Program Aims

To increase access to Palliative Care services by supporting the role of the GP and strengthening links between palliative care and mainstream General Practice.

Strategies

Facilitate access to Professional Development for Health Professionals that promotes best practice, quality and safety and a multidisciplinary approach.

  • Coordinate monthly meetings with GPs and regional Palliative Care team
  • Work in partnership with LHN’s and other agencies to address local health service issues and gaps
  • Promote the use of technology for communication and telehealth  
  • Improve GP knowledge and management in cancer and palliative care and to support GPs working in this area

Advance Care Planning

The Advance Care Planning program at Barwon Health is a program which:

  • Promotes an individuals understanding about their future treatment options
  • Assists individuals to document their wishes and preferences about their future medical treatment in an Advance Care Plan

Decision Assist Fact Sheets

These fact sheets have been developed by Decision Assist for health professionals:

HealthPathways

For clinical information regarding palliative care refer to HealthPathways.  For HealthPathways access or for further information contact the HealthPathways team on 03 5222 0800 or email

Community Resources

Community resources can be found on the Community Palliative Care page

Specialist Palliative Care Services in the Grampians Region

What services do Specialist Palliative Care Services (SPCS) provide?

  • Advice, information and support for other health professionals.
  • One off consultations with patients, carers and family for complex issues.
  • Short or longer term admissions to program where problems are complex and require regular evaluation and assessment. This may include end stage care.

Triggers for referral

  • The referring clinician would not be surprised if the patient died within the next 12 months
  • Recurrent presentations to hospital
  • For inpatients, it would not be a surprise if the person died this hospital admission
  • Progressive disease despite life prolonging therapy
  • Recent marked decline in physical function
  • Low probability of success from available therapeutic options
  • Withdrawal, or consideration of withdrawal, of life prolonging treatment (e.g. haemodialysis, ventilation)
  • Patient or family concern about end of life issues
  • Care needs exceed carer capacity

For more information refer to the Supportive and Palliative Care Indicators Tool (SPICT). The SPICT™ is used to help us identify people at risk of deteriorating and dying with one or multiple advanced illnesses for holistic, palliative care needs assessment and care planning. www.spict.org.uk

Referral criteria

The patient lives in the service area and has a progressive, life limiting or life threatening disease (malignant/non-malignant) and any of the following:

  • The patient has complex symptoms that require specialist assessment/management and which are beyond the capacity of the primary care team to manage optimally
  • The patient and/or their family has complex psychological, ethical, social or spiritual needs that require specialist assessment and support
  • The patient is approaching end of life and the primary care team requires additional support and/or advice.

Tips

  • To avoid delay in processing your referral, ensure copies of all relevant medical information is provided: e.g. current medication list, admission/registration sheet, scans, blood results, relevant specialists’ letters and doctors’ notes
  • All referrals require the consent of the patient or legal representative
  • Patients remain under the care of their primary health care team
  • Patients who are having life prolonging treatment are not excluded from referral to a SPCS.

PDF  Downloadable PDF of Specialist Palliative Care Services (SPCS) in the Grampians Region

Specialist Palliative Care Services (SPCS) in the Grampians Region

PalliativeCareServicesMap2

Other Services

Service Description Contact
 Decision Assist Advisory Line  Advance Care Planning and 24/7 Specialist Palliative Care Phone advisory support.    Phone: 1300 668 908
 Gandarra (Ballarat Health Services)  An 11 bed inpatient palliative care facility providing end stage care and symptom management for patients and their families who are suffering from a terminal illness  Phone: 03 5320 3895
Residential in Reach   Aims to prevent unnecessary presentation to Emergency Departments of acutely unwell people living in residential aged care through assessment and establishing goals of care

Wimmera Health Care Group

Phone: 03 5381 9052 or
Mobile: 0417 382 427

Ballarat Health Services Mobile:
0478 305 011

 

Wimmera Hospice Care (WHC)
Central Grampians Palliative Care (CGPC)
Ballarat Hospice Care Inc (BHCI)
Djerriwarrh Palliative Care (DjPC)
Grampians Regional Palliative Care Team (GRPCT) 

Wimmera Hospice Care (WHC)
Contact details Phone: 03 5381 9363
Fax: 03 5381 9170
Email: hospice@whcg.org.au
Website: www.whcg.org.au
Hours of service Monday to Friday: 9am to 5pm
After hours After-hours support negotiated for registered patients with consideration of available resources
Street address Day Centre Building
Robinson St
Horsham 3400 VIC
Postal address As above
Service type Nurse led consultation
This is a free service
Service area Yarriambiack, Hindmarsh, West Wimmera and Horsham Rural City
Referral process Referrals are accepted from patients, family members, carers and Health Care Professionals
For all referrals and phone advice during business hours phone: 03 5381 9363
Fax completed referral form/letter to: 03 5381 9170
All referrals are responded to as soon as possible.
Initial contact is usually made with the referrer to ensure referral is appropriate and patient is aware of the referral
Service profile

Specialised palliative care consultancy providing comprehensive nursing and allied health care, in collaboration with the local medical practitioner, based on the unique needs of the patients, their carer and family, when facing a life limiting prognosis.

