Wednesday, 2 October 2013

Liverpool Care Pathway - The QP EoL Pathways

The QP Pathways are legion and all encompassing...

This is the Ipswich and East Suffolk CCG (Clinical Commissioning Group) -

End of Life Care Advance Care Planning - QP11 Emergency Admissions
In addition to the EOL Advance Care Planning Pilot which supports residential care/nursing homes and attracts a £50 per plan payment, the QOF QP pathway focuses on patients who reside in their own home (launched in August 2012), the same principles apply, however the £50 per plan payment is excluded.
Fall Assessments from East of England Ambulance Service - QP11 Emergency Admissions and Referral of Fall Assessments from Ipswich Hospital A&E (over 65’s) - QP14 A&E Attendances
Focuses on patients identified by the East of England Ambulance Service Trust (EEAST) who have fallen. Fall notification forms are completed by EEAST and faxed to the GP practise. Practises are required to create a falls register, add the patient and discuss them if appropriate at their monthly Multi Disciplinary Team (MDT) meeting to ascertain if intervention from health and social care is appropriate. 
Admission Prevention Pathways - QP11 Emergency Admissions
A fast response to support patients who require urgent health and/or social care within their own home.

Fifty quid payments...
Fall notifications by Ambulance Service personnel, earmarking potential EoLC candidates...

We’ve got them in their home; we want to keep them in their home. We don't want emergency admissions...

This is the GP Claim Form-
Ipswich and East Suffolk CCG

Practises are asked to identify patients likely to die within 12 months and initiate fireside chats about EoLC. This goes on the patient notes, which is held in a Yellow Folder. If possible, an EoE DNACPR form is completed and faxed to the Ambulance Service on 01234 215399 and the patient is added to the practise Palliative Care Register.

Grooming sessions on end of life care planning are provided to GPs, ambulance, residential care/nursing homes staff.

Practises are paid £50 per care plan for patients who reside in a residential care/nursing home. The claim form can be used to support evidence for QOF QP11 in other cases.

Practises complete and send their claim forms to: Emily
Thurston, Ipswich and East Suffolk CCG, Rushbrook House, Paper Mill Lane, Bramford IP8 4DE on a monthly basis.

A productivity QP Pathways Locally Enhanced Services (LES) specification in Medway -

•        LES to allow practises to devote resource to implementing QP Plus
•        LES is NOT a financial incentive to reduce referrals to the acute trust nor increase referrals to community or other providers
•        LES payment will mirror QOF points (adjusted by QMAS)

The implication is exactly that, to reduce acute referrals. It is a Care LESs.

This is Macmillan GP, Dr. Elizabeth Towers –

According to Dr. Elizabeth Towers, involving patients, family and carers in EoL discussions is essential to reduce potential complaints. She points out that 54% of NHS complaints relate to care of the dying and refers to the 'recent LCP controversy'.

The GP 1% route is the logical route to go, of course. Catch them, groom them, downsize their care expectations: that's much more sensible.

"Do you really want the operation...?"

They can't expect to live forever...

Her weapon of choice is the GSF and she reproduces the GSF pie chart in her document. Poor old SPICT. Perhaps they shouldn't have copyrighted it.

Ask the 'Surprise Question'. This is also known as the Barton method...

Like soothsayers, psychics and seers!

Dr. Elizabeth Towers uses comics to illustrate her document -

This is reminiscent of the 'Mission Impossible' slide used in the Six Steps to Success promotion by Carmel Wiseman...

So, here's one of our own -

These people are truly cursed with the God Complex they may decide and determine when your time is come.

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