Analysis of cases and outcomes from GPwSI working concurrently cross-specialty in acute Frailty and Specialist Palliative Care

During the period September to December 2024 an individual GPwSI was working across specialist palliative care (0.2WTE) and acute frailty (0.6WTE) concurrently within the same Trust.  To allow Specialist Palliative Care consultants to concentrate on ward/inpatient/complex cases, the GPwSI saw a variety of patients where the CNS felt a doctor was needed with unclear or undifferentiated problems. We analysed the case mix and outcomes of 38 cases seen, demonstrating that cross-speciality working has positive outcomes for doctors, patients and services and reduces acute admissions

Of the 38 cases analysed, 71% were home visits (patient’s usual place of residence), 24% originated as cases identified as needed cross-specialty input whilst the GPwSI was working in ED/SDEC, and 5% were at the hospice/telephone.  Over a third (34%) of patient contacts involved patients with non-cancer or frailty related symptoms.

Outcomes of the visits varied widely – some were advice only, in two cases GPwSI and CNS administered anticipatory medications, most were referred on to other services eg Rapid Response, hospice inpatient unit, Frailty SDEC (Same Day Emergency Care). Patients were seen within 1-2 days on Frailty SDEC by the Frailty team (including GPwSI) for presentations that would otherwise likely have resulted in ED attendances or hospital admissions. At least 37% (up to 50%) of these contacts resulted in >1 ED attendances/admissions avoided through cross-specialty/sector working – some were seen multiple times in Frailty SDEC for follow up and prevention of crises. Presentations included deranged electrolytes, anaemia, infection, ascites. The 24% of cases seen in ED also involved more direct and rapid input from palliative care including inpatient hospice.

This cross specialty integrated method of working was highly successful in admission avoidance in those approaching the end of life, achievement of patient goals (PPC/PPD) and patient satisfaction. Staff also reported high impact of this way cross-sector working.