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GPs buried under trusts' workload dump

New standards can help improve end-of-life care

Dr Catherine Millington-Sanders

One person dies every minute in the UK every year, most of whom have an advanced serious illness. With our ageing population, this number is set to rise - along with a 17% increase in the need for palliative and end-of-life care by 2030.

GP practices play a vital role in caring for dying patients and, overwhelmingly, agree that this is a rewarding part of their job (87%). That’s why the RCGP and Marie Curie worked together to create a new set of standards that offer free, evidence-based resources to build on what practices are doing well.

Under the Daffodil Standards, it's recommended to start with an audit of your last 10-20 patient deaths and follow simple steps to create an improvement plan at your own pace.

Whether you select one or several standards to work on over the year, the most important thing is to get started. Quality improvement doesn’t have to be difficult – small changes can result in significant improvements. The standards are recognised by the CQC in England as a robust framework that evidences quality care.

We’ve tested the eight Daffodil Standards and there’s been some incredible work led by GPs around the country. The standards facilitate a clear practice team approach, where all staff are encouraged to consider their own part in how they can improve care.

The Daffodil Standards are a blend of quality statements, evidence-based tools, reflective learning exercises and quality improvement steps, relevant to all UK practices. They are:

1. Professional and competent staff

2. Early identification

3. Carer support – before and after death

4. Seamless, planned, coordinated care

5. Assessment of unique needs of the patient

6. Quality care during the last days of life

7. Care after death

8. General practice as hubs within compassionate communities

Case study: improving carer support

A practice in our pilot tested the third standard on carer support before and after death. In less than an hour, the team had audited their practice by looking at the last 20 deaths. They realised two things: only 30% of people who died had been recognised by the practice as being near to the end-of-life and only 40% of these had a carer or important other noted. Most of these were carers of cancer patients.

At the next practice meeting, the team agreed on a system to code the patient with an advanced serious illness on their supportive care register and to place this on the ‘problem list’. An administrator stepped forward to make sure each person on the supportive care register had been offered the opportunity to record important family members or carers.

The practice also looked at how they supported carers after someone dies. They talked with families of people who had died to help create a leaflet with information about grief, funeral planning and bereavement services available locally. Within three months they reported significant improvements in their processes and practices.

Supporting national aims for end-of-life care

The Daffodil Standards offer commissioners the option to encourage implementation across GP networks and integrated care partnerships. ‘At scale’ uptake can maximise population benefits, support reduced inequalities and help gain momentum on achieving outcomes aligned with the NHS long term plan for end-of-life and personalised care.

In England, the 2019/20 GP contract end-of-life care QOF module enhances this effect. Completing the QOF EOLC indicators (37 QOF points in total) is a firm foundation to achieving Daffodil Standards 2, 3, 5 and 7. 

More than 500 practices have signed up in the four months since the Daffodil Standards launched and a number of CCGs have shown support. So far, the feedback from the practices working through the standards has been incredibly positive.

Find out how your GP practice or CCG can sign up to the Daffodil Standards at mariecurie.org.uk/daffodil-standards

Dr Catherine Millington-Sanders is RCGP's Marie Curie end-of-life lead and a GP in Surrey

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