1. Gold Standards Framework
Dr Mohammed Javid

2. Aims Deaths End Of Life Care Gold Standards Framework Why, where, how
EoLC, ACP, PPC, PPD, GSF, LCP
Gold Standards Framework
3 steps
5 goals
7 Key tasks

3. Deaths 500, 000 per year in the UK 1% of the population dies each year
Cause of death
- 25% cancer
- 20% heart disease
- 15% respiratory disease
- 10% strokes and related disorders
- 30% other

4. Place of Death Where do people want to die ? Where do people die ?
55% Home
25 % Hospice
10 % Hospital
5 % Care Home
Where do people die ?
55 % Hospital
20% Care Home
20% Home
5% Hospice

6. End Of Life Care supportive and palliative care deterioration
death/bereavement
ACP / PPC
LCP
One year
Last days
ACP Advanced care Plan
PPC Preferred priorities of care
PPD Preferred place of death
GSF Gold standards Framework
LCP Liverpool Care Pathway
EoLC End of Life Care

7. Gold Standards Framework

8. GSF Step 1: Identify Sudden death Dementia and decline Organ Cancer
failure
Cancer
Sudden death
Dementia
and
decline

11. Assess Symptom assessment Personal needs Preferred priorities of care
Place of care
Place of death
Advanced Care planning
Statement of wishes and preferences
Advance decisions
Power of attorney
Patient focussed
Needs based
Voluntary

14. Plan Communication Out of hours handover Drugs in home
What drugs
DN prescribing
Pharmacy
Syringes, diluents
OOH bypass number
Crisis prevention

15. 5 Goals Patients are enabled to have a ‘good death’
1) Symptoms controlled
2) Preferred place of care
3) Safe + secure with fewer crises
4) Carers feel supported, involved, empowered, and satisfied.
5) Staff confidence, teamwork,
satisfaction, co-working
with specialists and communication better.

16. 7 C C4 Continuity Out of Hours C1 Communication C2 Co-ordination
Register, PHCT Meetings, care plan
Advanced care planning (ACP) eg PPC
C2 Co-ordination
Identified co-ordinator for GSF, keyworker for patient
C3 Control of Symptoms
Assessment tools,
C4 Continuity Out of Hours
Handover form + OOH protocol
C5 Continued Learning
Learning about conditions on patients seen, SEA / reflective practice
C6 Carer Support
Practical, emotional, bereavement, National Carer’s Strategy
C7 Care in dying phase- Protocol LCP / ICP

17. What should we do ?
Level 1 – register, PHCT meeting, co-ordinator C1,2 Level 2 – Assessment tools, OOHs handover, education, audit and reflective practice C3,4,5 Level 3 – Carer/family support, bereavement plan and protocol for final days C6,7 Level 4 – Sustain and build on developments, practice protocol, extend

18. Cancer (Cancer 1) Cancer (Cancer 3) Palliative Care (PC1)
Indicator
Points
Payment stages
Palliative Care (PC1)
The practice has a complete register available of all patients in need of palliative care/support. 3 —
Palliative Care (PC2)
The practice has regular (at least 3 monthly) multidisciplinary case review meetings where all patients on the palliative care register are discussed.
Cancer (Cancer 1)
The practice can produce a register of all cancer patients defined as a 'register of patients with a diagnosis of cancer excluding non-melanotic skin cancers from 1 April 2003'. 5
Cancer (Cancer 3)
The percentage of patients with cancer, diagnosed within the last 18 months, who have a patient review recorded as occurring within 6 months of the practice receiving confirmation of the diagnosis. 6
40–90%

19. Deaths where terminal care has taken place at home
Records and information (Records 13)
There is a system to alert the out-of hours service or duty doctor to patients dying at home. 2 —
Practice management (Management 9)
The practice has a protocol for the identification of carers and a mechanism for the referral of carers for social services assessment. 3
Education and training (Education 7)
The practice has undertaken a minimum of 12 significant event reviews in the past 3 years which could include:
New cancer diagnoses
Deaths where terminal care has taken place at home 4
Education and training (Education 10)
The practice has undertaken a minimum of 3 significant event reviews within the last year. 6

20. Mr W death
GP and DN ad hoc arrangements - no PPoD discussed or anticipated
Problems with symptom control - high anxiety
Crisis call OOHs - no plan or drugs available in the home
Admitted to hospital
Dies in hospital
Carer given minimal support in grief
No reflection by PHCT team on care given
? Inappropriate use of hospital bed?

21. Mr W with GSF On GSF Register - discussed at PHCT meeting (C1)
DS1500 and info given to pt + carer (home pack) (C1, C6)
Regular support, visits phone calls - proactive (C1, C2)
Assessment of symptoms, partnership with SPC - customised care to pt and carer needs (C3)
Carer assessed incl psychosocial needs (C3, C6)
Preferred place of care noted and organised (C1, C2)
Handover form issued – care plan and drugs issued for home (C4)
End of Life pathway/LCP/minimum protocol used (C7)
Pt dies in preferred place - bereavement support Staff reflect-SEA, audit gaps improve care, learn (C5, C6)

22. Take Home message Identify patients in last year of life Assess needs
Prognostic indicators
Assess needs
GSF tools
Plan for deterioration and death

23. Any Questions http://www.endoflifecareforadults.nhs.uk/