Dear colleague
Welcome to the August GGC Palliative Care MCN. As usual I have tried to put together a brief resume of current issues. I have structured this as GGC issues and National issues. Part of the GGC section deals with the GGC Palliative Care Action Plan and this is subdivided into the various Standing and Action sub groups.
GGC Issues
Reorganisation of NHS GGC NHS Acute Services
The reorganisation of NHS GGC Acute Services is now complete. For palliative care this has meant a subtle organizational shift! The major change is that the initial separation of services now occurs at a geographical level with the creation of 3 sectors – Clyde, North and South. The separation into Emergency Care and Acute Medicine, Surgery and Anesthetics and RAD now occurs at a Sector level. However, as Palliative Care is seen to be relatively small at an organizational level it is not managed through RAD in each sector but rather is hosted by Clyde RAD for all GGC Acute Palliative Care Services. John Kennedy remains as the relevant General Manager, which is extremely helpful! Operationally John now reports to Marie Farrell, the Clyde Director.
Executive Lead for Palliative Care
I am delighted to report that despite all the restructuring Anne Harkness currently continues as GGC’s executive lead for palliative care. Anne has a keen understanding of both the complicated nature and complexity of palliative care that would have been badly missed were she to have been removed from this role.
Lead Clinician for Palliative Care
As many of you will already know Dr Paul Keeley stepped down from his role as Lead Clinician for Palliative Care on 1st August. I would like to take this opportunity to thank Paul on behalf of the MCN for his contribution over the time he has been in post. I do hope that he will continue to be involved with the MCN, perhaps through the Acute sub group, as his input has been hugely valuable at the quarterly meetings.
I firmly believe that it is absolutely essential that palliative care in GGC has strong and visible leadership particularly in light of the challenges, and indeed problems, that we are currently facing and thus I hope that this vacant post is filled as soon as possible.
GGC Response to Marie Curie
Marie Curie wrote to GGC regarding two of their recent publications ‘Changing the conversation about terminal illness’ and ‘Triggers for palliative care’. Many, if not all of you, will have seen both the letter from Marie Curie and the GGC response but you may wish to circulate these further through your local structures.
GGC Palliative Care Action Plan
Since the last MCN meeting the new GGC Palliative Care Action sub groups have formed and indeed many of them have also managed an initial meeting. A very sincere thank you to all who have contributed is required particularly given some of the concurrent issues e.g. the integration of health care and social care, the opening of the new hospital and indeed the summer holidays.
There are a two structural points and then a list of the MCN standing groups and the new, or developed, action sub groups.
Sub group membership
The doodle poll is now closed. It would be most helpful if the lead for each sub group emailed a current membership list to Paul Corrigan. Sub group lists will then be published on the GGC Palliative Care web site. When there are changes in sub group membership please let Paul know so that the web site details can be kept up to date.
Sub group reporting template
As you know a new reporting template has been introduced. It is hoped that this will make it easier for people both within the MCN and out with the structure to see what specific work is being focused upon.I have added ‘key areas’, either decided or under consideration, below each sub group heading. There isalso a collated report of the sub group returns. In some instances where the group has yet to meet I have simply added some of the possible suggestions – editorial license!
Standing Sub Groups
Communications – Jacquie Lindsay
Key areas:
Updating sub group membership and contacting new members
Virtual communication
Closer communication with national and local groups – in particular: the NAG; NHS GGC CHCP palliative care groups; NHS GGC Palliative Care Pharmacists group; NHS GGC Acute group; Hospice Clinical Leads group; other MCNs
HI&T – Joanne Freel
This group continues to meet regularly. In Jackie Britton’s absence it has not been possible to define current key areas.
Therapeutics – Elayne Harris
Key areas:
Implementation of the palliative care Kardex to all primary care areas in GGC
Implementation of Just in Case prescribing to all primary care areas in GGC
Identification of the new preferred brand of fentanyl for acute hospitals and hospices
Access to oxygen in the Out of Hours period
Web development – Paul Corrigan
Key areas:
Website structure update
User feedback
Social media
Patient / carer content
Acute – Jane Edgecombe
The NHS GGC reorganisation of the Acute setting has I think made it rather difficult for this group to function at the moment. Hopefully normal service will soon be resumed.
