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"Palliative care prescribing"

About: Greenwich Hospital

(as the patient),

Palliative Care unit at Greenwich NSW has policy not to issue scripts to terminal patients, but get them from their GP.

They give several reasons for this, none of which make sense, e. g. so GP can be involved in shared care. Yet the palliative care nurses call GP's for Schedule 8 scripts (medications prescribed under strict supervision) for patients they've never even seen, which could get the GP into medico-legal trouble. Not shared care!

As well, to get one months worth of one drug recommended by palliative care requires the palliative care to contact a GP, and then the patient to spend their precious time and energy on another medical visit.

This is not even including regular difficulties at the pharmacist end.

It really shouldn't be so hard for people with a terminal illness to access pain relief.

I have spent literally 6 hours trying to access one medication, and still don't have it.

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Response from HammondCare 7 years ago
Submitted on 28/11/2016 at 5:38 PM
Published on Care Opinion on 29/11/2016 at 11:20 AM

Dear PK,

Thank you for getting in touch with us. I am sorry to hear of your experience with our palliative care services and for the distress you have experienced as a result. There are a couple of factors that affect how medication is prescribed including whether you are receiving inpatient or community care. As we are uncertain about which service you are receiving, it is difficult for us to know how HammondCare can be responsive to your particular situation. If you would like to contact me to discuss your concerns further, please feel free to call me at Greenwich Hospital on 02 9903 8333.

Yours sincerely,

Stewart James

General Manager - Health & Hospitals

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Update posted by PK (the patient)

I am receiving outpatient care, which I thought would have been obvious from my story.

Both my GP and oncologist are very angry about what this policy puts many of their cancer patients through.

The shared care excuse is a nonsense as I've described above. The only reason I can think of that a dedicated palliative care service won't prescribe pain medication to terminally ill people is to increase productivity for Hammond and shift the work to the GP, who often doesn't even know yet what the patient is on or even know the patient, or to another specialist who is often in the same situation, plus is already managing lots of other aspects of patient care.

Either way, a sick and often weak patient spends another few hours to get a script, not to mention pharmacy wrangling for S8 scripts.

Could you please explain this policy and the reason behind it clearly? It should be transparent to all. And please don't hide behind shared care. You don't need to prescribe the painkillers as a GP to be involved in shared care. Further, as previously mentioned, it is not uncommon for GPs to be called about patients they've never seen. I've heard from my GP this has occurred to them even if the palliative care doctor is actually at the patient's house at the time.

The distress you are putting patients through is unconscionable.

I'd rather you respond publicly than to me on the phone.

Looking forward to your response.

Response from HammondCare 7 years ago
Submitted on 9/01/2017 at 2:15 PM
Published on Care Opinion at 5:34 PM

Thank you PK for getting back into contact with us and letting us know that you are receiving outpatient care. I again apologise for the distress this situation has caused you and understand the frustration you are experiencing.

The Palliative Care unit at Greenwich Hospital is a consultative service and provides advice to the treating doctor, for instance your GP. In a service such as this, the primary relationship between a patient and their treating doctor is paramount and we do not want to intervene especially where multidisciplinary medication management is a priority. We recognise that care coordination is a major challenge when there may be an oncologist, radiation oncologist, palliative care physician and general practitioner involved. Our practice aims to keep the control of care with the treating doctor for patients in the community as they know you and your circumstance best.

The Palliative Care unit provides care to 1732 patients in the community a year (2015/16), and is a valuable service to many. I understand your frustration that it might seem like patients are spending much of their time getting scripts. However quality of care and effective care coordination is what makes the HammondCare palliative care service successful and valuable to so many people.

I want to thank you for your advocacy for positive change and recognise your desire for improvement. The Health and Hospitals Palliative Care Clinical leadership team at Greenwich Hospital meets again in February. I have raised this concern as an agenda item for the next meeting to ensure that we are considering all opportunities for improvement for an effective service.

Yours sincerely,

Stewart James

General Manager – Health & Hospitals

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Update posted by PK (the patient)

Dear Mr James

Thank you for your response, part of which isn't clear to me, and much of which sounds like a proforma reply.

It sounds as if you have never been responsible for an individual patient in a clinical sense, and are coming from a primarily PR/commercial perspective. Tell me if I'm wrong and you're a practicing clinician.

You repeatedly fall back on and hide behind the excuse that your service doesn't prescribe pain medications for palliative care patients (in pain) because you are encouraging coordinated or shared care with GPs.

However, there are several factual problems with your argument.

For instance, please tell me why GPs and oncologists are being phoned by your service to write scripts for patients they've never even seen? Even when your staff member is in the patient's home with a script pad in their hand? This obviously isn't shared care, and in itself reveals your excuse to be a furphy. I can confidentially provide names of doctors willing to testify to this if you'd like.

You could easily fulfill this purpose of clear practitioner communication by sending a letter or email to the GP keeping them in the loop, as the vast majority of specialists do. Why make it hard for patients and non-Hammond doctors?

And as you know, prescribing S8 drugs is much much more time-consuming and difficult for practitioners who don't know the patient, have no evidence of their condition and are in the midst of a fully-booked day seeing their own patients? GPs are already stretched. Why do you force patients to ask them to do that work for nothing when your doctors have the patient and computer in front of them?

I'm also sure you're well aware that community practitioners such as GPs and oncologists do not get paid for this work where they do not see the patient face to face, but includes learning all about a complicated patient's medical history from scratch, or writing scripts requested by phone. This is what you're often telling patients to request - sounds like asking other doctors to do Hammond work for free.

So you can see why your policy sounds like simple cost-shifting and buck-passing.

Several of your doctors have told me or implied that the non-prescribing policy is imposed by your institution, and is not supported by them. Some if not all of their computers and software by the way are pre-historic and connected to no-one. It's a joke. They don't even seem to be supplied with computer compatible authority script forms, which most palliative care patients require. Funny that.

In summary, you are going directly against your charter by adversely affecting the quality of life of terminally ill patients, who often have to see many practitioners and often. Shouldn't your service make it easier for these patients, when possible, to not have their precious remaining time and energy monopolised by spending it in doctors' waiting rooms and appointments just to get a script?

In my case, I have three medical specialists, a GP, and three allied health practitioners. Plus I'm struggling to keep working to pay the bills. And I'd like to see my kids.

Couldn't you help out?

This is not to mention that many people these days don't have a regular GP for various reasons, and that is their choice, whether for financial, time, geographic or other reasons.

For these people, they can be treated as drug seekers and denied pain relief when seeing a new GP.

I look forward to a meaningful reply without the spin.

Kind regards


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