NPCC GenPal - A Screening Tool for General Practice (Version 2)
Early identification of palliative care needs in general practice for GPs, Practice Nurses and Primary Health Networks.
Head to PCOC's YouTube channel to watch the GenPal video for General PracticeIntroducing GenPal, a screening and decision support tool for general practice. It helps GPs in the timely identification of patients with potential palliative care needs by using indicators and patient reported outcome measures. Cyclic GenPal screening begins in the general practice chronic condition clinic. GenPal is easy to implement. Once set up, it runs mostly in the background, creating ongoing efficiencies for the practice.
Step one: identify patients. Each month, general practice administration runs a preset search to identify patients who are aged 45 or more, diagnosed with at least one of the top five causes of expected death in Australia, and frequency of practice visits is on average once every three weeks. For those who meet these criteria, the GP then applies the surprise question.
Step two: GP review. Each GP reviews their patients on the list and applies the surprise question – “would I be surprised if this patient died in the next 12 months”? Patients for whom the answer is yes, those names are removed from the list. Those patients remaining on the list are then invited to participate in regular screening with GenPal.
Step three: start screening. At the first appointment, the benefits of participating in the screening process are explained to the patient. Consent is obtained and patients are shown how to complete the screening on their phone using the Edmonton Symptom Assessment System. Patients submit screening results in the waiting room. Just prior to seeing the nurse or GP for a review, the patient will be asked to respond to two questions and rate 11 symptoms on a scale from zero to 10 based on the symptom severity over the past 24 hours. Patients also submit screening results at home in between reviews at the practice. This means that the patient screening occurs every three weeks.
Step four: respond to results. Patients receive tailored symptom resources from healthdirect and other trusted sources. These resources are based on the severity of needs. High scores trigger repeat screenings. The patient may opt out later in the process. The practice receives a notification email with the subject line summarizing the screening results with concerning scores highlighted. The general practice responds according to their clinical pathway. Results are saved directly into the patient's record.
Step five: consider referral. If symptoms are problematic, the patient has reduced functioning and a recent unplanned hospitalisation, the GP may consider referral to specialist palliative care using their clinical judgment.
The patient then receives shared care from both the GP and specialist palliative care service.
For detailed information on GenPal, please visit the NPCC website.