A Cambridgeshire practice’s involvement in the Gold Standard Framework (GSF) programme has led to a vast improvement in their palliative support to the warm appreciation of patients and their families.
The practice, Cedar House Surgery, is one of the shortlisted entrant’s for the Management in Practice Awards 2008 – the winner for this award will be announced at the MiP Birmingham Event at the NEC on 8 October.
In co-operation with the practice’s PCT, a Macmillan nurse was relocated within the Cedar House practice in order to be based centrally to her caseload. The nurse became part of the practice team, benefiting patient care by closer co-operation and communications with GPs.
At this time, the surgery’s system for palliative support focused on patients with cancer, recorded on a list called “Category C”. The list was becoming unmanageable, as it not only included terminal patients but also patients who might survive or live with their disease for some time.
In early 2006, the practice agreed to pilot the GSF for all terminal patients. This involved adopting many changes, including: the appointment of a GP lead for palliative care (with support from the Macmillan nurse) to ensure continuity of care; monthly multidisciplinary team meetings; a clinician-led review of the “Category C” list to identify terminal patients; and the creation of a “Terminal Support List” for non-cancer patients.
In addition, the practice team was trained in handling contacts from terminal patients and carers. Advisory flags were entered into computer records, which now also included details of patients’ carers. Clinicians and support nurses agreed to discuss with patients their preferred place of death.
As practice manager Julie Faller explained: “The changes required a process of co-operation and training across the multidisciplinary team, and also careful and sensitive introduction to patients.”
An inaugural audit, conducted in June 2007, showed results beyond the practice team’s expectations.
“We had hoped to demonstrate an improvement from our first data collection from 30% to 50% of patients dying in their preferred place of death,” said Mrs Faller. “The results showed that, overall, patients’ wishes according to their chosen place of death was achieved in 82% of cases.”
This success was enormously encouraging, and firmly established the Macmillan GSF into the ethos of the entire multidisciplinary team. The GSF Framework pilot was adopted as an ongoing project in June 2007.
As a result of this success, Mrs Faller and the Macmillan nurse were invited to work on a multidisciplinary committee – Macmillan Crossroads Cancer & Palliative Care – considering countywide implementation of the GSF.
Yet the benefit to the practice’s patients proved the greatest reward. “The response from patients’ carers and families has been wonderful, with cards and flowers arriving on a regular basis,” Mrs Faller said.
“The practice team is very proud of the implementation of the GSF, and everyone involved derives a very great deal of satisfaction from the excellent standards of care provided for our terminally ill patients.”
