Our clinical teams work with other local healthcare professionals, such as GPs and district nurses, across our catchment area of West Surrey and North-East Hampshire. Timely referrals from GPs can help patients to access and benefit from our care earlier in their diagnosis. We liaise with all of the healthcare professionals involved in each patient’s care throughout their time with us, so that everyone is kept up to date.
Nina, a GP partner in Fleet, Hampshire, finds the mutual support and communication she has with our clinical teams very valuable.
“We have a close working relationship with Phyllis Tuckwell,” she said. "It’s a really important service for our local community and our patients, but also for us as clinicians. We have patients with all sorts of long-term conditions and terminal illnesses, and a growing elderly population, and having a good end of life makes a big difference to them. It’s also important to the people looking after them, their families and friends. By working together, we can ensure that the right people are there in the right place at the right time for our patients.”
GPs like Nina, and other healthcare professionals, can refer patients to any of our services: Living Well, which cares for patients earlier in their diagnosis, helping them to manage their symptoms and cope with everyday life; our In-Patient Unit, which offers 24 hour symptom management and end of life care; and our Hospice Care at Home team, which supports patients who want to spend their last days at home, instead of on our In-Patient Unit or in hospital. We take time to really get to know our patients and understand not just their medical needs, but their emotional and mental wellbeing too, so that we can offer them holistic care and address any concerns that they may have about their situation. An early referral to our care gives our teams time to put into place the medical, nursing, therapeutic, practical and pastoral support that each patient needs, and get to know the needs of their family members and carers too.
“Phyllis Tuckwell looks at patients as a whole,” said Nina, “and part of that is about patients accessing care early, so that they can understand their journey. Phyllis Tuckwell’s Living Well service is not just about the end of life, it’s about making every day as good as it can be and preparing for the last days. That lead up can be unpredictable and the length unknown, which can be quite scary for patients. Often when patients get a significant diagnosis, they will ask ‘how long have I got?’ and in all honesty none of us knows. We can say days, weeks, months, years, but we don’t really know as it’s so hard to predict, and that’s a really insecure and uncertain position for patients and their families to be in. Having support from Phyllis Tuckwell through their journey, for however long that is before the actual end of life phase, makes a really big difference. It allows patients to put their affairs in order so that they can look ahead, enjoying the good days and planning for the bad days.”
Once patients are under our care, we make sure that we stay in touch with the other healthcare professionals who are also looking after them, such as their GPs and district nurses.
“We are a prong of a multi-faceted team” said Nina, “and part of that team includes Phyllis Tuckwell. It also includes other community services, such as the integrated care team and the community nursing team. Every month we have a quality meeting, which is a multi-disciplinary meeting, and various agencies attend, so that we can review individual patients who may be having struggles or have complicated care. One of the palliative care nurses from Phyllis Tuckwell attends that meeting or, if she can’t, she’ll send information so that we can all be included in the loop. Whilst we don’t necessarily all need to be involved with that patient at that time, it’s about the right people at the right time. These monthly meetings are really important because it’s about joined up care; it’s not about one person being involved with that individual, this is a team effort. In addition to this, the consultants at Phyllis Tuckwell link in with us on a regular basis, and always keep us in the loop with emails or letters from clinic reviews and home visits that they’ve done, so there’s always constant communication with our shared patients. It’s also important so that when a patient has died, we can support their family through the challenges they face afterwards. The communication we have with Phyllis Tuckwell is really good, not only through meetings and letters, but also through the shared information on patients’ medical records, which we can all access to see what’s been going on recently.”
As well as doctors and nurses, our team at Phyllis Tuckwell includes physiotherapists, occupational therapists, complementary therapists, counsellors, patient and family advisors, and our pastoral care team. They can provide advice, guidance and practical support to help patients remain mobile, cope with symptoms such as breathlessness, manage their changing appetite, mood and sleep habits, and ensure that they and their carers are receiving the right benefits.
“As GPs, we know that can't provide the time and level of support that patients and their families will need when they’re living with an advanced or terminal illness. By referring patients to Phyllis Tuckwell, we know that they are getting the background support that unfortunately we haven’t got the time or resources to give them. With Phyllis Tuckwell, patients also know that should a different symptom occur or should something unpredictable happen, someone is there who can help them with that. But it’s not all about the medicine - it’s about the care, it’s about the familiarity, it’s about having time to be able to express themselves. Phyllis Tuckwell looks at people’s lives as a whole, so helps with finances, or making Wills, and documenting people’s preferences for their end of life care, and that is so important to all of us because then we’re always working towards the patients’ wishes.”
We are currently building a new Hospice on our existing site in Farnham, to cope with the increasing demand for palliative care that we are seeing. We are continuing to provide all of our services throughout the build, from alternative locations in Farnham, Guildford and Camberley. GPs can still refer patients to us as usual, and we will still provide the same high quality care that we always have.
"The new Hospice building is really important,” said Nina. "In my time as a GP, which is nearly 20 years now, Phyllis Tuckwell’s role has changed. Historically it was very much about dying, but in the last 10 years or so it’s been very different - it’s about living well up to the point of death, too. Death is the end point of that journey; it’s a journey and it takes time, so the role that Phyllis Tuckwell plays is increasing, and its services are increasing. The types of patients that it looks after has changed too; it used to be just people with terminal cancer, but now it’s people with end stage heart failure, end stage respiratory disease, dementia, there’s a whole host of conditions that Phyllis Tuckwell’s patients may have, it's not just end of life anymore.”
An important part of the new Hospice will be the garden area. Nature is important to the wellbeing of our patients and their families, and the garden will provide a place for them to feel the sun and wind, see and smell beautiful, fragrant flowers, watch their children and grandchildren play, and think about something other than their illness for a time.
“I think anyone who has a garden enjoys it,” said Nina. “It’s about being at one with nature. It’s fresh air, colour, sights, sounds, smells. It's good for anyone’s mental and physical wellbeing to have some outdoor space where they can enjoy that. We absolutely know that the medical evidence is that being in tune with nature is good for one’s mental health, and what better time to address that than during a final illness. It’s also important for their families to have a space where they can reflect, enjoy nature and just take a breath - I think that’s really important.”
As well as referring patients to our teams, Nina had first-hand experience of our care when she visited the Hospice for a day as a trainee GP. As a Centre for Excellence in Palliative Care, our Education and Clinical teams are involved in training other local healthcare professionals in palliative and end of life care, and we regularly welcome trainee GPs on rotation to our In-Patient Unit.
“When I was a GP trainee, I went to the Hospice for a day,” said Nina. “I was dreading it as I didn't really know what to expect, but it was the loveliest day! It was such a positive place, and I came out happy, which I wasn’t expecting. It was a nice reflection at that point in my career, knowing that it’s not a negative place, it’s about making the best of a really bad situation, and that could be done really well.”
Nina has also had very positive feedback from patients whom she has referred to our care. “I spoke to one lady this morning, who was very grateful for the care that Phyllis Tuckwell has given her. She has benefitted hugely from their counselling service. She actually felt that she needed a break from talking to people, and knew that she had some sessions left, so she put them on pause, but today said to me that she thought the time was right to go back to them. She said that they had been amazing, and that she might have a massage there too! She also said that her now-adult children were struggling with her condition and were going to tap into that counselling as well.”
“I would encourage all GP surgeries where possible to engage with the palliative care team at Phyllis Tuckwell. If you have monthly team meetings, invite them over or to join on Teams. You don’t have to discuss all of your patients on the register, just the complicated ones or the ones that you’re worried about. It’s really easy, it makes a big difference, and as we are working as a multi-disciplinary team, it’s really important.”
