to take time to explore the patient’s concerns about this news.

7. Communication Key Principles in the Communication of Significant News • Preferred place of care - Although most people want to die at home most actually die in hospital. Discussing and planning in advance a patient’s preferred place of care for when they are less well and dying can be very helpful. For this conversation using hypothetical questions can be a helpful way of initiating these discussions. Useful phrase: ‘If you need more help in the future, for example nursing care, where would you like to receive this?’ •  Dying - Patients are often greatly helped by a discussion about dying, but these conversations often don’t happen because they can feel uncomfortable to initiate. Patients often want to discuss arranging their affairs, future support for their family and be reassured about the process of dying.

8. Communication Key Principles in the Communication of Significant News • Sharing Any key discussions with a patient concerning their priorities for future care, and/or specific hopes concerning dying, need to be shared with those who might be called upon to help if/when a crisis arises. • Share with: • your colleagues • Out of Hours services • other key partners in care. • Coordinate My Care - will aid sharing • But is only as good as the entries made. • Good entries and up to date sharing will make all the difference. • Start practicing now!

9. Communication • There are many communication support tools available – please double click on the picture below to open this one

10. GP identification • The Higginson formula outlines that we should predict end of life for all cancer deaths and 67% of all other deaths • NICE projection tool estimates end of life needs are 830 per 100,000 population aged 18 years or over

11. End of life register standardisation • Many codes are used as the practice Palliative care register: • This makes it challenging for • non-practice based services to identify and manage patients with end of life needs (i.e. integrated care teams using health analytics) • measuring the success of end of life care

12. GP identificationStandardisation of end of life registers Recommend use of 8CM1.% for end of life register 8CM10 GSF supportive care stage 1 - advancing disease 8CM11 GSF supportive care stage 2 - increasing decline 8CM12 GSF supportive care stage 3 - last days: category C - weeks prognosis 8CM13 GSF supportive care stage 3 - last days: category D - days prognosis 8CM14 GSF supportive care stage 3 - last days: category B - months prognosis (v18)

13. GP identificationEnd of life register monitoring • An end of life scorecard is being developed • This will show the number of patients on the practice end of life register • The needs projection target is calculated using the NICE end of life needs projection tool for the practice list size • This will be provided via Health Analytics from September 2012

14. Thank you Any questions?