Greater Choices for at Home Palliative Care

GCPHN received funding through the Greater Choice for At Home Palliative Care (GCfAHPC) to improve coordination and integration of end-of-life care across primary, secondary, tertiary and community health services to support at home palliative care.

The aim of the Palliative Care project is  to clearly identify the needs of the local community in relation to palliative care and through co-design with consumers, providers and the broader community to determine the optimal model of palliative care for the Gold Coast supported by a regional implementation plan (Regional Plan).

This work has been completed and is now progressing to implement the key identified service components that have been identified within the Regional Plan. These include:

General Practitioner Share Care Program, supported by the development of Quality Clinical Management System

Project Statement:

Build the capacity and skills of general practitioners in providing palliative care to people with a life limiting illness through the provision of coordinated care, workforce capacity and ongoing support through the development of systems and supporting infrastructure.

Project Scope:

By the end of the project we expect to have established a process that enables the sharing of provision of care between general practitioners and specialist palliative care services, with clinical support and guidelines to assist GPs in meeting the needs of their patients. For general practitioners, there will be three key components to the GP Palliative Shared Care Program; the Program Framework, Orientation and Ongoing Education and the Provision of GP Palliative Shared Care. The shared care program framework will be available to participating GPs, via the development of the new ‘Regional online Palliative Care Portal’. This will be inclusive of the patient’s Needs Assessment, engaging in case conference with Multi-Disciplinary Teams and the development of shared care plans, which will be supported by a Patient Management Plan. These will then be loaded to My Health Records.

Across all palliative health and social care sectors, identified integration opportunities to improve patient transitions between care settings and enhance continuity of care will be implemented via the newly developed Quality Clinical Management System which will improve information transfer between service providers and with patients and families.