Strategic Plan 2012 - 2015grpcc.com.au/wp-content/uploads/2013/07/StrategicPlan20122015.pdf ·...

Strategic Plan 2012 - 2015

Gippsland Region

ConsortiumPalliative Care

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Overview

The Gippsland Region Palliative Care Consortium (GRPCC) is one of eight regional consortia established as part of the Victorian Government’s palliative care policy released in 2004. Over the next four years, the work of palliative care services, consortia and government will be guided by the Victorian Government’s current policy, Strengthening palliative care: Policy and strategic directions 2011-2015.

The GRPCC has ten funded palliative care services that have voting rights and four health and community services in a non-voting capacity.

Vision

Gippslanders with a progressive life-threatening illness and their families and carers will have access to a high quality service system which is innovative and provides evidence based co-ordinated care and support that is responsive to their individual needs.

Mission

The GRPCC will promote and deliver high quality palliative care services across the Gippsland region.

Objectives

The GRPCC provides leadership to its member services by:

• undertaking regional planning; • coordinating palliative care service provision;• advising the Department of Health about regional priorities for future service development

and funding; and• managing the service delivery framework and undertaking communication, capacity

building and clinical service improvement initiatives in conjunction with the Palliative Care Clinical Network.

Strategic Plan 2012 - 2015

A strategic planning workshop was held in October 2011 and attended by key stakeholders including members of the GRPCC Management Group, Operational Reference Group and Clinical Practice Group as well representatives from the Department of Health and GRPCC staff. The workshop was facilitated by an external consultant who led the review of the Strategic Plan 2004 – 2009 and undertook a SWOT analysis to identify the Consortium’s strengths, weaknesses, opportunities and threats. The results from the workshop were distributed to participants in October 2011.

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The priorities outlined in this plan aim to realise the strategic directions identified in the Victorian Government’s Strengthening palliative care: Policy and strategic directions 2011-2015 are listed below:

1. Informing and involving clients and carers2. Caring for carers3. Working together to ensure people die in their place of choice4. Providing specialist palliative care when and where it is needed5. Coordinating care across settings6. Providing quality care supported by evidence7. Ensuring support from communities.

However, for the purpose of this plan, members agreed to add a new priority of Stakeholder Communication in recognition of the need to improve the effectiveness of communication across member services and activities. There has also been a focus on strengthening governance between the GRPCC and member services in relation to funding arrangements which is reflected in this plan.

Funding 2011 – 2015

Department of Health funding for the period 2011-15 is outlined below.

Program 2011-12 2012-13 2013-14 2014-15 Total

Palliative Care Grant $106,000 $106,000 $106,000 $106,000 $424,000

Community Palliative Care Grant

$63,500 $63,500 $63,500 $63,500 $254,000

Rural Palliative Care Medical Purchasing Fund

$127,275 $127,275 $127,275 $127,275 $509,100

Motor Neurone Disease Grant $18,000 $18,000 $18,000 $18,000 $72,000

Palliative Care Consultancy Service

$500,000 $500,000 $500,000 $500,000 $2,000,000

Nurse Practitioner $80,000 $80,000 $80,000 $80,000 $320,000

Post-PEPA funding $10,000 $10,000 $10,000 $10,000 $40,000

After-Hours Palliative Care $150,000 $150,000 $150,000 $150,000 $600,000

Palliative Aged Care Link Nurse

$96,250 $77,500 $77,500 $77,500 $328,750

Palliative Care Disability Support

$25,000 $25,000 $25,000 $25,000 $100,000

Total $1,176,025 $1,157,275 $1,157,275 $1,157,275 $4,647,850

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Informing and involving clients and carers

Strategic Direction 1:

Reference Priorities Measures for Success Timeline

DoH – Action 1.2 Actively involve clients and carers in the planning and delivery of their care. Work with clients, carers and other clinicians, particularly the client’s GP to develop an interdisciplinary care plan that reflects clients’ and carers’ wishes.

