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Going for gold

Anthony Reid Macmillan Nurse, Primary Care Cancer Lead

Ashfield Primary Care Trust

E: tony.reid@ashfield­pct.nhs.uk  T: 01623 622626

 

Key team:         Members Of The Primary Health Care Team, The Specialist Palliative Care Team, Service Improvement Facilitator

 

 

 

Abstract 

The need for change arose from the findings of a baseline assessment I carried out in my capacity as Primary  Care Cancer Lead for Ashfield Primary Care Trust (PCT).  The focus of the assessment was based on "The Cancer Plan" and local implementation.  During analysis it was identified that the "Gold Standard Framework" (GSF) (Thomas 2003) programme for community palliative care provided support for issues raised within the assessment.

 

HOPES:

  • Support the provision of Palliative care services in the community setting

  • Enhance the provision of quality care

  • Increase job satisfaction for those providing care

  • Reduce unnecessary acute hospital admissions, or crises intervention

  • Introduce a multi-professional, proactive approach to the care of patients in the "palliative" stage of care

  • Provide the patient and those involved in their care with support and information that empowers choice

REFERENCE: Thomas K. (2003) 'Caring for the dying at home' - Radcliffe Medical Press.

 

It is anticipated that all those who are involved in the patients' experience during the 'palliative' stage of care in the community will benefit.

The change addresses issues that are relevant to organisational development and crucial to continuity of care, i.e. out of hours and bereavement support.

The programme provides (through formal and informal means) the necessary evidence to develop and sustain change.

 

HOW?

  • The change builds on the strengths of all those involved in patient care.

  • Introduction of multi-professional communication strategies to enable the effective use of resources.

  • The 'GSF' programme facilitates 'life long learning' as a natural consequence of patient experience, team discussion and specialist involvement.

  • A 'staged' implementation within the PCT is planned, which will allow programme facilitators quality time with GP practices. Eventually, a process of support for cascading information and implementation across the PCT will evolve.

 

The executives of the PCT were extremely supportive, and arranged discussion at Clinical Governance level and involvement in the nurse modernisation strategy.  Audit and research contributed to the presentation of the original assessment analysis and report.

 

ACHIEVEMENTS:

Implementation is still only in infancy, however, significant steps have been made:

  • A number of GP practices have agreed to implement the proposed GSF programme.

  • Key stakeholders essential to the implementation have attended 'workshops' in preparation for co-ordinating the programme.

  • The PCT has demonstrated levels of commitment by including the programme within professional development sessions for all PCT employees.

  • The PCT has included elements of the GSF in standards that reflect potential fulfilment of incentives from the General Medical Services (GMS) contract.

  • The Cancer Network and Cancer Services Collaborative Improvement Partnership are providing facilitative support.

 

CHALLENGES AND/OR BARRIERS:

  • Addressing the perception amongst Healthcare professionals that the change was ''yet another target'

  • Managing capacity and demand

  • Addressing perceived contraindication of proposals with current PCT policies

 

RESPONSE:

  • Identify 'champions of change', i.e. Palliative Care Consultant

  • Identify commitment of real support from myself as Primary Care Cancer Lead

  • Acknowledge existing constraints with which staff are working

  • Utilise a staged process of change, allowing change to develop naturally as evidence of benefit becomes available.

 

Work to date has raised the profile and importance of 'cancer services' across the PCT.  The process of introducing the initiative has clarified issues related to the role of specialist palliative care and those involved in providing the service.  The GSF is identified as a potential strategy within aspects addressed by the forthcoming NICE guidance on "supportive and Palliative care".  Feedback following the baseline assessment and subsequent presentations, confirms that the provision of quality care is a high priority across the Trust.  One comment received from a GP illustrates this: "This is why we came into GP work".

 

NEXT STEPS:

  • Develop a steering group from those GP practices and key stakeholders intending to implement the changes

  • The steering group will identify an action plan for implementation of the gold standard framework in community palliative care

  • A key reference for the group will be the provision of mutual support through collaboration of effort

  • It is anticipated this group will form the basis for dissemination of information across the Trust.

 

The GSF has scope to influence care from diagnosis, using the principles to improve communication and subsequent care.  In addition, I am aware of other initiatives examining the provision of palliative care in the care home setting.  Introduction of the GSF in this context would potentially be extremely beneficial.