Friday 7th September 2012
Dr Penny Coyle and Dr Clifford Jones reflect on their first year as Macmillan GP Facilitators.
As Macmillan GP facilitators, we aim to improve the quality of cancer and palliative care provided by primary healthcare teams within the local health economy, in line with national and Macmillan priorities. We represent people who are chronically ill by embedding their needs in the health system, empowering them to make informed choices about their treatment, and providing professionals with the right information to support these decisions.
Our first year in post has been both busy and challenging – not everything has gone perfectly, but we have found the role hugely rewarding and the early results encouraging. Our work has been supported and guided by two clinical mentors and a steering group of healthcare professionals, and Macmillan and patient representatives.
Our first challenge was to assess existing services. We began by circulating a questionnaire to all GP surgeries in the Trust area to understand what palliative care provision was available to the community. The results allowed us to map current practice, strengths, weaknesses and identify areas for improvement.
We intend to revisit the questionnaire at regular points during our post to track the improvements in these community services. We have also spent time meeting different team members to understand their experience of providing care to the chronically ill. Such patients are likely to be treated by many different professionals.
Understanding these roles and referral pathways has provided us with an insight into why systems don’t always work efficiently and helped us identify where improvements could be made. Meeting different team members has also given us the opportunity to share information and provide training.
We have facilitated interactive teaching sessions for GPs in each of the five localities that make up the Aneurin Bevan Health Board (ABHB). The sessions were run jointly with palliative care consultants, based around the key theme of ‘quality standards for end-of-life care’. We used these sessions to discuss how to:
- identify patients – what are the key signs of deterioration, what factors predict prognosis
- use the integrated care priorities
- control symptoms
- discuss sensitive topics with people who are chronically ill. We have supported these sessions with the production of templates to help professionals capture relevant information in palliative care meetings. Such information is invaluable in tracking and monitoring patients, particularly if their symptoms require further treatment.
Access to care
We have complemented our training scheme with specific projects in the ABHB area aimed at improving access to appropriate care and promoting advance care planning. Our objective is to ensure health and social care professionals are wellinformed about the patients’ histories and current situations, so patients do not need to repeat this information when encountering someone new.
For example, we have initiated a project to enable people to be cared for in their preferred place of care and to reduce unnecessary admissions to hospital at the end of life. The project focuses on understanding why hospital admissions occur and on developing protocols to enable people to access appropriate care.
In particular, we will focus on people in residential and nursing homes to emphasise how they should be offered every opportunity to be involved in planning for their future regardless of diagnosis.
Care at home
A second project has focused on the care of people at home. We have looked at improving two critical areas – ensuring people have access to the right medicine at any time of the day and that medical professionals can be quickly brought up to speed on a patient’s history should an emergency occur.
With the first area, we recognise that the needs of people in palliative care change very quickly and they may require immediate access to new medicines outside of the normal working day, when these are least likely to be available. We have worked with other professionals to launch ‘Just in case’ boxes, which provide medicine in anticipation of a prescription being written, avoiding the need to visit pharmacies late at night. The second area is based on the need to share important information.
We have designed an advance care planning communication tool. This is a simple document that can be used to record important information about the patient and their future wishes and decisions. It is then stored in the patients’ notes and also faxed to doctors working in different sectors, eg hospital and out-of-hours service. We have also been helping to promote the ‘Message in a bottle’ scheme.
This specially designed bottle is stored in the fridge and contains vital information for any health professionals visiting the home. This could be about medicines, medical notes or in some cases resuscitative preference.
A sticker on or near the front door alerts visitors of the bottle in the fridge, which can be particularly important in an emergency situation or when the patient may not be able to respond.
While our first year has presented many challenges, it has also proved that although the health service is complex, improvements to patient care can be made by simple, small changes. We are excited to move on to different projects that will involve assisting in the development of cancer services and cancer survivorship. These roles would not exist without Macmillan’s invaluable support and funding.
For more about Macmillan's primary care community.
Email Dr Penny Coyle.