Tag Archives: Projects

Dundas medal launched to commemorate Aberdeen consultant

Scottish charity PATCH and Royal College of Surgeons of Edinburgh and collaborate to recognise those delivering best palliative care.

News release – 25 April 2017 – A new medal has been introduced by Scottish charity PATCH (Palliation And The Caring Hospital) and The Royal College of Surgeons of Edinburgh to recognise efforts to improve the provision of palliative care for patients when they are in hospital. The Dundas medal commemorates a former Aberdeen anaesthetist who died in 2014 from hepatobiliary cancer.

The family of Dr Dundas provided the legacy for this medal to acknowledge the importance of good palliative care for patients approaching the end of life, particularly in a hospital setting. The need for appropriate pain and symptom control, as well as clear communication with patients and families, is fundamental for those at the end of life.  The Dundas Medal aims to raise the profile of this need right across the UK.

The Dundas medal will be open to any individuals or teams, medical, nursing or paramedical working in the UK. The applicants or the applying teams are invited to submit an example from their own clinical experience detailing how they have made a difference to the provision of palliative care in their own hospital setting.

Dr Charles Robert (Bertie) Dundas was a consultant anaesthetist in Aberdeen Royal Infirmary and a senior clinical lecturer at the Foresterhill campus of Aberdeen University for over 30 years. He also served in the Gulf War as a consultant anaesthetist in the Royal Army Medical Corps.

Sir Michael Nairn, Chairman of PATCH commented:

We are delighted to announce the inauguration of the Dundas Medal in partnership with The Royal College of Surgeons of Edinburgh. Dr Dundas was dedicated to the medical profession his whole life and we are privileged to be able to recognise his commitments with this new award.

The importance of palliative care in the hospital setting is something that he was very aware of, and his family wishes to encourage and recognise far greater availability of this, in his memory.

The majority of us are destined to die in hospital, and now, more than ever, there is a clear recognition of the need to provide good palliative care for patients when they are in hospital. This is being provided by members of the hospital staff right across the UK and we want to recognise and congratulate these teams or individuals with this new award.

Mr Mike Lavelle-Jones, President RCSEd commented:

I am delighted to launch the Dundas Medal as one of our initiatives with our new partners at PATCH.  This award recognises the dedication and commitment of all those involved in the advancement and delivery of palliative care highlighting the contributions not only of medical individuals or teams but also the valuable work undertaken by nursing and paramedical staff.

Further information

For more information or guidance about the Dundas medal, see Awards and medals – The Royal College of Surgeons Edinburgh

“SPOT” Safer Prescription of Opioids Tool

PATCH funded the prototype stage of SPOT – a novel application that can be used on a range of mobile devices including laptops, tablets and smartphones to calculate painkiller dosages.

Senior woman in a hospital bed having talking to male doctor with stethoscope and clipboard

SPOT (Safer Prescription of Opioids Tool) is a clinician-led, clinically validated, clinician decision support tool, devised by Dr Roger Flint who trained at Dundee University and Ninewells Hospital. The application is designed to to reduce opioid prescribing error.

A number of strong painkillers, morphine derivatives, are used in the management of patients with advanced illness or cancer. Converting from one painkiller to another requires care and is presently performed using paper tables of approximate equivalence.

As Dr Flint explains:

Two weeks after starting work as a doctor I was asked to switch painkillers for a patient who was very ill and towards the end of their life. It took me a long time to calculate the correct dosage. There was no way to double check my calculation, and I felt unable to prescribe the pain relief.  It was a sobering lesson and I was determined that no other junior doctor or patient should be put in the same position.

SPOT double checks such drug conversions. It is a CE marked medical device, and is undergoing clinical investigation in NHS Tayside. SPOT has the support of the University of Dundee, NHS Tayside, the Digital Health and Care Institute and Scottish Enterprise.

Further information

The Safer Prescribing of Opioids Tool (SPOT)

PATCH funds communications pilot project at University of Dundee’s School of Medicine

Simulation-based workshops enable healthcare professionals to hold open and honest discussions with their patients.

PATCH (Palliation and the Caring Hospital) has funded a project at The University of Dundee to help doctors care for and communicate more easily with those at the end of life. The support for the project was marked with the unveiling of a plaque at the School of Medicine’s Institute of Healthcare Education (IHSE) in Ninewells Hospital on 1 November 2016.

From L-R: Professor John Connell, Chairman of NHS Tayside; Dr Ben Shippey, Director, Institute of Healthcare Skills Education; Dr Gordon Paterson, Director, PATCH; Mrs Trudy McLeay, Director, PATCH; Sir Michael Nairn Bt, Chairman, PATCH; Sandy McDonald, Consultant for Thorntons LLP; Dr Stephanie Sim, NHS Tayside; Dr Pam Levack, Medical Director, PATCH.

From L-R: Professor John Connell, Chairman of NHS Tayside; Dr Ben Shippey, Director, Institute of Healthcare Skills Education; Dr Gordon Paterson, Director, PATCH; Mrs Trudy McLeay, Director, PATCH; Sir Michael Nairn Bt, Chairman, PATCH; Sandy McDonald, Consultant for Thorntons LLP; Dr Stephanie Sim, NHS Tayside; Dr Pam Levack, Medical Director, PATCH.

