GPs should maintain a Palliative Care Register for those in the last 12 months of life.

Your medical team, in conversation with yourself and your friends and family are looking to recognise that you have more palliative care needs and that these can be provided for at home.

For extra information, evidence and best practice please scroll down to the bottom of the page.

Regional offerings

Community Occupational Therapy Team

You can request an assessment for equipment and adaptations to make it easier for you to live independently.
Weblink: https://www.gov.uk/find-local-council

Dementia Wellbeing Plan for Greater Manchester; Dementia United

The Greater Manchester dementia wellbeing plan promotes personalised planning conversations with people living with dementia and carers about their needs and wants. The plan ensures an improved standard of care planning for people living with dementia and also facilitates sharing across the system. It will be available as a standardised plan which can be accessed and shared digitally between practitioners; as well as being available from the website for people affected by dementia to be using when having person centred care plan reviews
Weblink: https://dementia-united.org.uk/dementia-wellbeing-plan/

Housing for People Living With Dementia in Greater Manchester - From Policy to Practice

The report and recommendations within it are part of an extensive period of consultation over the past 18 months and including more than 250 stakeholders across housing, health and social care in Greater Manchester, alongside people with lived experience of dementia, carers and loved ones.
Weblink: https://dementia-united.org.uk/housing/

National offerings

Advance Care Planning

Advance care planning for people with dementia guidance from NHS England
Weblink: https://www.england.nhs.uk/wp-content/uploads/2018/04/my-future-wishes-advance-care-planning-for-people-with-dementia.pdf

Gold Standards Framework

GSF is a practical systematic, evidence-based end of life care service improvement programme, identifying the right people, promoting the right care, in the right place, at the right time, every time. The training is for generalist front-line care provider. The guidance is a tool to assist in the early identification of people nearing the end of their life.
Weblinks:
https://www.goldstandardsframework.org.uk/
https://www.goldstandardsframework.org.uk/cd-content/uploads/files/PIG/NEW%20PIG%20-%20%20%2020.1.17%20KT%20vs17.pdf

Social Care Institute for Clinical Excellence - End of Life Care Resources

When a person is living with advanced stages of dementia, all areas of human ability are severely compromised. They have to rely on others for social engagement, occupation and activities of daily living. This section looks at what it's like to live with advanced dementia, communication and the impact on carers.
Weblinks:
Carers’ needs - End-of-life care and dementia: https://www.scie.org.uk/dementia/advanced-dementia-and-end-of-life-care/advanced-dementia/
Advanced Dementia: https://www.scie.org.uk/dementia/advanced-dementia-and-end-of-life-care/end-of-life-care/last-days-hours.asp
End of life care - dying at home: https://www.scie.org.uk/socialcaretv/video-player.asp?v=dyingathome

Healthwatch

Healthwatch is your health and social care champion. If you use GPs and hospitals, dentists, pharmacies, care homes or other support services, we want to hear about your experiences. As an independent statutory body, we have the power to make sure NHS leaders and other decision makers listen to your feedback and improve standards of care. Last year we helped nearly a million people like you to have your say and get the information and advice you need.
Telephone: Call: 03000 683 000 between the hours of 08:30 – 17:30 Monday to Friday
Email: enquiries@healthwatch.co.uk
Weblink: https://www.healthwatch.co.uk/your-local-healthwatch/list

Eating and Drinking - information for family and friends as dementia progresses towards the end of life

This booklet has been designed for family or friends providing support for someone living with dementia who is experiencing difficulties with eating and drinking in the later stages.

This booklet may help you to make decisions, provide care, plan for future care, and it may also help to guide discussions with health professionals. You may not want to read all of this information at this time but might wish to come back to this booklet at a later time.

PDF: Eating and Drinking - information for family and friends as dementia progresses towards the end of life - eating_and_drinking_final (1)

Evidence

Palliative Care Guidelines In Dementia: "The inclusion of patients with a dementia diagnosis within Primary Care-led palliative care meetings can facilitate a more holistic and coordinated approach to care during the last 6- 12months of life. Having proactive discussions as a multi-professional team when someone with dementia is thought to be nearing the last few months of life will enable the early recognition of advance care planning processes that have already taken place, thereby assisting the proactive management of care in accordance with an individual’s previously expressed wishes."

Best Practice Resources

Royal College of General Practitioners: The Gold Standards Framework Proactive Identification Guidance: "QOF points specifically targeted for palliative care patients - 3 points for having a register for all patients predicted to be in the last 6- 12 months of life with any diagnosis, and 3 points for holding a multidisciplinary meeting at least 3 monthly (plus other general points included in end of life care – see later e.g. dementia)"