P-217 Improving end of life care in kirklees at a primary care network level

The formation of Primary Care Networks provides a real opportunity to influence and improve the care and support provided to people with a life limiting illness within Kirklees. Following formation, the next phase is an integration of community care with the overall vision for integrated services provided by place-based primary, community and social care organisations. Kirkwood Hospice has been a key partner in a number of emerging networks, most notably with The Valleys Health and Social Care Network. This network is made up of partners from Kirklees Council, Locala CIC, My Health Huddersfield GP federation and six practices with a combined patient population of 54,000. This focus on end of life care has provided a tangible and meaningful way of developing integration between the network partners. Network funding is supporting a range of activity, including the development of a link worker role, dedicated training and education and support to practices in undertaking QOF Quality Improvement activity. With support from CCG Data Quality teams, a data summary has been created to identify current activity and areas for improvement. This captures key themes and areas for improvement including numbers on palliative care registers, EPaCCS (Electronic Palliative Care Co-ordination Systems) care home activity and numbers with Advance Care Plans. A network-wide training and education event was held in June 2019, with over 50 attendees representing GPs, practice managers, practice and community nurses, adult social work assessors and Kirkwood staff. The event reiterated the agreed network approach to meet the following aims, which are continuing to be progressed by a dedicated Project Task and Finish group: Increase numbers of patients identified as being within the last year of life; Increase the proportion of people on EPaCCS; Promote Advance Care Planning; Improve training and education across our network in order to achieve people’s preferred place of care.