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'Sometimes Parkinson’s patients have complex needs and it helps having someone to see them at home'

Lynn Gill’s ingenuity has transformed life for patients with Parkinson’s disease.

A nursing initiative started by Parkinson’s specialist nurse Lynn Gill in rural Devon has resulted in a dramatic fall in the number of people with the disease who are admitted unnecessarily to hospital.

As well as benefitting patients and carers, the effects on the NHS are equally positive – typically, a patient with Parkinson’s will spend 10-20% longer in hospital than someone without, at a cost of some £2,500 per episode, as calculated by Parkinson’s UK.

Ms Gill and her colleagues at Northern Devon Healthcare NHS Trust set up the project amid growing evidence that admissions could be avoided. One patient, for example, was continually being admitted to hospital, despite insisting he was taking his medication. No-one could understand why until Ms Gill visited him at home and worked out what was going on.

“He took me to the kitchen and showed me a cupboard full of tablets. I asked him which he was taking and he said: ‘Any’.”

Realising patients like this were coming into hospital with seemingly preventable problems, she and the team developed a home-based support system for them. Ms Gill wrote to all the local GPs and district nurses to ask them to let her know when patients with Parkinson’s were going into a crisis at home. She and her team have now been working with 25 GP practices and four community hospitals for the past two years. 

“Sometimes GPs have Parkinson’s patients with complex needs and it helps them having someone to see them at home.”

Ms Gill sees patients referred to her on the same day or the next to assess them and arrange treatment plans, then typically visits weekly if necessary for the next six to eight weeks. Strategies for keeping patients at home include reviewing medication, and dealing with non-Parkinson’s-related ailments as well as follow-up visits.

“Initially, I spend one to two hours with them and find out the problem. I take a good history, then go back to the GP and tell them what I think we should do,” she explains. She then plans how best to work with the patient and their holistic care package with the aim of preventing hospital admission.

“If patients need other services, I can arrange for other members of the multidisciplinary team to visit their home, so home adaptations or additional care can be discussed with both patient and their carer.”

By building up a full picture, she identifies how she can help, and signposts to other agencies and professionals.

With a background in palliative care, she is also familiar with the needs of clients with terminal diagnoses.

“One patient was in the palliative phase so I visited her every day for two weeks to give advice and support. I worked closely with the GP and she died at home, which was what she and her family wanted,” Ms Gill recalls.

The service is proving beneficial all round. Ms Gill says: “Patients like it as they can stay at home regardless of being poorly. Carers like it because they are involved in changes to the patients’ care and often, being in a rural area, it’s difficult for them to come to hospital. And by the service’s second year, no patients were admitted to hospital for not coping with Parkinson’s at home, only for other reasons, such as falls.”

The team will continue providing the service to patients in crisis and Ms Gill offers training to other professionals in northern Devon. An education day, held in 2009, was attended by 112 multidisciplinary staff. This helped raise awareness of Parkinson’s and its treatment. The team is planning another such day in April at the start of Parkinson’s Awareness week.

In Ms Gill’s eyes such schemes should not just be for Parkinson’s but rolled out to any long-term condition.

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