Dr. Patrick McDaidLast Years of life GP Clinical Lead

15th March 2018 @ RCGP

Camden and Islingtonmcdaid@nhs.net

07939 119 131

Agenda

• 14.00 -14.05 Introductions

• 14.05 - 14.35 Themes from Peer Review meetings.

• Support for and monitoring of Urgent care planning

• other updates

• 14.35 - 15.25 Oncology Palliative care GP Project

• 15.25 - 15.35 Break

• 15.35 - 16.15 Oncology and palliative care Case

Discussions

• 16.15 - 16.50 Rationalizing medications in various long-

term conditions

• 16.50 - 17.00 Summary and Closing remarks

Themes from Peer Review meetings.

CMC – Urgent Care Plan

• On CMC does not mean has to be on Pall Care register

– On Pall Care register means they should be offered a CMC Urgent care plan.

• CMC Template on EMIS

– Records on EMIS what's needed for a CMC plan; That then still needs ->CMC

DNACPR

– Demand remains for teaching like the “Forth Bridge”; increasingly pressured

NHS/Time; new team members

– CMC – when information completed DNACPR form can be printed from CMC

– Blanks (e.g. for visits) available from Camden GP Website

Standby Medications.

– Where possible forms completed by Pall Care/team

– Give (commission) Spec Pall Care SPCT a prescribing Budget for initial prescribing

– SPCT aims for, but does not have, a full compliment of Prescribers

Supporting Urgent care planning

• Care planning order of priority

• Develop the language you use to open up

difficult/EOL discussions

– Comfortable shoes

– Suggestions from SPICT

– Atul Gawande 4Q

• Practice the Q you use in your regular

consultations

Care planning order of priority

• Current:

– Here and now

• Urgent:

– In anticipation of urgent problems

Treatment escalation plan….this is central to

CMC.

• Advance

– in advance of loss of capacity

– If Dying, priorities for care and where

In challenging terrain wear

comfortable shoes!

Phrases that are at home in

your everyday consultations

…it’s basic General Practice to

explore concerns and expectations.

“What’s your greatest health concern?”The Picture is from the Spotlight: on Palliative Care beyond Cancer BMJ 16th Sep2010

Sexual

health

Continance

Sick notes

Acne

Depression

Am I dying?

To provide an opening…use an

open question

For example

• What’s the main thing on your mind?

• What's your greatest health concern?

• How do you see the future?

• What are your priorities?

• You can add…if you want…given your state of health.

• Who’s at home and what will they want to know we talked about?

• “For difficult conversationswear comfortable Shoes”

Use phrases that are equally at home in everyday consultations.

And practice those phrases

in everyday consultations

SPICT

www.spict.org.uk

This year, to help practices consider who might benefit

from supportive or palliative care, the SPICT TOOL is

being promoted as the aid memoir to use.

There is the tool itself.

There is also a separate one page help sheet with

suggestions on how to use it.

Including some useful questions

Guide to using SPICT in the community

www.spict.org.uk

Click to link to document

SPICT

www.spict.org.uk

SPICT

www.spict.org.uk

Atul Gawande was the 2014 Reith Lecturer.

The 3rd Lecture deals with ageing and dying. He has concluded the

most reliable way to know what people’s priorities are is to Ask,

and has settled on four key questions.

Four Useful Questions

• What is your understanding of where you are with your

condition or your illness at this time?

• What are your fears and worries for the future?

• What are your goals……if time is short?

• What outcomes would be unacceptable to you?

OK!

Maybe be a bit

cautious with

this one in

a regular

consultation

Try adopting/adapting these for your regular

consultations, especially Long-term conditions

Two quick wins on DNA CPR forms

1. Download the above from the GP website, print to fill in by hand

and carry with you

2. After DNA CPR has been entered on CMC, click on the CPR print

logo to print off the already completed form from CMC.

CMC incidents

WHO YA GONNA CALL when

things go wrong.

An Urgent Care plan has been

recorded on CMC but does not

go to plan.

cmc.incidents@nhs.net want to

know so they can investigate

and improve the system.

Email them or

T: 0207 811 8513

WHO YA GONNA CALL is also

a good question to talk through

with relatives & carers…and

what are they going to say?

GP? OOH

Doc?

PallCare?

Emergency?

Death?

The problem..

Expected

Death…

..on CMC

End of life care LES

Any Q?Dr. Patrick McDaid

mcdaid@nhs.net