The service provides:

  • Assistance with care coordination
  • Symptom assessment and management
  • Addressing emotional and social concerns
  • Providing quality care for those approaching the end of life including equipment loans
  • Assistance with Advance Care Planning
  • Carer support
  • Grief and bereavement support.
Allied health services   Facilitates access to relevant allied health services
Other services
  • Bereavement/counselling support
  • Volunteer support
  • Carer education program and community education program
  • PEPA placements
Works in partnership with

 All health care providers including:

  • General Practitioners and Specialists
  • District Nursing Services
  • Local Health Services
  • Grampians Regional Palliative Care Team
  • Local Government and Regional and Tertiary Services
  • Residential in Reach
 

Palliative care discharge criteria

  Based on discussion with the primary health care team, the patient and their family/carer, when the needs are no longer complex or the patient relocates out of the service area

 

Central Grampians Palliative Care (CGPC)
Contact details Phone: 03 5352 9328
Fax: 03 5352 9425
Email: cgpc@eghs.net.au
Website: www.eghs.net.au
Hours of service Monday to Friday: 8.30am to 5pm
After hours After-hours emergency phone support for patients registered with the service
Street address Girdlestone Street
Ararat 3377
Postal address Postal address P.O. Box 155
Ararat 3377
Service type Nurse led consultation
This is a free service
Service area Rural City of Ararat, Northern Grampians and Pyrenees Shires
Referral process Referrals are accepted from patients, family members, carers and Health Care Professionals
For all referrals and phone advice during business hours phone: 03 5352 9328
Fax completed referral form/letter to: 03 5352 9425
Once referral received, the patient is contacted within 1-3 business day to discuss appointment for assessment.
Service profile

Comprehensive nursing and allied health care in collaboration with the local medical practitioner based on the unique needs of the patients, their care and family when facing a life limiting prognosis including:

  • Assistance with care coordination
  • Symptom assessment and management
  • Addressing emotional and social concerns
  • Providing quality care for those approaching the end of life
  • Assistance with clinical decision making
  • Carer support
  • Grief and bereavement support
Allied health services   Facilitates access to relevant allied health services
Other services
  •  Equipment loan
  • Carer education program
Works in partnership with
  •  General Practitioners and Specialists
  • Local Health Services
  • Grampians Regional Palliative Care Team
  • Local Government and Regional and Tertiary Services
 Palliative care discharge criteria   Palliative care discharge criteria Based on discussion with the primary health care team, the patient and their family/carer, when the needs are no longer complex or the patient relocates out of the service area
Ballarat Hospice Care Inc. (BHCI)
Contact details Phone: 03 5333 1118
Fax: 03 5333 1119
Email: admin@ballarathospicecare.org.au
Website: www.ballarathospicecare.org.au
Hours of service Monday to Friday: 9am to 5.30pm
After hours For registered patients only, 24 hours a day, 365 days a year.
After-hours contact number supplied on admission to BHCI
Street address 312 Drummond Street South
Ballarat 3350
Postal address P.O. Box 96
Ballarat 3353
Service type Community palliative care service – home based
This is a free service
Service area Ballarat, Hepburn (Daylesford, Clunes, Creswick, Trentham), Moorabool (west only), Golden Plains (northwest only – Haddon, Linton, Scarsdale, Snake Valley) and Waubra
Referral process Referrals are accepted from patients, family members and carers and Health Care Professionals
For all referrals and phone advice during business hours phone: 03 5333 1118
Fax completed referral form/letter to: 03 5333 1119
Once referral received, the patient is contacted within 1 business day to discuss appointment for assessment.
Service profile

Interdisciplinary team made up of Medical Director, Specialist Palliative Care Nurses, Counsellors specialising in palliative care and bereavement, trained patient support volunteers.
Incorporated and funded by Dept. of Health and Human Services (DHHS) with funding support from the community.

