End-of-life care initiative halves patient deaths in hospital

A GP whose practice greatly increased the number of patients able to choose to die in their own home has called for more surgeries to take part in a national end-of-life care scheme.

End-of-life care: many patients are not granted their wish to die at home (Photo: Paul Starr)
End-of-life care: many patients are not granted their wish to die at home (Photo: Paul Starr)

Coastal Medical Group in Morecambe, Lancashire halved the numbers of its terminally ill patients dying in hospital and almost doubled the number dying in their normal residence.

It followed a push by practice staff to seek special palliative care training and accreditation by the National Gold Standards Framework (GSF) in End of Life Care.

Dr Andrew Foster, a partner at the practice, told GP more practices could help patients plan their end-of-life care by working towards the standards.

Nationally, about 51% of people die in hospital, despite most people wanting to die at home.

The not-for-profit GSF centre aims to improve quality of life in patients' final years and help more people die where they choose.

The centre offers palliative care training to GP practices, care homes, other community services and hospitals, and formal GSF accreditation is awarded to providers that can prove high standards of end-of-life care.

Coastal Medical Group is one of only nine practices that have achieved accreditation since it launched in 2012.

Dr Foster, who leads the practice's palliative work, said working towards the accreditation led to a five-fold increase in the number of the practice's patients on the palliative care register when they died.

Twice as many carers have had their needs assessed, while the number offered bereavement support and advice has risen from 5% to 77%. 

Starting discussions

Dr Foster said: 'For patients, it means they can predict things a little bit more, a little less reactively, and more proactively. They get early involvement with Macmillan nurses, for instance.

'It prompts GPs to have discussions with family and patients about where they'd like to be cared for in future. Then we can put services in early to try to keep patients in their home.'

For advice and support, patients at the practice can contact a named palliative clerk, who is familiar with their situation, rather than use the routine practice phone numbers where they may have to wait for a consultation.

The practice holds a list of patients' carers and ensures local services are informed so they can help give carers some respite when possible.

Practices have also adjusted their visits roster to ensure where possible GPs can see the same patients with palliative care needs, to improve continuity.

Dr Foster encouraged other practices to sign up to GSF training and seek accreditation. 'If more practices could be involved with it, going for higher standards is only going to be good for patients.'

He said although some may be 'put off' by the amount of initial work required for GSF accreditation, the ageing population, increased expectations on end-of-life care and the need to keep people out of hospital meant it was something practices should consider.

Each year, 75% of cancer patients in England who die in hospital - 36,000 people - had wanted to die in their home, according to a report by Macmillan Cancer Support, published last month.

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