Managing care pathways

Spring 2012

Dr Liliana Risi and Tracy Cunningham developed an award-winning end-of-life care reference guide for GPs

One evening in 2009, an experienced GP, who had been working in Tower Hamlets for many years, had problems accessing a syringe driver and palliative care drugs.

This incident resulted in a complaint. In the same month, a small group of palliative care experts wrote to the Daily Telegraph| criticising the Liverpool Care Pathway (LCP), further raising anxiety among some sessional GPs.

These issues prompted the creation of a quick guide for GPs to make the LCP guidance more portable and easily-accessible. They also reinforced the need for GPs to have local, up-to-date information for home visits.

It was hoped that the guide would support GPs to deliver good end-of-life care, especially for people wishing to die at home. Another intention of developing the guide was to reach out to sessional GPs. 61% of the GPs in Tower Hamlets are in fixed-term contracts[1] and between one third and half of all GPs in London are sessional.[2] For some GPs, this may not be out of choice – in 2010, only 12 GP partnerships were advertised in the British Medical Journal, while roughly 300 new GPs qualify each year.[3] Sessional GPs can also be harder to reach and keep updated with contact information and service changes.

Liliana, GP Clinical Lead for Cancer and EOLC, and Tracy, Tower Hamlets Palliative Care Centre Manager, drafted the leaflet, with contributions from St Joseph’s Hospice. Funding came from the North East London Cancer Network.

The draft was reviewed by 10 GPs, including the Tower Hamlets Medical Director. The content included actions that GPs could and should take in specific circumstances. A social enterprise called Sparrow Design designed the guide so that it could be downloaded and printed easily. Key phone numbers were included so GPs could contact necessary services while on home visits.

The first version of the leaflet was distributed to 36 GP practices, and electronic copies were sent to a wider audience, including trainee GPs in Tower Hamlets and to key stakeholders in other parts of the country. Liliana gave brief presentations to GPs at more than half of the practices in Tower Hamlets.

Some GPs from outside the area showed an interest and it has now been adapted for GPs in Waltham Forest. Dr Jennie Read, a GP at Limehouse Practice and Medical Director of Out of Hours Service in Tower Hamlets, says the guide, ‘is easy to accommodate’ and ‘will aid joined-up thinking and good communication between services.’

Last year, Liliana was awarded the North East London Faculty Provost General Practitioner Award for Excellence in General Practice for the guide.

Related Information

Sparrow Design can adapt the quick reference guide at minimal cost. Call 020 8709 9758 or email sparrow|.

Further information

Contact Dr Liliana Risi, GP Clinical Lead Cancer and EOLC Clinical Commissioning Group, NHS Tower Hamlets on 020 7092 5217 or email Liliana.
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Contact Tracy Cunningham, Tower Hamlets Palliative Care Centre Manager by email.  |

References

1. Communication with Dr Isabel Hodkinson, Co-Vice Chair of Tower Hamlets Commissioning Group. 2011.
2. The King’s Fund. Improving the quality of care in general practice|. March 2011.
3. BMJ Careers. Salaried GP tutor pilot scheme by Bruna Carnevale|. (accessed 16 Jan 2012).