dr david plume macmillan gp facilitator central norfolk
Download
Skip this Video
Download Presentation
Dr David Plume Macmillan GP Facilitator Central Norfolk

Loading in 2 Seconds...

play fullscreen
1 / 30

Dr David Plume Macmillan GP Facilitator Central Norfolk - PowerPoint PPT Presentation


  • 136 Views
  • Uploaded on

Dr David Plume Macmillan GP Facilitator Central Norfolk. What is the PPoC? What patient groups should we be using it with? Where does it fit with GSF/LCP etc? Who completes the documentation? Are there any downsides? Local Experience-ACP/PPoC pilot. Questions.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Dr David Plume Macmillan GP Facilitator Central Norfolk' - dinah


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
dr david plume macmillan gp facilitator central norfolk
Dr David Plume

Macmillan GP Facilitator

Central Norfolk

slide3
What is the PPoC?
  • What patient groups should we be using it with?
  • Where does it fit with GSF/LCP etc?
  • Who completes the documentation?
  • Are there any downsides?
  • Local Experience-ACP/PPoC pilot.
  • Questions.
slide4
Formerly known as Preferred Place of Care
  • Lancashire and South Cumbria Cancer Network.
  • Originally patient-heldform for people living in the community with a cancer diagnosis
  • Focus on where people wanted to be cared for at the end of their lives.
  • Now Preferred Priorities for Care.
  • Place only one possible priority.
  • Priorities, preferences and wishes also important.
  • ID’d within the NHS End of Life Care programme as an example of an advance care plan.
slide5
Advance Care Planning
  • “process of discussion between an individual and their care providers.” (The PPC Document: Guidelines for Health and/or Social Care Staff)
  • Add “Continuing”
  • What are this patients feelings on their disease, what concerns do they have, what goals are they looking to reach, do they understandtheir illness and its prognosis, do they have particular care preferences, now and in the future?
  • Know your patient!
slide6
Not legally binding
  • but
  • MCA (2005)
  • Any person making a decision regarding care/treatment of a P lacking capacity has to take into account any statement of wishes and preferences.
  • Therefore has legal status
  • Patient needs to take into any health encounter.
slide7
2 new proxies
    • Lasting Powers of Attorney (P appoints, decides on P’s behalf)
    • Court appointed Deputies (appointed and makes decisions on P’s behalf)
  • 1 advocate
    • Independent Mental Capacity Advocates (advocate, don’t make decisions)
  • Refusal of treatment

www.ncpc.org.uk

slide8
Absolutely anyone!
  • Life limiting illness
  • Doesn’t have to be cancer.
  • Allows patients to have input into planning their own future.
slide11
Imagine if that wasn’t only your holiday!
  • Planning and being in control is important for some patients.
  • Limitation should not be placed on them due to diagnosis, age, gender, sexual orientation, race or beliefs.
slide13
Routine review
    • Possibly patient initiated
  • Anticipated decline
    • Patient or professional initiated
slide14
There is no specific time appropriate for everyone.
  • Sooner the better-even at diagnosis!
    • More gentle conversation
    • More likely patient will be able to fill in
    • More time for patient to think and discuss with family/friends
    • Easier to plan logistics with family, friends, GP, social care professionals, specialists etc.
    • Have to be prepared to alter and adjust plans over time.
slide15
Patient held document
  • Ideally patient
  • Could be a relative with patients input
  • Could be professional with patient
  • Potentially an individual with LPA could fill in for a patient.
slide16
Real potential to improve patients experience
  • Provides idea of patients wishes
  • Personally responsive health system
  • May provoke discussion and conversations
  • Allows better planning of services
  • Allows patients freedom to change their mind, but still have their views listened to.
slide17
May spark difficult conversations within families
  • Patients written views may end up being a product of coercion by others-”you don’t want that, think of mums health!”
  • Potential for patients stated wishes to “trap” other family members into caring role-”what ever happens I want to stay at home” “my wife will look after me” “I certainly don’t want any carers”
  • Patients may feel aggrieved if their preferred priorities of care are not met, -raised expectations.
  • Implementation and delivery costs include leaflets, paperwork, and the time of a highly trained professional, who could be utilized elsewhere.
  • May require sizable service re distribution towards primary or tertiary care.
  • May require money currently going to secondary/tertiary care to be redistributed to social care.
slide18
Meetings for last year
    • ASSD
    • Specialist Palliative Medicine
    • GSF Facilitators
    • GSF in Care Home Facilitator
    • GP Facilitator
    • Community Specialist Palliative Care Teams
    • District Nurses
    • LCP Lead Nurse
slide19
Workshop for professionals involved in implementing the PPoC Pilot.
    • DN’s
    • SW’s
    • LCP Lead Nurse
    • GP Facilitator
    • CSPCN
    • GSF in Care Homes Facilitator
    • GSF Facilitators
    • Care Home Managers
  • Review of documentation, experience of completing the document, look at potential pitfalls of the document, and support.
slide20
Implementation for pilot differs slightly.
  • Initiated by professional
  • Supported with leaflet
  • Completed either then and their or on a later visit
  • Completed by the professional and the patient.
  • Form left with patient
  • Form may not be initiated if
    • Patient too ill to engage with the process
    • Patient confused, agitated or unable to communicate for other reasons
    • Inappropriate time in the illness (focussing on living, in denial, refusing or overwhelmed with bad news)
    • Contact time with patient too short to initiate the document appropriately
    • Insufficient staff time
    • Other (please state)
  • Log documents are completed.
  • Fax sent to all appropriate professionals informing them that the document has been initiated.
slide21
Pilot project commenced 1st April 2008!
  • Four GP Surgeries
    • Mile End
    • Fakenham
    • Blofield
    • Attleborough
  • Two care homes
    • Sutherlands (Wymondham)
    • The Old Vicarage (Ludham)
  • In-Patient unit PBL
  • Rowan Day Centre PBL
  • NNUH wards
slide22
Locally written
  • Adapted PPoC Document
  • Patient Leaflet
  • Idiots guide
  • Checklist
  • Log documents
  • Fax forms
slide28
Ongoing pilot
  • Due to cease October 2008
  • Should have conclusions by early 2009
    • Looking particularly at deaths in Preferred Place of Care, and how preferred place of care may change over the disease trajectory.
  • Plan to roll out across Central Norfolk in 2009
slide29
What is the PPoC?
    • Patients making their wishes known
  • What patient groups should we be using it with?
    • Anyone with a life limiting illness, at least initially!
  • Where does it fit with GSF/LCP etc?
    • Start as early as appropriate, feeds into GSF meetings
  • Who completes the documentation?
    • Ideally patient, or professional and patient
  • Are there any downsides?
    • Of course!
  • Local ACP/PPoC Documentation and pilot.
    • Started April 2008, due to report early 2009
    • May lead to wider roll out across Central Norfolk.
ad