Key areas still to be discussed and decided and may include:
Equality of access
Implementation of national guidelines
ACP
Improving communication between Acute and Community
Action Sub Groups
Heritage / Legacy / Bereavement – Jackie Britton
Key areas:
Medical Certification of cause of Death (MCCD)
NES Scottish Bereavement Care Project
Patient / Carer Involvement – Claire Donaghy / Paul Corrigan
For a variety of reasons it has proven very difficult to organise the facilitation of this group. I am delighted though that in the short term Claire and Paul have agreed to jointly bring the group together.
Key areas:
Ascertain current involvement of patients / carers.
Explore the experience of patients and carers.
Offer advice to other MCN sub groups regarding patient / carer involvement
Identify groups of patients / carers that can be accessed for future consultation
Care in the Latter Stages of Life – Gillian Sherwood
This group is a development of the existing group that Gillian chaired.
Key areas:
GGC Guidance for Person Centred Care in the Last Stages of Life.
This is conveniently broken down into work in the Acute, Mental Health and the Community
Care Homes – Kevin fellows
Key areas:
Information sharing: GP; social care; care homes; OOH services; relatives
Medication availability in care homes
Training and education to include: training based on needs analysis; new staff members; recognition of dying; SPAR; consistent message for relatives and patients
Education / Training – Shirley Byron / Fiona Wylie
This group is fundamentally the Palliative Care Practice Development Steering Group (PCPDSG) – but expanded!
Key areas:
Mandatory T34 syringe pump competency framework training
Implementation of Guidance for Person Centred Care in the Last Stages of Life
CAAS Standard 11 End of Life Care
Medical Certification of Cause of Death (MCCD)
Non-Malignant Palliative Care – Karen Hogg / MaireO’Riordan
This group is meeting for the first time in early September.
Key areas still to be discussed and decided and may include:
Explore and share transferable models (or components of established models) between non- malignant services
Out of hours provision of palliative care
The roles of disease specific and palliative care specialists in non-malignant disease
The core components of care
Education
Research
Out of Hours Period – Katie Clark
This group is keen to increase it’s membership to improve representation.
Key areas:
24/7 care and the Community Nurse review
Community nurse and Scottish Ambulance Service communication with OOH Medical Services
Specialist palliative care cover
Palliative Care Resources – Sandra McConnell
This group met for the first time on 19th August.
Key areas still to be discussed and decided.
Sandra is hoping to be able to attend the MCN meeting to provide a verbal update / key areas though clinical commitments may preclude this.
Power of Attorney – Andrew Strachan
This group will meet in early September.
Key areas still to be discussed and decided and may include:
Adults with incapacity; promotion of PoA/Guardianship
Treatment plans (including part 5 medical treatment)
Role of proxies/relatives/carers
Special groups e.g. learning disability and dementia
Queen Elizabeth University Hospital – Alistair McKeown
Initial focus on generalist and specialist palliative care in Renal Medicine
Key areas:
Joint education
Identification of supportive/palliative needs
Availability and support from Specialist Services
Recognition – Euan Paterson
Unfortunately there weresome problems in organising the facilitation of this group and so initially I will undertake this role. The first meeting will be on 31st August.
Key areas still to be discussed and decided and may include:
Identifying current work in this area; increasing use of existing tools e.g. SPICT, SPAR, PPSv2; promote identification through the palliative care DES; build on work with Respiratory, Renal and Heart Failure; recognition of palliative care needs post admission; communication of palliative needs between services; recognition by non social/health care professionals.
National Issues
National Advisory Group (NAG)
As you know the NAG ran three engagement roadshows in the early summer to help inform the development of the Strategic Framework for Action (SFA). The output of these groups is available here: Glasgow – Edinburgh - Aberdeen
Professor David Clark, Director, School of Interdisciplinary Studies, University of Glasgow is now acting as the consulting editor for the SFA. Professor Clark founded the Glasgow End of Life Studies Group in 2014.
The next NAG meeting is actually the day after the MCN. If there is anything from that meeting that requires either urgent consideration or rapid feedback the MCN representatives will be circulated.
Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) & Children and Yong People’s Acute Deterioration Management (CYPADM) Scottish Policies
The Scottish Government ‘light touch review’ has produced the first draft of both of these policies (attached). The MCN membership and attendees have already been invited to send any comments back to John Kennedy for collation before a GGC response is sent to the Scottish Government. The closing date for responses is Friday 28th August.
I look forward to seeing you all on the 26th.
Euan Paterson
Chair, GGC Palliative Care MCN
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