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Feature Primary carePrimary care developmentDr Penny Coyle and Dr Clifford Jones reflect on their firstyear as Macmillan GP FacilitatorsFurther informationDr Penny CoyleMacmillan GP Facilitator,Aneurin Bevan HealthBoardpenny.coyle@wales.nhs.ukAs Macmillan GP facilitators,we aim to improve the quality ofcancer and palliative care providedby primary healthcare teams within the localhealth economy, in line with national andMacmillan priorities. We represent peoplewho are chronically ill by embedding theirneeds in the health system, empoweringthem to make informed choices abouttheir treatment, and providing professionalswith the right information to supportthese decisions.Our first year in post has been bothbusy and challenging – not everything hasgone perfectly, but we have found the rolehugely rewarding and the early resultsencouraging. Our work has been supportedand guided by two clinical mentors and asteering group of healthcare professionals,and Macmillan and patient representatives.AssessmentOur first challenge was to assess existingservices. We began by circulating aquestionnaire to all GP surgeries in the Trustarea to understand what palliative careprovision was available to the community.The results allowed us to map currentpractice, strengths, weaknesses and identifyareas for improvement. We intend to revisitthe questionnaire at regular points duringour post to track the improvements inthese community services.We have also spent time meetingdifferent team members to understandtheir experience of providing care to the20 Mac Voice Autumn 2012
Primary care Featurechronically ill. Such patients arelikely to be treated by many differentprofessionals. Understanding theseroles and referral pathways hasprovided us with an insight into whysystems don’t always work efficientlyand helped us identify whereimprovements could be made.Meeting different team membershas also given us the opportunityto share information and providetraining. We have facilitated interactiveteaching sessions for GPs in each ofthe five localities that make up theAneurin Bevan Health Board (ABHB).The sessions were run jointly withpalliative care consultants, basedaround the key theme of ‘qualitystandards for end-of-life care’.We used these sessions to discusshow to:• identify patients – what are the keysigns of deterioration, what factorspredict prognosis• use the integrated care priorities• control symptoms• discuss sensitive topics with peoplewho are chronically ill.We have supported these sessionswith the production of templates tohelp professionals capture relevantinformation in palliative care meetings.Such information is invaluable intracking and monitoring patients,particularly if their symptoms requirefurther treatment.Access to careWe have complemented our trainingscheme with specific projects in theABHB area aimed at improvingaccess to appropriate care andpromoting advance care planning.Our objective is to ensure health andsocial care professionals are wellinformedabout the patients’ historiesand current situations, so patients donot need to repeat this informationwhen encountering someone new.For example, we have initiated aproject to enable people to be caredfor in their preferred place of care andto reduce unnecessary admissions tohospital at the end of life. The projectfocuses on understanding why hospitaladmissions occur and on developingprotocols to enable people to accessappropriate care. In particular, wewill focus on people in residential andnursing homes to emphasise how theyshould be offered every opportunity tobe involved in planning for their futureregardless of diagnosis.‘Our first year in posthas been both busy andchallenging – not everythinghas gone perfectly, but wehave found the role hugelyrewarding and the earlyresults encouraging’Care at homeA second project has focused onthe care of people at home. Wehave looked at improving two criticalareas – ensuring people have accessto the right medicine at any time ofthe day and that medical professionalscan be quickly brought up to speedon a patient’s history should anemergency occur.With the first area, we recognisethat the needs of people in palliativecare change very quickly and theymay require immediate access tonew medicines outside of the normalworking day, when these are leastlikely to be available. We haveworked with other professionalsto launch ‘Just in case’ boxes, whichprovide medicine in anticipation ofa prescription being written, avoidingthe need to visit pharmacies lateat night.The second area is based on theneed to share important information.We have designed an advance careplanning communication tool. This isa simple document that can be usedto record important information aboutthe patient and their future wishesand decisions. It is then stored inthe patients’ notes and also faxed todoctors working in different sectors,eg hospital and out-of-hours service.We have also been helping topromote the ‘Message in a bottle’scheme. This specially designed bottleis stored in the fridge and containsvital information for any healthprofessionals visiting the home. Thiscould be about medicines, medicalnotes or in some cases resuscitativepreference. A sticker on or near thefront door alerts visitors of the bottlein the fridge, which can be particularlyimportant in an emergency situationor when the patient may not beable to respond.Moving forwardWhile our first year has presentedmany challenges, it has also provedthat although the health service iscomplex, improvements to patientcare can be made by simple, smallchanges. We are excited to move onto different projects that will involveassisting in the development of cancerservices and cancer survivorship.These roles would not exist withoutMacmillan’s invaluable supportand funding.Related informationFor more about Macmillan'sprimary care community, visitmacmillan.org.uk/pcclwww.macmillan.org.uk/macvoice 21
Page 1 and 2: For Macmillan professionalsIssue 62
Page 3 and 4: EditorialRarer cancersA cancer may
Page 5 and 6: Survival variationsTwo separate rep
Page 7 and 8: NewsBoots and Macmillanbroaden loca
Page 9 and 10: NewsChanges to onlineinformation fo
Page 11 and 12: NewsDemonstrating impactHow Macmill
Page 13 and 14: delivery, such as ensuring complian
Page 15 and 16: Follow-up FeaturePiloting a nurse-l
Page 17: added benefit that someone trainedt
Page 23 and 24: In this section24 Access to treatme
Page 25 and 26: Penile cancerSarah Henderson, Macmi
Page 27 and 28: Hodgkin lymphomaTrish Hughes, Macmi

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