Professor John Connell, Chairman of NHS Tayside, and Dr Ben Shippey, Director of IHSE, were on hand to recognise the unique collaboration between PATCH the University and the NHS.

The three organisations have come together to develop and pilot a series of workshops to equip young healthcare professionals with the skills they need to have honest and open conversations with patients and their families about dying– particularly with those people whose needs might be better served by active palliation of their symptoms rather than other healthcare interventions.

The unveiling of a plaque to recognise a unique collaboration between the University of Dundee, the NHS, and PATCH.

The unveiling of a plaque to recognise a unique collaboration between the University of Dundee, the NHS, and PATCH.

The half-day sessions began in March 2016, and include open discussions, practical opportunities and expert feedback. The activity is simulation-based, with debriefing by skilled faculty using video recordings of conversations with simulated patients and actors.

The School of Medicine ultimately aims to open the workshops to healthcare providers from other institutions around the country, and to share materials and resources needed to deliver the training.

Dr Ben Shippey, Director of IHSE, said:

“In Western societies we seem to have lost our way with regard to recognising and caring for people who are dying.”

“Advances in medical technology mean there is an overwhelming pressure to offer treatments to people where the benefit to them is less clear, because it can be psychologically easier for healthcare professionals to commit to unpleasant — and ultimately futile –treatments than to ask ‘are you really sure that’s what you want?’”

“The skills healthcare professionals need to engage with these open and honest conversations can be learned — and we in the IHSE believe we can deliver that learning effectively and efficiently using simulation-based learning.”

The issue of appropriate patient care is a timely one.

Scotland’s Chief Medical Officer Dr Catherine Calderwood used her 2014-15 annual report, Realistic Medicine[1], to challenge healthcare providers to reduce the waste and harm from unnecessary treatments by actively engaging in a process of shared decision making with patients.

And earlier this month, the Academy of Medical Royal Colleges published a list of 40 commonly-used treatments that bring little or no benefit to patients as part of their Choose Wisely campaign[2], which is designed to highlight the need for patients and doctors to talk frankly about how health issues should be treated.

“We hope this training will be a step towards a cultural shift,” Ben said, “such that healthcare professionals acknowledge they can make a real difference by actively managing dying for more patients, and take a step away from delivering what they can do toward asking what they should do for people at the ends of their lives.”

Pam Levack, Medical director of PATCH, commented:

“We are so pleased to be able to support this project, as it really reflects one of the serious issues which PATCH was set up to address – the improvement of communication between medical professionals and patients and their families at the end of life.

“Should palliative care be the most realistic and best option for patients, it is so important that doctors and nursing staff feel comfortable, equipped and trained to discuss this openly. It requires compassion and understanding and an ability to relate to patients and their families at a time when they are most frightened.”

“PATCH believes it is vital to be able to discuss what is happening to patients to make a real difference to their care at the end of life.”

“This is an excellent project and we hope that it is just the beginning for other similar initiatives across the NHS.”

Further information

References and Footnotes

  1. NHS Scotland. (2015). Realistic Medicine, Chief Medical Officer's Annual Report [Accessed: 3 November 2016].
  2. Academy of Medical Roya1 Colleges. (2016). Forty treatments that bring little or no benefit to patients. [Accessed: 3 November 2016].

PATCH funded research presentation is well-received at the WONCA Europe conference 2016

PATCH funded Dr Sarah Mills to attend the WONCA Europe conference 2016, where she gave four presentations regarding her research into unscheduled care and cancer.

Dr Sarah Mills SCREDS Lecturer in General Practice, Tayside Scotland, was funded by PATCH to present her research at the WONCA Europe international conference of primary care physicians in Denmark in June.

The World Organization of Family Doctors (WONCA) is a not-for-profit organization and was founded in 1972 by member organizations in 18 countries. WONCA now has 118 Member Organizations in 131 countries and territories with membership of about 500,000 family doctors and more than 90 per cent of the world’s population. [1]

Dr Mills’ research can potentially:

  • identify factors associated with unscheduled care use.
  • Suggest clinical and service provision changes to improve the patient journey in patients with terminal cancer.
  • Ensure quick access to pain and symptom control.

Following is a report from Dr Mills following her series of presentations that she gave at the conference.


WONCA 2016 Conference Report

Dr Sarah Mills, SCREDS Lecturer in General Practice, Tayside

I attended the WONCA Europe conference from 15th to 18th June in Copenhagen, Denmark. This was an international research meeting for General Practitioners from around the world to present their research to a primary care audience. It was a fantastic opportunity to network with GPs from different cultural, socioeconomic and political backgrounds and to present the research I have been working on to a diverse audience.

