Parkinson s Disease Service Standard Multidisciplinary Parkinson's Disease Care Royal Derby Hospital and London Road Community Hospital Dr Rob Skelly
Key Drivers NICE guidance NSF for long term conditions Best practice tariff "Mind the gap" All party parliamentary report on PD "Room for improvement" living with Parkinson's today NHS England Health and Social Care Act 2012 Better care fund National Parkinson s Audit
What we are trying to do in Derby: Total patient management involves service provision across many levels of the health care system, ranging from acute and rehabilitation hospitals to outpatient clinics, community rehabilitation centres and home-based care. The aim is to provide a seamless service, whereby health professionals communicate effectively across service provision sites with the overall aim of enabling people to remain living in the community with a high quality of life for as long as possible. Parkinson s Disease: A Team Approach Iansek & Morris Australia,1997
Service provision for all stages of PD Diagnostic post-diagnostic counselling education and exercise group Maintenance Exercise Individualised assessment, advice and medication review Complex Prompt 1 stop assessment Future care planning Palliative Home visits Liaison with palliative care team Carer support
The team Geriatrician MD neurologist PDNS Specialist PT Specialist OT SALT Dietitian Nursing staff and assistants Admin and sec Psychiatry trainee Palliative care specialist
MDT clinic Weekly clinic Therapy assessments in am Grid Dr or PD nurse in afternoon MDT meeting later afternoon Letter to patient Virtual clinic
Added benefits of MDT Meetings Discuss clinic patients Working towards the same goals Team education: shared understanding of disease Stimulus for audit and research Stimulus for service development Team building Interdisciplinary care
Additional services for patients and carers Telephone advice PT treatment Tai chi Gait and balance Exercise (eg Otego) Education groups Anxiety management group Upper limb and writing CBT Post diagnostic counselling Carer support Singing group Signposting Home visits Continence service Specialist speech therapy and dietetics Derby PD service website Advanced diagnostics
Community Links Developing regional therapy network to ensure seamless integrated care with gold standard delivery Babington Community Hospital, Belper MDT approach Regular community clinics Ripley Ilkeston Long Eaton National OT network Excellence networks Education courses (NCORE)
Best practice National PD audit Other audits: bone protection Achievement on KPI Patient involvement Steering group Satisfaction surveys Research focus groups
Best value One stop shop multidisciplinary clinic Virtual clinic Group therapy Rehabilitation ethos: maximising independence Advance care planning: avoiding unwanted admissions
Inpatient care More than 50% of urgent PD admissions got to elderly care wards Training staff to higher standard, better availability of drugs and use of PD guidelines led to improvements: Less omitted PD medication More PD medication given on time Shorter length of stay Better patient experience of care
PD Rehab trial - a warning PD rehab trial suggests that physiotherapy and OT as currently delivered in the NHS is ineffective But there is plenty of evidence for physio interventions, SLT, and MDT care in PD.
Summary A comprehensive, holistic, patient-centred clinical service The drugs don t work, they just make you worse and I know I ll see your face again. [MDT rules!] the verve 1998 Close working between neurology and medicine for the elderly Excellence network (support and education) Patient and carer involvement
Take Home Message: Be Encouraged! Steering Group helps focus on pathways and commissioning Team work is vital Use the resources available: e.g. Parkinson s UK Network as much as you can Contact us: fiona.lindop@nhs.net rob.skelly@nhs.net clare.johnson9@nhs.net lisa.brown8@nhs.net