• Regional agreement to use consistent palliative care clinical tools, as endorsed by the PCCN, across inpatient, community and consultancy services.

• Improved ratings in the Victorian Palliative Care Satisfaction Survey.

2012-13

2013-14

GRPCC Ensure patients and carers are involved in care planning and expectations are understood. Include regular reviews as patient condition and carer role may change.

• Regional guidelines for care planning developed by the Clinical Practice Group.

• New guidelines to form part of ongoing education program delivered by GRPCC.

2012-14

2012-14

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Caring for Carers



DoH – Action 2.5 Develop a project to improve after-hours support, including telephone support and home visits where appropriate.

• Advisory Group established.• Needs analysis undertaken with key stakeholders. • Options paper developed for after-hours model of care.• Consortium endorsement of preferred model of

after-hours care. • After-hours model of care implemented.

Sept 2012Dec 2012April 2013June 2013

2013-15

DoH - Action 2.3 Ensure access to a range of respite options to meet the needs of clients and carers.

• Links established with Very Special Kids Gippsland• Information and education on respite, including providing care

for children with a life-threatening condition available on the GRPCC website.

• Member services use respite eligibility criteria developed by the PCCN (2012-2013) to assess respite service eligibility.

2011Dec 2012

2014-15

GRPCC Ensure palliative care beds are awarded appropriately under the new eligibility criteria to be developed by the PCCN in 2012-13.

• Member services informed of new eligibility criteria and their obligation to comply.

• Biannual audits undertaken to ensure compliance.

Aug 2013

Dec 2013 & June 2014, ongoing

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Working together to ensure people die in their place of choice



DoH – Action 3.1 Provide consultation and support to health, community and aged care providers that are caring for clients with palliative care needs.

• Annual education schedule developed using best-practice tools such as the Palliative Care Toolkit that targets public and private health, community and aged care providers.

• Closer links developed with Aged Care Assessment Service (possible protocol development explored).

Dec 2012

2012-13

DoH – Action 3.2 Develop consistent and clear information for health, community and aged care providers about when and how to refer clients to palliative care; information for GPs will be developed as a priority.

• Develop links with Medicare Locals.• Clinical Practice Group to review national guidelines released in

2007 – Guidelines for a palliative approach for aged care.• Regional health, community and aged care providers and

networks mapped.• Increase in number of public and private residential aged

care facilities (RACFS) that adopt the Pathway for Improving the Care of the Dying (PICD) and relevant Clinical Practice Guidelines.

• Increased representation from health, community and aged care providers at Gippsland Palliative Care Conference and ORG forums.

Aug 2012Dec 2012

Dec 2012

June 2013

July 2013, ongoing

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DoH – Action 3.4 Improve palliative care capacity in disability accommodation services.

• Project officer appointed.• Relationships developed with regional Department of Health

disability officers/accommodation services. • Relationships developed with non-government disability

accommodation services.• Project paper developed for endorsement by Consortium

Management Group. • Disability sector representation at the Gippsland Palliative Care

Conference.• Increased stakeholder awareness of the Disability Residential

Services Palliative Care Guide and increased palliative care referrals that align with the guide.

Feb 2012June 2012

June 2012

July 2012

July 2012, ongoingDec 2012

DoH – Action 3.5 Establish protocols and strengthen relationships between palliative care and aged care services, including residential, community and aged care assessment services.

• Regional palliative/aged care plan developed and implemented following the appointment of the palliative aged care resource nurse.

2012-13

DoH – Action 3.6 Establish an aged care palliative link nurse in the region.

• Options paper developed; preferred option for project development nominated by Consortium Management Group.

• Stakeholder consultation conducted.• Project brief developed.• Palliative aged care resource nurse/s employed in region.• Biannual review of project conducted to determine increase in

number of residential aged facilities supported to implement the Pathway for Improving the Care of the Dying (PICD).

