Spotlight case study

This page is dedicated to the case studies relating to the Daffodil Standards.

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Broadway Health Centre – embedding the Daffodil Standards to improve end of life care

National evidence highlights persistent inequalities in access to, and experiences of, palliative and end of life care (EOLC) among people from ethnic minority backgrounds. Cultural barriers, limited awareness, language challenges and systemic inequities often result in late identification, lower rates of advance care planning, and poorer bereavement outcomes.

Birmingham, with over 450,000 residents from ethnic minority backgrounds (42% of the population, 2021 Census), faces significant challenges in delivering equitable, culturally sensitive EOLC.

Broadway Health Centre (BHC), located in one of the 10% most deprived neighbourhoods in England, recognised these challenges and committed to addressing them by adopting the RCGP and Marie Curie Daffodil Standards in August 2024.

Broadway-Health-Centre-team

Practice background

Broadway Health Centre is part of the NHS Birmingham and Solihull Integrated Care Board (ICB), serving a population of approximately 7,000 patients. An estimated 61% of the practice population are from ethnic minority communities (25.6% Asian, 23.4% Black, 5.8% Mixed, and 6.6% other non-white groups).

At our starting baseline in August 2024, only 18 patients were recorded on the palliative care register. Using the Standards we learned that 60-70% of deaths are predictable, this indicated under-identification and late-stage recognition of patients approaching the end of life.

Leadership and team vision

Under the leadership of Dr Aslam, Clinical Lead Partner for End-of-Life Care and Practice Manager Noorin Akhter, the practice embarked on a mission to embed the Daffodil Standards across all areas of care.

Their vision was to create a proactive, compassionate, and coordinated approach to end-of-life care — one that honoured dignity, choice, and inclusivity. The practice saw the Standards not simply as a checklist, but as a cultural and relational framework that united the team around shared values of empathy, respect, and excellence.

The multidisciplinary team of 18 includes GPs, GP assistants, nurses, Health Care Assistants, a social prescriber, care coordinators, a pharmacist, and administrative staff. The care coordinator and social prescriber maintain regular contact with patients and carers, providing bereavement support and wellbeing guidance.

Focused Daffodil Standards and data collection

The practice prioritised improvement across the following Daffodil Standards:

  • Standard 1: Professional and competent staff
  • Standard 3: Early identification, holistic assessment and personalised care planning
  • Standard 5: Carer support before and after death
  • Standard 8: General Practice as hubs within compassionate communities

To measure progress and guide learning, BHC adopted tools and approaches recommended within RCGP Daffodil Standards:

  • Palliative care register audits
  • Case review templates and reflective learning tools in MDT meetings
  • Patient and family feedback surveys conducted six weeks after bereavement
  • Internal communications reviews to strengthen team collaboration and learning loops.
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Achievements and impact

Since adopting the Standards in August 2024, BHC has demonstrated measurable and cultural change:

  • Palliative care register growth: from 23 patients in October 2024 to 62 by November 2025, with a target of 72 by March 2026.
  • Faster and more responsive care: Medical Certificates of Cause of Death (MCCD) are now routinely completed within 24 hours - previously this took several days.
  • Enhanced communication: Case review templates and reflection tools have improved the quality of MDT discussions and clinical decision-making.
  • Earlier identification and planning: The GP assistant now conducts compassionate conversations, initiates Respect and DNACPR conversations, and coordinates reviews, with final discussions led by Dr Aslam through home visits or face-to-face meetings.
  • Carer involvement: Families are engaged from the outset of care planning. Carers receive early support, condolence cards, and structured bereavement follow-up from the social prescriber.
  • Partnership working: Close collaboration with community pharmacists ensures timely access to anticipatory medications and pain relief.
Our ability to provide Medical Certificates of Cause of Death within hours, rather than days, has given grieving families dignity and relief during critical times.”
Dr Aslam, Clinical Lead, Broadway Health Centre.
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“The culture of the practice has shifted; we don’t just ‘do’ palliative care -  we live the values of the Daffodil Standards every day.”
Noorin Akhter, Practice Manager, Broadway Health Centre and Spark Medical Group.

Hearing the voices of patients and families

Standard 8: Patient and Family Feedback – Building Compassionate Community Hubs.

As part of the practice’s ongoing Daffodil Standards quality improvement work, bereaved families were invited to share feedback on their experiences of end of life and bereavement care. The responses demonstrated strong alignment with the Daffodil Standards’ principles of compassionate, coordinated, and person-centred care.

Key strengths identified

  • Compassionate and clear communication:
    Families consistently described feeling supported through clear, sensitive, and timely communication. Many highlighted the empathy and understanding shown by staff, which helped them feel listened to and reassured during a difficult time.
  • Effective multidisciplinary team working:
    Respondents praised the integrated approach involving the GP, advanced nurse practitioner, pharmacist, care coordinator, and social prescriber. This collaborative model provided continuity, practical problem-solving, and emotional support for both patients and families.
  • Accessibility and proactive support:
    Families valued the ease of access to advice, home visits, and follow-up calls. These proactive touchpoints were particularly appreciated by those living at a distance, helping them stay informed and emotionally prepared.

