Table of contents

Current services in relation to need

Adults :: End of life :: Current services in relation to need

Palliative Care Register

There are about 2000 deaths per year within the Medway area. It is recognised that the number of deaths per year is about 1% of a GP practice caseload and there is a national campaign to encourage GPs to identify these patients called Find Your 1%. A register of palliative care patients is held within GP practices. In 2015/16, 554 people in Medway were on the General Practice palliative care register.[1] Patients on this register should be reviewed on a 3-monthly basis by the practice health care team. A DS 1500 form should be issued if requested by a patient (or their representative) if it is identified that the patient may be suffering from a potentially terminal illness. The DS 1500 is a form used by GPs in the UK allowing the immediate release of funds to aid a patient with a terminal illness. Identifying patients who are coming to the end of life is key to better palliative care, allowing for coordination and planning of care, prevention of crisis and support for families and carers. A well-maintained register of patients who are approaching the end of life is a tool to allow for better care planning and coordination.

'My Wishes' register

The 'My Wishes' register is an important secure record of how patients wish to be cared for as they approach the end of their life. It ensures people caring for them know what they want. The process for end-of-life care coordination in Medway is dependent on 'My Wishes'. This is a formal record of patients' preferred priorities for care and is held by Medway Community Healthcare (MCH). GPs, MCH and staff at the acute trust can view patient preferences held on 'My Wishes'. However, ambulance staff are required to telephone the out-of-hours service in order to access the same information.

Provider data, as reported to the Medway CCG, shows that in 2015/16, 451 patients were added to the 'My Wishes' register. Of this number, 207 had either confirmed their preferred place of death or were undecided at the time they were asked. Overall, 174 of these patients died during the course of the year and of this number, 130 (74%) died in their preferred place of choice. Given that the overall number of deaths in Medway is on average 2,140 per year for the five-year period 2010-2016, an increase in the number of patients on the 'My Wishes' register would support health and social care colleagues to make decisions about care provision that reflect the wishes expressed by the patient.

Primary Care

GPs provide generalist support for end of life patients according to their needs in line with the Gold Standards Framework, including pain management, emotional support and coordination of care dependent on the patient and carers needs.

The Palliative Care Helpline is in place to provide patients at the end of life, including their carers and family, access to 24/7 crisis support. GPs and nurses consult, visit patients, provide telephone advice, and refer to community and specialist teams where appropriate.

Community Nursing Service

The Community Nursing Service, provided by Medway Community Health Care, delivers 24/7 nursing services to patients registered with a Medway GP who are over the age of 18 years and are either permanently or temporarily housebound. The service functions as part of an integrated health and social care model and works collaboratively with stakeholders to deliver high quality patient care. Community nursing provides the majority of the palliative and end-of-life care for patients living in their own homes or residential care.

Secondary Palliative Care Service

The Secondary Palliative Care Service is provided by Medway Community Health Care. This service provides support alongside community nursing to palliative care patients over the age of 18 years who have complex care needs that are difficult to manage, such as pain, nausea, vomiting, dyspnoea, constipation, anxiety, and agitation. The service also supports patients, their families and carers who have complex psychological needs including concerns about children or vulnerable individuals, and spiritual or religious concerns.

For a detailed breakdown of the components of the Secondary Palliative Care Service, and other services that support end of life care, please refer to Medway's End of Life Care Strategy for Adults 2017-2020.


[1]   NHS Digital. Quality and Outcomes Framework