May 2012

Aug 2012Sept 2012Nov 2012Jun 2013 & Dec 2014, ongoing

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GRPCC Raise awareness of the Program of Experience in the Palliative Approach (PEPA).

• Regular updates about the PEPA program included in the GRPCC’s newsletter and other forms of communication specifically targeting clinicians.

• Increased number of clinicians completing the program.

Ongoing

Dec 2013, ongoing

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Providing specialist palliative care when and where it is needed



DoH – Action 4.2 Implement the palliative care service delivery framework (to be developed by DoH by 2011-12) in the consortium’s service planning.

• Regional service planning is aligned with the Service Delivery Framework (SDF).

• Annual audit conducted to identify future service delivery gaps and opportunities.

2011Aug 20122012-15

GRPCC Establish a Nurse Practitioner in three sub-regions (East Gippsland, Central West and Southern Region) to improve palliative care services.

• Three Nurse Practitioner Candidates (NPC) employed.• Service agreement between GRPCC and the three member

services employing the NPCs developed and signed.• Increase funding of the NPC positions to 0.4 EFT to develop a

pathway for endorsement as Nurse Practitioners.

2011Aug 2012

2012-15

GRPCC Establish a resident Palliative Care Specialist Consultancy Team in the region by 2015.

• Visiting Palliative Care Specialist Program continued until resident service is established.

• Updated MoU between GRPCC and consultant/cy.• Multidisciplinary Team teleconferences held fortnightly.• Conduct evaluation of the program and report to Consortium

Management Group.• Contract signed with resident Palliative Care Specialist

Consultant/cy.

Ongoing

Aug 2012OngoingEarly 2014

End 2014/start 2015

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Providing specialist palliative care when and where it is needed



GRPCC Implement a sustainable resident regional palliative care consultancy by 2015.

• Develop a Specialist Palliative Care Consultancy Service Plan for the region.

• Recommendations outlined in Service Plan endorsed by Consortium Management Group.

• Revisit the Medical Scholarships Fund for GPs to attain postgraduate qualifications in palliative care.

• Collaborate with the Divisions of GPs/Medicare Locals to apply for Medical Specialist Outreach Assistance Program funding for the visiting palliative medicine specialist.

• Identify which services have the potential to achieve Level 2 palliative care community and inpatient service status for each sub-region.

• Feasibility study conducted into the recruitment of a palliative medicine specialist to be based in the region.

• All palliative care services achieved Level 1 palliative care community and inpatient service status.

• Investigate the option of applying for a palliative medicine GP registrar position in each sub-region.

• Develop a strategy to address gaps in psycho-social support at the sub-regional level and purchase specialist psycho-social support services.

• Relationships developed with specialist colleges, rural and remote doctor associations and the Rural Workforce Agency Victoria to advocate for the palliative care needs of the region.

2011

2011

Oct 2012

Dec 2012

Dec 2012

Early 2013

June 2013

July 2013

July 2013

Ongoing

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Coordinating care across settings



DoH – Action 5.2 Develop stronger links between the PCCN, the consortium and all other relevant stakeholders.

• Links between consortium and networks including Primary Care Partnerships are strengthened.

• Strong and sustained links developed with Medicare Locals.• Increased attendance of GPs at annual Gippsland Palliative

Care Conference.

2011-12

2012-13July 2013, ongoing

DoH – Action 5.3 Strengthen consortia governance and accountability processes and document them consistently.

• Revised or new consortia role statements are implemented (DoH is responsible for reviewing consortia role statements in 2011-12).

Sep 2012

DoH – Action 5.4 Encourage consistent and equitable IT solutions that facilitate coordination and consultation across all palliative care services.

• Education sessions organised as part of the Visiting Specialists Program will continue to be offered via video-conferencing as well as face-to-face.

• Gaps in member services’ access to IT, telephony and videoconferencing identified. Findings tabled at Consortium Management Group.

