Patients across Greater London are to be given greater power to inform GPs, hospitals, ambulance crews, 111 providers, care homes, hospices and out of hours services, about their urgent and end of life care wishes, following the launch of a new online urgent care record called ‘myCMC’.
Coordinate My Care (CMC), an NHS clinical service, has helped tens of thousands of patients in London. For patients with a plan, which have been created by their clinician, everyone they meet along their health journey knows their diagnosis, how they wish to be managed and what to do in the middle of the night when their own doctors and nurses may not be available.
The new myCMC patient portal, launched by CMC, means that for the first time, patients can go online and easily initiate their own urgent care plans. Patients can specify the treatment they want, where and when they want it, should their condition deteriorate. They can detail their key contact information and document if they would like their organs donated.
Substantial time is saved for GPs, or for one of many CMC trained nurses and consultants in hospitals, communities and hospices, who meet with the patient to complete their already started plan, where clinicians add clinical details and approve it. Vital information in the plan is then shared across urgent and emergency providers, safely and securely.
This will tell healthcare professionals, across a range of settings, circumstances in which the patient does not want to be taken to hospital, when they prefer to receive care at home, and other important information to ensure appropriate care is given in accordance with their wishes. This includes a patient’s do not resuscitate wishes and their preferred place of death.
The new myCMC patient portal is now available for use, and throughout 2018 CMC will be seeking feedback from clinicians and patients during an evaluation period.
Professor Julia Riley, clinical lead at Coordinate My Care, said: “Empowering patients to tell NHS and care providers the care they want to receive at a crucial point of their life is a priority. As care providers we have a responsibility to coordinate our services around patient wishes – especially when they are faced with difficult diagnoses that may require urgent or end of life care.
“CMC has already had a big impact for many patients, but there are many more who are still inappropriately sent to hospital when they do not want to be there, causing distress for patients and pressure on the system. MyCMC is accessible online and will allow many more patients, families and carers, to set up plans that can make a huge difference to their experience.”
CMC has already significantly reduced inappropriate and unnecessary hospital admissions. Importantly, less than one in five patients with a plan spend their last days in hospital, compared to almost 50% nationally, which, in addition to respecting patient wishes, is saving the NHS an average of £2100 per patient.
More than 46,000 CMC plans have so far been created for patients. The launch of the new myCMC online care plan is expected to see significantly more plans created, whilst reducing burdens faced by healthcare professionals.
The myCMC development has been made possible having been built on InterSystems’ unified health informatics platform HealthShare, recognised as one of the most advanced and interoperable platforms in use across global health and care systems. It has been designed to be intuitive, having been developed in consultation with healthcare professionals. Online training for myCMC will also be made available to anyone who may need it.
MyCMC has been welcomed by nurses, ambulance providers, hospitals, and GPs in London, where more than 1,000 practices are already signed up to the CMC service.
Dr Naz Jivani, a GP in New Malden, said: “Creating an action plan for patients whose condition might escalate, means we can ensure they are appropriately treated, and avoid unnecessary hospital admissions. Frail patients, who may be coming toward the end of their life, often do not want to be sent to A&E; they prefer to be treated in their home or care home. But where plans are not in place, staff and carers can panic without the right information and send patients to hospital for events that may be part of the natural process of dying, sometimes leading to patient distress or people spending their final hours in A&E.
“Working with patients at the coalface to understand their wants and needs in advance, allows out of hours services to come to a very quick decision on the most appropriate care for that patient in the event of deterioration.
“CMC has continued to evolve, meaning plans can now be more easily created, reviewed and approved in minimal time, without burdening GP workload. MyCMC will also mean that the patient has access to their plan on their smart phones, and can show it to any health or care professional.”
Tracey Bleakley, CEO of Hospice UK, added: “Giving patients and their families the means to plan for end of life and urgent care is critical and there is clear public demand. You are far more likely to have the end of life care experience that you want with a plan, rather than leaving it to chance. Birth plans help many people to achieve their wishes, and it is just as valid that we talk about end of life and urgent care plans.
“Poor coordination of records across health and social care can often make it difficult to know when and how to do the right thing, creating a lot of pressure for professionals and patients.
“CMC plans can make sure important questions and discussions about the patient’s wishes are not overlooked. And they can help professionals understand when it is not appropriate to take patients to hospital where they may feel frightened, or when to avoid resuscitation and the unintended consequences of cracked ribs or severe pain often associated.
“People want to be involved in the decisions about their care. Creating a CMC urgent care plan is something that stimulates discussion and gives patients control.”
Dr Anna-Marie Stevens, a nurse consultant in symptom control & palliative care at The Royal Marsden NHS Foundation Trust, said care homes are now better prepared to deliver the care their residents need. She said: “Part of my job is to help care home staff recognise when someone is reaching the end of their life so that we can plan ahead. That is where CMC comes in – planning to make sure that resident’ wishes are supported.
“Through advance planning around escalations of treatment and care, CMC now helps a multitude of professionals to identify those people who should be admitted to hospital, and those who should receive ongoing care in the care home. It can mean alerting ambulance staff to patient wishes, or simply making sure that the care home has necessary medication in case of breathlessness, sickness, or agitation.
“Professionals across our GP surgeries, care homes, the London Ambulance Service, and beyond have been very supportive of this fantastic initiative, which is connecting London together. This is not about stopping people going to hospital for acute events such as a broken leg. But when expected acute events occur, such as an infection, staff can more easily do what is in the best interests of the resident.”
