End of life care with the Daffodil Standards is starting to bloom

End of life care picture

13 September 2019

Dr Catherine Millington-Sanders, RCGP and Marie Curie Clinical Champion for End of Life Care

Quality improvement in end of life care with the Daffodil Standards, co-produced by the RCGP and Marie Curie, is starting to bloom. Has your practice signed up yet to help improve end of life care?

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

So how do you know if all your patients experience a consistent level of care at the end of life? We can all think of patients for whom planning their care and death went well, which is really reassuring. Equally, there will be others where things could have gone better. We’re trained to use our clinical judgment and experience. However, this doesn’t always work - for example, people who aren’t well-known to us, those who have complex psychosocial issues or those who deteriorate rapidly.

GP practices play a vital role in caring for dying patients

Despite local gaps across the wider system, evidence tells us that a few simple baseline principles are likely to improve consistent care across our practice population. For example, identification of the patient and their caregivers; offering, documenting and sharing end of life planning discussions; good multidisciplinary team working; assessing and offering support to caregivers before and after death.

GP practices play a vital role in caring for dying patients and overwhelmingly agree this is a rewarding part of their job (87%). Whatever their age, diagnosis, culture or socioeconomic background, GPs are the only professional group that have a duty of care to our local, registered population. That’s why the Royal College of GPs and Marie Curie worked together to create the Daffodil Standards. The Standards offer free, evidence-based resources to build on what you are already doing well.

You pick the Standards that are relevant and feasible to your practice population

The key first step is to understand your baseline practice. To help with this, start with an audit of your last 10-20 deaths using the Daffodil Standards template. You do the ‘diagnosis’ with your team. You pick the Standards that are relevant and feasible to your practice population and you do this at your own pace. Appendix A offers some examples of SMART goals for each Standard.

Some people say they worry they can’t do it all - it looks a lot! From working with many practices around the country now, I can honestly say that it’s best to just start somewhere. Do the audit. It takes about an hour and you quickly start to see trends. You then just need to pick what you want to make a difference on. Small changes can make a big difference. For example, simple identification coding flags, identifying carers or next of kin for all people on the palliative or supportive care register, sending a bereavement card – all these things can have an impact. It doesn’t all have be done by GPs. We have great teams of receptionists, nurses, health care assistants and pharmacists, to name a few, who are passionate about making a difference. So, ask who’d like to contribute. Share the tasks between your practice team and the multidisciplinary team (MDT).

Whether you select one or several Standards to do over the year, each improvement step counts. The Daffodil Standards are recognised by the CQC in England as a robust framework that evidences quality care.

Supporting national aims for end of life care

The Daffodil Standards robust framework for general practice offers 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 10 Year Plan for end of life and personalised care. In England, the 2019/20 GP Contract - EOLC 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. Daffodil Standards will release regular newsletters to help practices and networks keep up their momentum. This new Daffodil Standards PCN guidance  pack supports QOF delivery at scale.

In just six months since the launch of the Daffodil Standards, the new RCGP and Marie Curie general practice standards for advanced serious illness and end of life care,700 practices have signed up across the UK. So far, the feedback from the practices working through the Standards has been incredibly positive.

Find out how your GP practice can sign up to the Daffodil Standards today.

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