Dr Sarah Mills at WONCA Europe 2016

Dr Sarah Mills at WONCA Europe 2016

I was fortunate enough to be selected to give four presentations at the WONCA conference, which was among the highest number of presentations given to any individual speaker at the conference. I presented two ePosters, which were a one-slide 5 minute oral presentation. The titles for these were ‘Use of Unscheduled Care in both GP Out-of-Hours and Accident & Emergency departments by Patients with Terminal Cancer’ and ‘Consultation Outcomes And Analgesic Prescribing In A&E For Patients With Terminal Cancer’. This was an interesting presentation method which I had not tried before. It allowed me to take small aspects of my research and present them in a snapshot fashion to an intimate audience with similar research interests. The way the ePoster sessions worked meant that researchers were able to target attending sessions that reflected their clinical interests. It was excellent practice to be able to put across research findings in such a time-focused way, and really helped me distill the message behind my research. The presentations were well received and there were a large volume of questions afterwards. I was also asked to give two oral presentations, which were 15 minutes long and which were given in lecture theatres. The titles of these talks were ‘Use of Emergency Care by Patients with Cancer’ and ‘Pain-related Emergency Care Presentations by Patients with Terminal Cancer’. This gave me the opportunity to present aspects of my research in greater depth. I was again very pleased with the audience reaction – I had a lot of questions and had researchers come to speak to me afterwards. I made a number of excellent contacts with potentials for future collaborations. I recorded all the questions I was asked and will use them to inform and develop the discussion and analysis elements of my research in order to ensure it targets the information, service and research needs within this niche of primary care.

Dr Sarah Mills giving a presentation at WONCA Europe 2016

Dr Sarah Mills giving a presentation at WONCA Europe 2016

The conference was also an excellent chance to network with other UK-based researchers; the UK had the fifth largest delegation there and it was useful to be able to compare fields of interest with other British colleagues, with a view to future collaborations and input.

It was so gratifying to see how well received my research was and to get to discuss the challenges of unscheduled care use in patients with terminal cancer with other primary care colleagues from around the world. It has given me many new angles and perspectives on how this research can influence policy, and will help to make my research more robust, well-rounded and real-world applicable.

Without outside sponsorship I would not have been able to attend this conference and I am very grateful to have had this fantastic opportunity.


Further information

References and Footnotes

  1. WONCA. (2016). Global Family Doctor - WONCA online - WONCA in brief [Accessed: 02 September 2016].

PATCH-sponsored research into unscheduled care and cancer – a huge amount of progress

A first year report on PATCH funded research into patients with advanced cancer who are seen urgently at A+E and GP Out-of-Hours services because of pain.

There continue to be many reports of patients with advanced cancer who are seen out of hours because of pain. Many of these patients are seen in Accident and Emergency Departments and may need to be admitted to hospital.

Dr Sarah Mills SCREDS Lecturer in General Practice, Tayside Scotland is working collaboratively with the Departments of Palliative and Supportive Care and Oncology, Ninewells Hospital, Dundee to study this is depth.

Sarah Mills (3rd from left) with the Chronic Pain research team in the Population Health Sciences department.

Sarah Mills (3rd from left) with the Chronic Pain research team in the Population Health Sciences department.

Dr Mills has just recently been awarded a Fellowship to continue this work which she is developing towards her MD. She is delighted to have been funded by PATCH to present this research at the WONCA Europe international conference of primary care physicians in Denmark this July.


First year report into PATCH funded research into patients with advanced cancer who are seen urgently at A+E because of pain

Dr Sarah Mills, SCREDS Lecturer in General Practice, Tayside

The last year has seen a huge amount of progress with the PATCH-sponsored research into unscheduled care and cancer.

First, it was necessary to define a cohort of patients whom we could study, namely those patients in Tayside who have died from cancer in a three-year period, from 2011-2014. The cohort was identified using General Register Office ‘Cause of Death’ Data. Routinely collected clinical data from all unscheduled care during their last year of life was collected and linked to demographic and prescribing datasets using patient Community Health Index (CHI) numbers. The CHI is a unique patient identification number used in all clinical encounters in both general practice and hospital services.

The A&E data has given us a wealth of information, including the percentage of patients with cancer who use A&E, the frequency with which they attend, their reasons for attendance and when they attend relative to their date of diagnosis and date of death. We have defined 197 clinical reasons for why patients present to A&E and have examined the most common reasons for seeking emergency care. We are in the process of convening a group of experts in order to decide which presentations are directly pain-related and cancer-related. We have looked at ways in which patients present, whether they are accompanied by family and friends, what medications they are given and whether they are admitted, discharged or transferred. By mapping these trends over time we can also see how these patterns change in the few weeks before death.

Comparing GP Out Of Hours and A&E data has shown that patients with cancer present frequently to unscheduled care and that such presentations become more common in the weeks before death often due to uncontrolled pain. Initial analyses have demonstrated vital information about how, why, when and where patients with cancer access unscheduled care services. This research can potentially identify factors associated with unscheduled care use, suggest clinical and service provision changes to improve the patient journey in patients with terminal cancer and ensure quick access to pain and symptom control.

The preliminary findings of this research have been presented at the Scottish Pain Research Community Annual Conference (SPaRC) and the University of Dundee College Research Symposium. At both occasions the research has been very well received and PATCH has been credited for the research funding.