Areas for improvement

Some families identified the need for greater visibility and timely access to home-based support for relatives caring for loved ones at home, particularly around managing distress and symptoms in the final days of life.

Impact and next steps

This feedback is now directly informing the next phase of BHC’s quality improvement work.
The team plans to:

  • Strengthen home-based and out-of-hours support for families.
  • Enhance communication pathways with community and hospice teams.
  • Continue bereavement follow-up and use feedback to inform MDT learning cycles.

Overall, these findings reflect a strong culture of compassion, teamwork, and continuous learning within the practice. They reinforce the value of the Daffodil Standards as a framework for embedding human, relational care in everyday general practice.

Future plans and quality improvement ambitions

Building on their success, the BHC team intends to:

  • Continue expanding their palliative care register and proactively identify patients earlier.
  • Strengthen carer wellbeing and bereavement pathways through co-designed feedback tools.
  • Develop shared learning sessions across Spark Medical Group to spread best practice.
  • Partner with local faith and community organisations to deepen cultural sensitivity and inclusion in end of life care.

Their dedication has been nationally recognised:
Dr Aslam was Highly Commended as GP of the Year, and Spark Medical Group received Highly Commended GP Practice of the Year at the RCGP and Marie Curie Daffodil Standards Awards 2025.

Additional case studies

Portsdown Group Practice

A GP practice in England, signed up to the Daffodil Standards in 2020/2021. Practice is a Primary Care Network (PCN) in its own right.

Key staff and roles include a GP lead for the Daffodil Standards, care coordinators supporting DS activities, salaried GPs and Registrars.

Key Daffodil Standard activities being undertaken

Early identification (DS2)

  • Whole practice/ PCN has a clear protocol to follow for identifying and caring for all palliative patients.
  • Developed written guidance for the role of the administrative teams who process letters from the hospital to identify new palliative patients.
  • Reception staff have training to identify distressed relatives and patients who are deteriorating and have regular contact with the duty clinician to ensure care is provided as soon as the need is identified.

Carer support (DS3)

  • Care coordinators contact carers, offering support and signposting to services within the practice and the community.

Seamless, well-planned and coordinated care (DS4)

  • MDT has been established, consisting of two palliative care coordinators, a lead GP, administrative support, dietician, frailty practitioners, social prescribers and carer leads.
  • Care coordinators developed close working relationships with PCN led district nursing team, community matrons, the ICB led palliative care team, the local hospice social work team, local charities, local well-being services, living well centre and support groups.

Quality care in the last days of life (DS6)

  • Developed a ‘Daffodil line’ – a dedicated phone line which bypasses all call queues and is answered as a priority – which is given to all patients in the last days of life, their relatives, and the district nursing team, to provide direct access to the duty GP, ensuring swift care at the time of need.
  • Patients in the last days of life also receive a supportive phone-call every 3 days.

Bereavement support (DS7)

  • ‘Care after death’ protocol developed, to be followed by all team members.
  • All relatives receive a condolence call and a sympathy card, signposting to appropriate support.

Differences the Daffodil Standards have made:

  • A whole practice/PCN belief that all patients deserve a peaceful, comfortable death and end of life care is something that is a privilege to provide.
  • MDT have a shared ethos and strives to provide best possible care to all patients who are nearing the end of their lives.
  • Receive regular positive feedback and compliments from relatives of patients who are grateful for the care provided.
  • Care coordinators have an extensive unique role in the care of end-of-life patients, providing wellbeing support, befriending, signposting, and listening.
  • By having a PCN led team, the practice can ensure dedicated staff are available to patients for mental, physical, and emotional wellbeing support.

Key enablers to implementation of DS:

  • Dedicated funding and control over how funding is allocated.
  • Dedicated funding for care coordinators.
  • GP lead for DS with background, passion and interest in end-of-life care.
  • Support staff with personal experience in end of life care.
  • Dedicated time.
  • Embedding DS in current activities, protocols, and procedures.

Barriers and challenges to implementation of DS:

  • Limited training and education around DS.
  • Limited awareness of DS.
  • No formal recognition for DS activities.
GP Partner, Dr Sarah Swindells ‘We were thrilled to visit the Royal College to receive recognition for the work the practice puts in to End of Life care. It is an integral part of good general practice and something that all our staff are invested in. We are immensely proud of what we do.’

Nominate who you think deserves recognition for delivering outstanding end of life care. Watch award-winning, Portsdown Group Practice, reflect on winning 'GP Practice Team of the Year'.

Portsdown Group Practice
Winners of the Daffodil Standards Awards GP Practice Team of the Year 2023
Winner of the Daffodil Standards Awards 2025 Non-Clinical member of the year 2025 - Lisa Davies