Community Medical Update By Jill McKane, Consultant in Palliative Medicine
Since August 2022, a part-time Community Palliative Medicine Consultant has been in post at The Ayrshire Hospice. This has enabled the Hospice to significantly increase the number of face-to-face assessments and to develop the ability to conduct “Near Me” community assessments for patients.
advice by the community medical consultant for Specialist Palliative Care Nurses (SPCN). We have expanded our reach as a medical team, providing care to more rural areas of Ayrshire and collaborating with teams in Glasgow on highly complex cases with positive outcomes, including joint clinical reviews in Glasgow. A key focus has also been on teaching and supporting external professionals, such as District Nursing Teams, GP colleagues, GP Trainees, GP Out of Hours services, Medical Trainees at various levels, and Psychiatry colleagues. We are pleased to announce the development of a GP with Special Interest in Palliative Medicine post, which is now part of the community medical service. This addition increases our weekly clinical sessions from 5 to 9, allowing us to further enhance our responsiveness and impact on patient care while continuing to grow as a team.
Previously, The Ayrshire Hospice carried out approximately 10–20 medical domiciliary visits per year, but this has now risen to 210 face-to-face patient assessments in 2023. As part of this expanded community role, we have also mapped services and developed referral criteria for the community medical service, which has seen the number of people on the medical community caseload more than double in one year, rising from 60 patients in 2022 to 125 patients in 2023. This role has also supported the completion of several community-based quality improvement (QI) projects, including: • A Rural Palliative Care QI Project • An Internal Medicine Trainee Community Palliative Medicine Project • A Medicines Reconciliation QI Project
we have shared our achievements at National Palliative Medicine, NHS, and General Practice conferences. We have also established a community team journal club and developed clinical slots to support the Living Well Hubs. Multi-disciplinary team (MDT) meetings have been introduced to discuss new and complex patients three times a week, with senior medical community involvement as part of a QI project. These meetings also led to the development of improved documentation in patient notes. The The MDT meetings allow for discussions on new patients, complex cases, fast-track referrals to the community medical service, and the provision of routine
Cat Killin, Lead Consultant (left), and Jill McKane, Consultant
• A Deprescribing QI Project
• An Assessment of Need for Subcutaneous PPIs in a Community Setting
• A Clinic Pilot Project
Additionally, we have embarked on research to better understand the complexity of patient care within The Ayrshire Hospice’s community caseload. As a team,
November 2024 | EDITION 38
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