Capital Health Network

The experience of death and dying has changed considerably in Australia over the last century. Social, economic, and carer circumstances have evolved, and life expectancy has increased alongside a greater prevalence of chronic conditions with complex symptoms and multi-morbidity. This has influenced a shift to larger proportion of deaths into hospitals and residential aged care homes.  

However, being cared for and dying at home is most people’s preference. The Greater Choice for At Home Palliative Care (GCfAHPC) measure aims to help make that possible. The GCfAHPC measure provides funding for coordinating palliative care through PHNs. Goals include to:  

• improve your access to the best palliative care at home  
• support palliative care services in primary health and community care  
• make sure you get the right care, at the right time and in the right place to reduce unnecessary hospital visits  
• generate and use data to improve services  
• use technology to provide flexible and responsive care, including after-hours care.  

During Advance Care Planning Week 2024, CHN conducted a face-to-face workshop for Practice Nurses, promoting advance care planning programs and resources. CHN is represented at the ACT Advance Care Planning Networking Meeting, which identifies gaps and enablers in advance care planning and solution brokering across the ACT.  

Two workshops were held including a ‘Breathlessness’ webinar and an evening workshop titled ‘Palliative Care in RACF for GPs’. They were well attended by GPs and Practice Nurses. The aim of the second workshop was to increase GP awareness of resources available to them when supporting their patients in residential aged care for end of life. GPs met with services providers such as CALMS, PEACE and GRACE to learn about their service models of care. In collaboration with GPs and RACF palliative care services providers, a ‘Residential Aged End of Life Primary Care Resource’ was created and sent out to all GPs, CALMS and RACF facilities across ACT. CHN participated in the RACGP palliative care GP training session and promoted CHN palliative care activities.  

CHN began chairing the ACT Health Palliative Care Operations Committee and is represented at the Governance Committee. CHN is represented at the palliative care Single Point of Referral and Triage Working Group which aims to create a model of care for consideration of a single point of referral and triage. CHN has collaborated with local palliative care networks and working groups including Palliative Care ACT, Health Care Consumers Association, Carers ACT and other key stakeholders.  

CHN supported the Community Health Nursing Team to assess, monitor and respond to physical and psychosocial needs of patients as they approach end of life. CHN has promoted palliative care resources, learning opportunities and programs available to service providers and general practices through GP Liaison Units, CHN newsletters, HealthPathways and social media. 

CHN engaged with the sector to design a quality improvement activity, ‘Palliative Care in General Practice’, to develop strategies to improve linkages, coordinate services and improve access to palliative care in primary care and the community.