How The Myton Hospices set up a monthly GP Information Clinic across three Primary Care Networks (PCNs) in Leamington Spa, Kenilworth and Warwick. This helped improve early access to palliative care and supported patients earlier in their illness.
The Myton Hospices wanted to improve visibility of their services in the local community, to raise awareness of what the hospice provides and who they care for.
They wanted to increase the number of referrals to its services from GP surgeries, helping ensure people can access hospice services earlier in their illness.
Pilot
To do this, Myton established a GP Information Clinic, initially as a six month pilot across Coventry. The clinic aimed to:
provide early access to palliative and end of life care and improve overall outcomes and experiences for patients
work in partnership with GP Practices and community services, supporting their allied health professionals while raising awareness of Myton’s services
increase awareness of and referrals to Myton’s outpatient services
support integrated community care teams to recognise and respond to palliative care needs.
The pilot GP Information Clinics provided patients with the opportunity to speak with a nurse about their condition, their preferences and the support available to them. Appointments were flexible, offered in person, via telephone or, in certain circumstances, at home.
The clinics were led by Myton’s Community Engagement Manager, Olivia Bowskill (Registered Nurse).
Referrals
The referral criteria includes:
those aged 18 and over with progressive, life-threatening and incurable conditions (e.g. metastatic cancer, chronic obstructive pulmonary disease (COPD), heart, renal, liver or lung failure)
individuals with neurological diseases such as motor neurone disease (MND), Parkinson’s disease and Multiple Sclerosis (MS)
patients with palliative care needs and a prognosis of years to months (rather than days to weeks).
carers of individuals with life-limiting conditions
anyone wishing to learn more about Myton’s services and how they can be beneficial.
Outcomes
Text
The GP Information Clinic pilot was a resounding success. The pilot saw over 190 patients - of these 63 were referred into Myton’s outpatient services and 77 accessed other forms of supportive services.
Key benefits are:
Increasing early referrals to Myton’s outpatient services for patients with life-limiting conditions.
Bringing early palliative care services to more people in South Warwickshire. Facilitating appropriate and timely referrals into Myton’s services.
Providing clear, timely information on available support services, earlier on in a patient’s illness.
Working with with a range of healthcare and support services to improve experiences for patients needing end of life care.
Image
“I think the clinic is vital. We felt extremely listened to and not rushed. The nurse gave time to my husband and that meant so much to us. It’s good to know what support is available to help improve my quality of life. I feel reassured now and pleased that I have attended this clinic in my GP Practice.”
Carer who attended the Information Clinic
Expanding the model
Text
Building on this success, the project expanded to include Leamington North Primary Care Network (PCN), Leamington South PCN and Kenilworth and Warwick PCN using a hybrid model.
In Leamington, 17 clinics were held with 49 patients attending – 70% of whom were referred into Myton’s Outpatient Services.
In Kenilworth and Warwick, four clinics took place across five practices, with 15 patients attending and more than half going on to receive further support from Myton.
Following the successful initiative, Myton has spent almost four years developing and refining the model. The GP Information Clinics continue to operate using a hybrid approach, with monthly clinics across the three PCNs.
Facilitators, challenges and advice
Text
Key facilitators
The Information Clinic has become a vital part of the palliative care pathway within the participating Primary Care Networks (PCNs). The service supports GP Practices to meet Quality and Outcomes Framework (QOF) standards and Care Quality Commission (CQC) ratings, while aligning with local operational plans for integrated, holistic care.
Nationally, the service contributes directly to several of the objectives set out in NHS England’s Ambitions for Palliative and End of Life Care. These include personalised care, equality of access and coordinated support.
Myton’s Community Engagement Manager, Olivia Bowskill (Registered Nurse) attended the GP Practices’ palliative care meetings. This provided a presence and clinical resource, and helped raise awareness of the clinic.
Patients need to give informed consent for the Information Clinic to contact them, which is recorded on their electronic record. Doctors and practice nurses are asked to inform the patient about the clinic and what it entails. This helps ensure expectations are met and provides a more seamless transition from the GP to the information clinic (and ultimately the hospice).
Around 75% of patients attending the Information Clinic pilot also needed signposting or referral to other organisations.
Myton was able to work in collaboration with a wide range of community multi-disciplinary team members to help make sure more of patients’ and carers’ priorities and concerns were addressed. This also raised awareness of The Myton Hospices and their care services amongst other professionals and organisations.
The local GP practices use EMIS to manage patient records. Each Information Clinic can utilise a cross-organisational booking system via EMIS, which means that a single clinic session can serve multiple PCNs. This also provides the electronic framework to expand the Information Clinic to other PCNs.
Challenges
Text
There are still some misconceptions amongst clinicians about when and where palliative care support should be offered.
Some clinicians also had different expectations of the Information Clinic. Myton had to be clear about the referral criteria and clarify that this service was not replacing any other palliative care pathways. It was important to highlight that the Information Clinics were filling a gap by supporting people with a prognosis of years to months, rather than days to weeks.
Tips and advice
Text
Maintaining strong relationships with the GPs is key to this initiative. Helpful strategies include:
building trust
providing feedback
keeping communication channels open
staying flexible and adaptable.
Future development
Text
The clinic model has proven replicable and scalable. It improves co-ordination between primary care and hospice services, and addresses a critical gap for patients with a prognosis of years to months.
Myton is exploring funding opportunities so they can expand the offer further, aiming to support more patients and their carers across Coventry and Warwickshire.