• Strategy developed to improve telehealth capability.

Ongoing

2012-13

2012-2014

GRPCC Introduce a communication training program focused on role-playing bedside manner in palliative care scenarios.

• Annual Communication Master Class held as part of the Gippsland Palliative Care Conference.

July 2012, ongoing

GRPCC Improve palliative care education for paramedics.

• Paramedics consulted as part of the development and implementation of the After-hours project (Strategic Direction 2).

• Paramedic representation on the After-hours Advisory Group.• Education sessions offered as part of the ongoing relationship

with local paramedics.

Sep 2012

Sep 20122012-13

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Providing quality care supported by evidence



DoH – Action 6.1 Develop consistent clinical care protocols that are informed by research and evidence.

• Clinical Practice Group continues to work with the PCCN to identify and action quality improvement opportunities.

• Clinical Practice Group continues to implement new and updated clinical tools released by the PCCN.

• GRPCC nominate a representative to attend regular PCCN meetings and act as a conduit between services, the Clinical Practice Group and the PCCN.

• Annual audit shows increased uptake of existing clinical tools by services and facilities across the region, eg. PICD.

Ongoing

Ongoing

Ongoing

2013-14

DoH – Action 6.6 Develop region-wide clinical service improvement programs that link with the work of the PCCN.

• Clinical Practice Group continues to effectively operate and provide leadership across the region.

• A consortium representative attends the PCCN to report on clinical service improvement activities.

Ongoing

Ongoing

DoH – Action 6.7 Continue to build and support the palliative care workforce to meet increasing demand for palliative care.

• Review GRPCC’s current education program to identify gaps and opportunities, and develop an annual education program.

• Develop a scholarship program to improve palliative care understanding and expertise across the region.

• Increase in the number of participants supported by GRPCC to attend the Palliative Care Short Course run by Monash University.

• Promote existing training options through the GRPCC website. • Nurse Practitioner Candidates supported to achieve

endorsement and a succession plan developed to ensure workforce continuity.

June 2013

Dec 2012

June 2013

OngoingDec 2015

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Ensuring support from communities



DoH – Action 7.1 Develop and implement a strategy that helps to build awareness and understanding of death, dying and loss across Victorian communities.

• Attendance levels at regional health promotion events conducted during National Palliative Care Week.

• Strategy developed and endorsed by Consortium Management Group.

• Links between the consortium and health promotion officers (local councils, community health centres, PCPs) are enhanced or established.

May 2013

June 2013

June 2013

GRPCC Raise awareness of palliative care scope and issues communicated in user-friendly language.

• Information provided by GRPCC on website and across all collateral is clear and concise.

• Media releases issued to local papers across region on regular basis.

• GRPCC advertisement developed for WIN TV.

Ongoing

Ongoing

Dec 2013

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Improving stakeholder communication



GRPCC Improve the effectiveness of communication across GRPCC member services and activities.

• Increased attendance at annual regional conference.

• Conduct audit of current communication channels.• Annual stakeholder survey conducted.• Quarterly ‘Life Matters’ newsletter distributed.• GRPCC website content updated regularly. Utilise Google

Analytics to ascertain which pages attract highest no. of hits.

July 2012, ongoing Dec 2012Dec 2012OngoingOngoing

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Strengthening governance arrangements



GRPCC Strengthen corporate governance arrangements between the GRPCC and member services in relation to funding of key initiatives.

• MoUs developed and signed between the GRPCC and member services.

• MoU developed and signed between the GRPCC and the Palliative Care Specialist Consultant/cy.

• Service agreement between GRPCC and the three member services employing the NPCs developed and signed.

Nov 2012

Dec 2012

Dec 2012

c/- West Gippsland Healthcare Group Landsborough Street Warragul VIC 3820

Ph: 03 5623 0684 Email: [email protected] Web: www.gha.net.au/grpcc

Gippsland Region

ConsortiumPalliative Care

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