Background Cancer patients spend 90% of the last year of their life at home. At least two thirds of the working week is out of hours. The Gold Standards Framework aims to optimise care for patients nearing the end of their life in the community, with consistent care coordinated effectively across all settings and delivered by practitioners who are aware of the person's medical condition, care plan and preferences.
Aims This audit aimed to establish, in August 2013, how many of the patients known to the Specialist Palliative Care Team (SPCT) at St Luke's Hospice, Plymouth, were also known to Devon's GP Out of Hours (OOH) coordinator, DDocs, in the form of Special Notes. The standard was set at 85%.
Results 461 patients were known to the SPCT, but 79 were excluded as were not end of life. Of 382 patients remaining, 90% had cancer and 10% had MND or chronic diseases. 290 patients (76%) had Special Notes. Smaller numbers had further information highlighted, including Diagnosis (72%), Resuscitation Status (54%) and Advance Care Plans (9%). 235 patients (62%) had contacted DDocs in the last 6 months, almost all for a palliative problem.
Conclusions The audit standard of 85% was not met, however, this is an improvement from 2011, when 63% had Special Notes, and is better than other counties, i.e. Dorset, where only 22% of patients were flagged in 2011. A Dorset GP survey revealed that the majority of GPs thought they had flagged patients to OOH, yet only 22% had. A survey of Devon GPs is underway to establish attitudes to handover of patients to OOH, and identify why Devon is better, though not meeting the standard. One hypothesis is that GP cooperatives are run differently across counties, with Devon GP practices taking a more active role in OOH care.
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