Recently, we’ve been engaging with primary care across London. As part of this work, we’ve been learning about different services that are available to support primary care with creating UCPs for patients. In this newsletter, we’ve invited two of these services to share more about their work.

Lorraine Wells, Health and Wellbeing Coach – Barnet PCN3

In Barnet PCN3, Health and Wellbeing Coaches (HWBC) have been given responsibility of the UCP workstream. Our intensive training equips us with the skills needed to have difficult conversations with patients to complete the non-clinical aspects of the UCP before sending it on to our GP partners for sign off.

We proactively reach out to vulnerable, elderly and housebound patients identified by searches across all seven practices in the PCN. This approach offers several key benefits: we have the time to call and schedule conversations at convenient times, check whether patients want a family member present, and ask if they have any communication needs – such as hearing problems – that mean a telephone call is unsuitable, in which case we can offer a home visit. Where possible, we always encourage involvement of a family member, trusted friend or neighbour.

We also attend the one-stop clinic at Hope Corner, a local community centre, where patients with learning disabilities receive their annual health checks. The clinic brings together professionals including Nursing Associates, Barnet Mencap and Barnet Care representatives, a dietitian, and us as Health Coaches. This face-to-face approach works very well with establishing trusting and secure relationships and helping to reduce health inequalities for this vulnerable group of patients. 

Recently, we’ve introduced a self-referral form system through the PCN where patients and professionals within the practices can contact us directly through a monitored email account and request a call back.

Feedback from patients has been overwhelmingly positive. Many express how important it is to have an opportunity to make these decisions whilst they are still able, easing the burden on their families. They value being asked about their wishes and preferences, in a setting with fairly unrestricted time to have these conversations. 

Christopher Clarkson, Marie Curie – North Central London

Marie Curie provides an advance care planning service, using the UCP, for individuals throughout North Central London. Our Advance Care Planning Nurses make appointments for a telephone consultation with the individual and/or their representatives to discuss what they wish to go into their UCP.  The nurses work 9 to 5 Monday to Friday, though appointments can be made, by special arrangement outside these hours, for those who have difficulty making time during working hours. Exceptionally, it may be possible to arrange a home visit to meet with those who find telephone consultations problematic due to communication issues. Once the UCP has been created, the GP is notified and requested to complete the clinical recommendations for CPR and treatment escalation.

The consultations are normally with the individual who wants the UCP, but, if the person does not have mental capacity for advance care planning discussions, then the consultation may be done with the Lasting Power of Attorney (LPA) for Health and Welfare. We check with the Office of the Public Guardian as to whether there is a registered LPA in existence. If there is no LPA, then our nurses may record the family wishes and request that the GP complete the UCP on a Best Interests basis.

Marie Curie accepts referrals from all healthcare professionals and from patients (self-referrals). It is important the referrers have had an initial discussion about advance care planning with the individual or their representatives and have gained consent for referral to the Marie Curie ACP service. Referrals should be sent to lat.mariecurieacp@nhs.net and should include: Name, NHS number, date of Birth, contact details, any background information which it is felt may be helpful, confirmation of consent for referral.

Patients and families have told us that they find it very re-assuring to have UCP’s in place. One said:

“what a help it was to talk to a professional, who had time and empathy to listen, before going ahead with Advance Care Planning”