Case study:

14 July 2010

Worcestershire End of Life and Palliative Care Network initiatives

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Key points

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Worcestershire End of Life and Palliative Care Network is planning a range of initiatives to improve the quality of care for both patients and carers in the area.

Although at an early stage, the initiatives have already led to greater access to specialist palliative care. In addition the local enhanced service has made a big impact on primary care provision with improvements already evident in advance care planning, especially for those patients in nursing and care homes and those with dementia.

The network is also planning a scheme to give patients rapid access to trained carers in their own home with the aim of ensuring that those who wish to die at home can be discharged rapidly from acute hospital.

At the same time it is ensuring all carers are assessed and supported and is developing an integrated bereavement service across all providers.

The range of initiatives, which have been derived from Phase 1 of the Worcestershire Marie Curie Delivering Choice Programme and are supported by the network’s clinical champions, reflects the whole systems approach to change needed to ensure all aspects of the patient pathway work well together and that patients experience seamless care.

Other planned initiatives include:

* Nursing and care homes

All care homes with nursing within Worcestershire are to be offered Gold Standards Framework (GSF) for Care Homes training. The current training is to be evaluated with a view to commissioning further training programmes.

* Communication across pathway/coordination of care

The network is investigating the possibility of increasing access to current IT systems which allow clinicians to access the records of patients receiving specialist palliative care. It also plans to encourage appropriate sharing of palliative care registers held by GPs.

* Access to specialist palliative care

The network aims to improve access to specialist palliative care beds out of hours by employing GPs with special interests to cover weekend sessions. It also wants to improve access to specialist palliative care (SPC) nurses, introduce seven day service for SPC nurses and improve access to SPC consultants.

* Community hospitals

The service will increase development and support for staff in all the county’s community hospitals, using the internationally recognised model developed in Pershore Community Hospital.

* Ambulance service

An out of hours/ambulance communication form has been developed that allows GPs to communicate with the ambulance trust and out of hours providers.

* Education and workforce

The network will commission training on advance care planning, holistic care planning, assessment and communication skills to ensure the right staff with the right competences are available in the right numbers to deliver high quality end of life care.

* Pharmacy

The network is working with providers to improve access to palliative care drugs out of hours, including the introduction of ‘just in case’ boxes county wide.

* Access to equipment

An action plan has been identified to improve timely access to equipment, mattresses, syringe drivers etc in and out of hours.

* Primary care

Every lead GP for each practice has undertaken a whole day’s study facilitated by the specialist palliative care team. All GPs have also undertaken two-hour long modules on the use of the LCP and symptom control. More training is planned for later this year focusing on end of life care in dementia.

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