Focus on end of life care in Leicester city
23rd April 2014 | By Liz Mattock | Posted in End of Life
More patients at the end of their lives are dying in their place of choice than ever before, including in the comfort of their own homes surrounded by loved ones, thanks to a service developed by GPs from Leicester City Clinical Commissioning Group (CCG).
Since April 2013, more than 800 city patients in their last twelve months of life and who are on the city’s palliative care register have benefitted from having an Emergency Healthcare Plan (EHP). As a result 85 per cent of patients who have had a care plan in place have died in their place of choice and their wishes carried out. The national average is 45 per cent.
The care plan sets out their requests when they come to the end of their life and is agreed with the patient, the registered GP and their family ahead of their death.
Dr Rish Prasad, GP at Willowbrook Medical Centre and GP Lead for End of Life Care at Leicester City CCG, said: “Over the past year we have been offering patients in the last twelve months of their life the opportunity to put in place an Emergency Healthcare Plan (EHP), as part of a national campaign ‘Deciding right – Planning your care in advance’.
“Caring for someone at the end of their life is a sensitive and often difficult subject to discuss. Not everyone will choose to talk about this, but for those who want to plan their care in advance, this will help them to think about their future treatment and get advice on how to make their wishes known.
“Care planning enables doctors and nurses to have discussion with patients and their loved ones when they are well enough to make decisions for themselves. This process can make care towards the end of someone’s life more tailored to their own needs and wishes. Of course, we continue to care for all patients as best we can, in my experience I think we can offer better care when they have plans in place.
Dr Mo Ayubi, GP Mentor at Johnson Medical centre, said: “There are four mentors in the city who work with the 63 practices. We work alongside GPs to support them with identifying individual patient needs, as well as their patients so that they themselves feel in control of deciding where they want to spend their final weeks and days, helping them to look at what options are available, what pain relief they may want and how to make their wishes known if they want to refuse certain treatments.
“The earlier this is discussed, the greater the chance that the patient will have a more comfortable death, reducing the amount of distress for the patient and their family, in a preferred place of care.”
The original care plan will remain with the patient at all times to ensure that the document can be quickly accessed by whoever is treating or caring for them, including acute hospitals, the GP out of hours service and ambulance staff.
The plan includes:
- A record of who else to involve in the decision making (e.g. health professionals, next-of-kin, carers)
- details of the patient’s condition and treatment
- instructions for the patient’s treatment in emergency situations
- confirmation if the patient has any ‘do not resuscitate’ instructions in place
- a record of the patient’s wishes with respect to place of care/death and decisions regarding their treatment
- Confirmation that the patient’s wishes have been shared with external organisations with the patient’s consent (e.g. out of hours service, community nurses, LOROS, secondary care consultants).
Anyone with a terminal illness, or who is worried about a loved one with life-limiting conditions such as end stage heart or lung disease, or dementia or incurable cancer, is encouraged to talk to their GP, consultant or community nurse about the options available to them. They can also log onto the CCG website to find out more about end of life and planning care in advance via our helpful guide.
*Deciding Right – Planning your care in advance aims to help patients think about what care they may want to receive in the future should they become seriously ill, disabled or unable to make decisions for themselves.