The Daffodil Standards: A breakdown by standard

To make it easier, here’s a breakdown by Standard domains. This includes self-assessment evidence and guidance, by Standard. So, as you’re working through Levels 1-3 and start to uncover areas for improvement, this provides evidence based details for reflection and links to tools to help support your quality improvement activities

To get you started, at the end of each Standard, there’s an example SMART goal.

Full list of standards and evidence-based tools that can be used (PDF file, 481 KB).

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1

Standard 1: Professional and competent staff

Purpose: To create an infrastructure in the practice which a supportive end of life support strategy can be built upon.

2

Standard 2: Early identification

Purpose: To identify patients approaching/ in end of life to enable audits and targeted interventions.

3

Standard 3: Carer Support before and after death

Purpose: Identification of other patient groups who may benefit from EOLC improvements - i.e. carers.

4

Standard 4: Seamless, well-planned, coordinated care

Purpose: To suggest ways of improving proactive EOLC supported by infrastructure beyond the practice.

5

Standard 5: Care is based on the assessed unique needs

Purpose: To create a personalised, holistic and reflective approach to EOLC through care planning.

6

Standard 6: Quality Care during the last days of life

Purpose: To support patients at the end of their life, and reflect on recent deaths.

7

Standard 7: Care after death

Purpose: To improve support for people experiencing bereavement and making supportive links with the community.

8

Standard 8: General practice being hubs within Compassionate Communities

Purpose: To integrate and embed general practice and EOLC practices into the wider system and community.

Full breakdown by standard

Standard 1: Professional and competent clinical and non-clinical staff required to provide high quality, safe and compassionate care in Advanced Serious Illness and EOLC

The General Practice commits to:

To meet this standard the practice commits to:

Self-Assessment

1.1 Ensure that each individual staff member (clinical and non-clinical) understand their role and responsibility for Advanced Serious Illness and EOLC  


 


 

1.1a Ensure individuals can demonstrate an understanding of which skills relate to their role and consider staff training requirements to support Advanced Serious Illness and EOLC core standards
  • Agree as a practice, which clinical and non-clinical staff are involved in caring for people and care-givers.
  • Training needs assessment for staff.
  • Relevant Learning action plan for staff with SMART objectives.

Standard 2: There is early identification and recording that a person, has an Advanced Serious Illness, or EOLC needs.

The General Practice commits to:

To meet this Standard the practice commits to:

Self-Assessment

2.1 Early identification of patients 

 

 

 

 2.1a Understand how to identify people who have an Advanced Serious Illness, or EOLC needs
  • An agreed protocol for identifying people with an Advanced Serious Illness, or EOLC needs.
  • Include seamless transition of practice supportive care registers, such as those for: dementia, frailty, disease specific long-term conditions, recurrent admissions, palliative care.
  • Demonstrate active use and timely, regular reviews of people identified on the register.

Standard 3: Carer Support – before and after death.

The General Practice commits to:

To meet this standard the practice commits to:

Self-Assessment

3.1 Early identification of carers

 

 3.1a Achieve consistent identification of carers
 
  • An agreed protocol for identifying carers of people who have advanced serious illness or who may be approaching the end of life.

Standard 4: Seamless, well-planned, coordinated care.

The General Practice commits to:

To meet this standard the practice commits to:

Self-Assessment

4.1 Multi-disciplinary team meetings 

 4.1a Understand the role and optimum outcomes of the MDT meeting in Advanced Serious Illness and EOLC
  • Practice agreement for MDT meetings, for example, how often, who attends, goals etc
  • Objectives of MDT agreed by practice team and recorded.
  • Assess effectiveness of meetings by obtaining feedback by attendees.

You can use the following documents found on the learning resources page to assist you in collecting data.

  1. Daffodil Standards: Example EoLC audit dataset SMART goals.
  2. RCGP Marie Curie EOLC example audits MDT template - to prospectively collect and monitor relevant information for people on palliative/ supportive care register.
  3. Example after death audit report template - use relevant criteria from MDT template to audit deaths, for example last 20 deaths (all causes, on and off palliative/ supportive care register).
  4. Presentation of audit and share learning outcomes at MDT.
  5. Share learning outcomes with wider stakeholders, as necessary. For example, other practices in primary care networks/ federations/clusters (Wales), Clinical Commissioning Groups/ HSCP (Scotland), acute providers and community providers.

Standard 5: Care is based on the assessed unique needs of the patient, carer and family.

The General Practice commits to:

To meet this standard the practice commits to:

Self-Assessment

5.1 Implement Personalised Care and Support Planning (PCSP)

5.1a Understand the role and optimum outcomes of Personalised Care and Support Planning (PCSP)/Anticipatory Care Planning (ACP)
  • Objectives of Personalised Care and Support Planning (PCSP)/Anticipatory Care Planning (ACP) agreed by practice team and recorded
  • Objectives need to cover:

    Medical planning

    Demedicalised (non-health) Wellbeing planning, such as mapping care and support networks to enable care preferences

Standard 6: Quality care during the last days of life.

The General Practice commits to:

To meet this standard the practice commits to:

Self-Assessment

6.1 Provide care in the Last Days of Life, that aligns with the Five Priorities for Care:
  1. The possibility that a person may die within the coming days and hours is recognised and communicated clearly, decisions about care are made in accordance with the person's needs and wishes, and these are reviewed and revised regularly.
  2. Sensitive communication takes place between staff and the person who is dying and those important to them. Conversations are appropriately documented.
  3. The dying person, and those identified as important to them, are involved in decisions about treatment and care.
  4. The people important to the dying person are listened to and their needs are respected.
  5. Care is tailored to the individual and delivered with compassion – with an individual care plan in place

A practice policy agreement on caring for patients and those important to them in the last days of life, to recognise the objectives from the Five Priorities of Care above, to include:

  • Timely recognition of imminently dying person
  • Care is safe, effective, responsive and appropriate
  • Care plans are developed, implemented and reviewed regularly to support people who are imminently dying, their families and carers
  • Timely symptom control assessments using best-practice guidance and tools
  • Evidence that patients, family and carers are provided with information and support in accessible ways.

6.3a In practice mortality review for all patients using RCGP Marie Curie EOLC example audits MDT template and Example after death audit report template found on the learning resources page.

At each MDT, discuss, complete and record mortality reviews on all deaths between MDTs, ideally monthly. >br>SEA for deaths covering the last days of life, written up and discussed with the practice team.
Share learning outcomes with team and wider stakeholders, as necessary. e.g. CCG, GP cluster group (Wales), HSCP (Scotland), hospitals, community providers.

Standard 7: Care after death and Bereavement Support.

The General Practice commits to:

To meet this standard the practice commits to:

Self-Assessment

7.1 Have understanding and be able to manage grief and bereavement

 

 7.1a Understand the process of anticipatory grief and bereavement
  • Roles and responsibilities for each team member discussed and recorded

Standard 8: General Practice being hubs within Compassionate Communities.

The General Practice commits to:

To meet this standard the practice commits to:

Self-Assessment

8.1 Support the development of compassionate communities

8.1a Develop the practice itself as a compassionate community
  • Discussion in practice meeting what would be expected within a practice to actively support practice team (clinical and non-clinical) in personal death, crisis, loss.
  • Practice plan documented for supporting staff in loss.
  • Plan annually reviewed.
  • Staff survey.