Allied health services Facilitates access to relevant allied health services
Other services
  • Specialist Palliative Care Nurses provide clinical assessment and ongoing symptom management with 24 hour support.
  • Liaison with GPs and medical team
  • Counsellors provide advocacy, support and counselling, grief and bereavement support and spiritual support
  • Free loan of medical equipment to patients registered with BHCI
  • Carer education program
  • Patient support volunteers provide transport, companionship, advocacy
Works in partnership with
  • General Practitioners and Specialists
  • District Nursing Services
  • Local Health Services
  • Grampians Region Palliative Care Team
  • Local Government and Regional and Tertiary Services
Palliative care discharge criteria Based on discussion with the primary health care team, the patient and their family/carer, when the needs are no longer complex or the patient relocates out of the service area
Djerriwarrh Palliative Care (DjPC)
Contact details Phone: 03 5367 9137
Fax: 03 5367 9641
Email: palliativecare@djhs.org.au
Website: www.djhs.org.au
Hours of service Monday to Friday: 8am to 4.30pm
After hours After-hours support negotiated for registered patients with consideration of available resources
Street address Grant Street
Bacchus Marsh 3340
Postal address P.O. Box 330
Bacchus Marsh 3340
Service type Nurse led consultation
This is a free service
Service area Bacchus Marsh and eastern parts of Moorabool Shire
Referral process Referrals are accepted from patients, family members/ carers and health professionals
For all referrals and phone advice during business hours phone: 03 5367 9137
Fax completed referral form/letter to: 03 5367 9641
Once referral received, the patient is contacted within 1-3 business days to discuss appointment for assessment
Service profile

Comprehensive nursing and allied health care in collaboration with the local medical practitioner based on the unique needs of the patients, their carer and family when facing a life limiting prognosis including:

  • Aassistance with care coordination
  • Symptom assessment and management
  • Addressing emotional and social concerns
  • Providing quality care for those approaching the end of life
  • Assistance with clinical decision making
  • Carer support
  • Grief and bereavement support.
Allied health services Facilitates access to relevant allied health services
Other services
  • Bereavement/counselling support
  • Volunteer support and carer education program
  • Community education program
  • PEPA placements
Works in partnership with
  • General Practitioners and Specialists
  • Local Health Services
  • Grampians Region Palliative Care Team
  • Local Government and Regional and Tertiary Services
Palliative care discharge criteria Based on discussion with the primary health care team, the patient and their family/carer, when the needs are no longer complex or the patient relocates out of the service area
Grampians Regional Palliative Care Team (GRPCT)
Contact details Phone: 03 5320 3553
Mobile: 0408 612 699
Fax: 03 5320 3893
Email: info@grpct.com.au
Website: www.grpct.com.au
Hours of service Monday to Friday: 8.30am to 5pm
After hours No after-hours support
Street address 102 Ascot Street South
Ballarat 3350
Postal address P.O. Box 199
Ballarat 3353
Service offered Specialist palliative care consultancy providing medical support for patients with complex needs.
This is a free service.
Service area Grampians region including Yarriambiack, West Wimmera, Horsham, Hindmarsh, Pyrenees, Ararat, Northern Grampians, Ballarat, Hepburn, Golden Plains and Moorabool
Referral process For URGENT referrals and phone advice, during business hours, phone the Palliative Care Physician: 0408 769 941 or Clinical Nurse Consultant: 0408 612 699
Complete GRPCT referral form, located at www.grpct.com.au, and fax to: 03 5320 3893
Once referral received, the patient will be contacted within 1-3 business days
For NON URGENT referrals complete GRPCT referral form and fax to: 03 5320 3893
Outpatient clinic can be accessed through Ballarat Health Services Outpatient Service
Service profile

The service provides episodic clinical consultation for complex symptom management.
Outpatient clinic held at Ballarat Health Services each Thursday
Palliative Care Physician and Nurse Practitioner make regular visits throughout the region. Contact GRPCT for a copy of the visiting schedule
Palliative Care Physician coordinates access to Gandarra (Ballarat Health Services) which is an 11 bed palliative care inpatient ward

Other services

The service also provides:

  • Education, research, policy and procedure development
  • Service development.
Works in partnership with
  • General Practitioners and Specialists
  • Local and regional health service providers
  • Community based specialist palliative care services
Palliative care discharge criteria Based on discussion with the primary health care team, the patient and their family/carer, when the needs are no longer complex or the patient relocates out of the service area

GP Program Advisors

Dr Deb Harley and Dr Michael Homewood.

Contact

For further queries, please contact your local Western Victoria PHN office as listed below.

Ballarat Goldfields - 5331 6303
Geelong Otway - 5222 0828
Wimmera Grampians - 5381 1756
Great South Coast - 5564 5888