End of Life Care Quality Improvement Resources

General practice, alongside primary and community services teams, plays a key role in the delivery of care to people, and those important to them, affected by advanced serious illness and end of life care - a clinical priority area for the RCGP. The College encourages GPs and primary teams to regularly keep up to date on end of life care, depending on their role and relevant learning needs. General practice service development plans should consider how practices continuously improve the provision of end of life care, both directly and in collaboration with the wider system.

In 2019-2020, end of life care featured as a quality improvement module in the Quality and Outcomes Framework in England. Working in partnership NHS England, RCGP and Marie Curie partnership, Macmillan and the North West Clinical Network have developed a series of multi-professional blended learning resources to support learning and best-practice end of life care quality improvement in your practice.

These modular education resources are free to access, simple to use and provide useful and meaningful continuous professional development (CPD). The resources can be used over coffee, with colleagues or as part of teaching. They can also be used by, and with, colleagues beyond primary care.

The resources also support the RCGP and Marie Curie Daffodil Standards – the UK General Practice Standards for Advanced Serious Illness and End of Life Care. The Standards have been designed by GPs and experts to offer a structure for practices, whatever the starting level, to have a clear strategy to consistently deliver the best care to all people affected by terminal illness. Further information on RCGP EOLC resources RCGP End of Life Care toolkit and quality improvement tool, RCGP QI Ready. Please make use of these resources as personal CPD, teaching aids as well as to help enable service improvement within your practice.

We would like to thank NHS England and NHS Improvement for commissioning the development of these resources to help support General Practice improve end of life care.

Animation film

This short video provides an overview of how to undertake a retrospective death audit and interpret an initial baseline audit. We recommend starting with essential CPD on 'Diagnose how your practice delivers EOLC and best-practice learning examples' + retrospective death audit below.

Diagnose how your practice delivers EOLC and best-practice learning examples

This masterclass is focused on Learning from your retrospective death audit in general practice. This masterclass equates to 0.5 CPD points. (Note: doing an audit of your last 20 deaths, using the RCGP template [Excel], will earn a further 1 CPD. Reflection on your audit and forming your practice quality improvement plan can earn additional 1-2 CPD points)

Identifying, assessing and supporting carers in EOLC

This masterclass is focused on identifying, assessing and supporting carers (up to 1.5 CPD points). Access a list of resources relevant to this masterclass [Word].

Module 1: Introduction - the context of caregiving: developing 'carer-awareness'

Module 2: ‘Getting started’ – Practice processes for identifying carers in palliative and end of life care.

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Module 3: Enabling practices to become ‘carer-ready’

Module 4: Comprehensive, person-centred carer assessment and support

Early identification and Advance Care Planning for patients with EOLC needs

This is a set of four short videos to introduce the concepts around the benefits of early identification of patients reaching the end of life, how we may be able to improve our identification of such patients, why Advance Care planning is important, and an introduction to information sharing and mental capacity. These videos are brief resources that can be used by a professional for their individual learning or as part of a presentation or workshop.

This video outlines some of the reasons identification of patients nearing the end of life is important.
This video gives some tips and tools that can be used to identify patients nearing the end of life.
This video gives an introduction to care planning for patients nearing the end of life.

4. This video outlines some of the questions and challenges surrounding Mental Capacity and Data Sharing.

Courageous Conversations - primary care training workshop

Macmillan Cancer Support - Courageous Conversations primary care training workshop

‘Courageous Conversations’ is a workshop designed to support primary care professionals to have conversations with people about cancer and other diseases, from diagnosis to discussions at the end of life.

The workshop resources encourage reflective practice and help participants to consider barriers and facilitators to challenging conversations.

Comprehensive resources include video consultations, facilitation information and scenarios for skills practice. They should be used as a full suite of interrelated resources and are not intended for separate use. They should also be delivered by colleagues who have attended one of Macmillan’s ‘train the trainer’ workshops.

The link will take you to the Macmillan ‘Support for primary care’ page and if you scroll down the list of resources, ‘Courageous Conversations’ is the sixth tab down.

Personalised Care and Support Planning - a training guide for facilitators

The masterclass is designed to be delivered by a facilitator as part of a study morning/ afternoon, the training consists of 4 lessons which are accompanied by facilitator notes [Word].

Lesson 1 [PowerPoint] provides clarity around what a PCSP is as well as how it fits in with other EoLC related tools.

Lesson 2 [PowerPoint] demonstrates skills and behaviours which enable the process of PCSP to be initiated and conducted in a way that is person-centred and supportive of the person.

Lesson 3 [PowerPoint] considers how to involve those close to the person in the process according to their wishes and lesson.

Lesson 4 [PowerPoint] considers practice processes in terms of documenting, sharing and reviewing PCSP. We would envisage Lesson 3 and 4 being delivered at the same time.

If you have any queries about this masterclass please contact england.personalisedcare@nhs.net

Multi-professional mini-modules and podcasts

Multi-professional mini-modules

Practical steps to assessing your baseline and developing a compassionate workplace culture and leadership in general practice (0.5 CPD points)

Note: doing a staff survey on EOLC experience and compassion in the workplace, using RCGP template, will earn a further 1 CPD. Reflection on your survey and forming your practice quality improvement plan can earn additional 1-2 CPD points.

Communication and listening skills – An introduction, for receptionists, HCAs, administrators etc (10 minutes)

Multi-professional podcasts

How to support family and carers in end of life (0.5 CPD points)

Developing a compassionate workplace culture and leadership in general practice – learning from a GP pilot site (0.5 CPD points)

Acknowledgements

NHS England and Improvement
RCGP
Marie Curie
North West Clinical Network
Macmillan
Sage and Thyme
Dr Catherine Millington-Sanders, RCGP and Marie Curie End of Life Care Clinical Champion
Dr Joanna Bircher, RCGP QI Clinical Champion and Clinical Director of GM GP Excellence Programme
Dr Dharini Shanmugabavan, RCGP Medical Director of Clinical Quality
David Parker-Radford, RCGP Head of Clinical Quality and Improvement
Rosie Alouat, RCGP Quality Improvement Project Manager
Professor Gunn Grande, University of Manchester
Dr Gail Ewing, University of Cambridge
Dr Elizabeth Phillips, GP Partner, Springfield Surgery
Michael Connolly, Manchester University NHS Foundation Trust
Dr Rachael Marchant, RCGP End of Life Care Clinical Support Fellow
Jo Harvey, Personalised Care Group - NHS England and Improvement
Dr Charles Campion-Smith, Macmillan GP Advisor (retired)