GSF is the bedrock of generalist palliative care
DN, Norfolk
| Background to Gold Standards Framework (GSF) |
| GSF Primary Care Programme |
- Developed in 2000 from within primary care for primary care
- Optimising care and best working with specialists
- Evidence based, recommended best practice model spread through the UK NHS and now other countries
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| GSF Care Homes (GSFCH) |
- Developed in 2004 - similar cascade
- Fully adapted, developed and piloted with care home staff as a specific GSFCH training programme and accreditation
- Now the biggest palliative care initiative in care homes in the UK
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| Other GSF Support Programmes |
- Acute Hospitals, Domiciliary Care, Community Hospitals etc
- Based at National GSF Centre CIC - helping best implementation of GSF and supporting 200 facilitators across the UK
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Origins of GSF
GSF was originally developed in 2000 as a grass roots initiative to improve primary palliative care from within primary care. It was developed by Dr Keri Thomas, a GP with a special interest in Palliative Care, supported by a multidisciplinary reference group of specialists and generalists. It was first piloted in Yorkshire in 2001 in Phase 1, followed by a national phased programme supported by the NHS, Macmillan and more recently the DH End of Life Care Programme. An intrinsic element of the work has been the internal and external evaluations, originally using questionnaires and more recently the on-line After Death Analysis audit tool, plus several independent University based evaluations, which contributed to the further development of the work. National spread was enabled through a strategic national cascade plan with the GSF Central Team supporting local facilitators, enabling best implementation of the work, overseeing training and audit plus developing further adaptations and resources.
GSF has developed and expanded over the last nine years to meet the challenge of end of life care, in the light of the NHS End of Life Care Strategy in England and the growing acceptance of its importance within health and social care in our country. International use has also increased with interest from over 13 countries and pilots in Australia, New Zealand, USA, Canada, Belgium, Holland etc
The work is now based at the National GSF Centre in the West Midlands, and led by Prof Keri Thomas (National Clinical Lead for the GSF Centre and Hon Professor End of Life Care, University of Birmingham) with a small central team of very committed clinicians plus admin support, Clinical Associates and reference groups.
The National GSF Centre Overview Paper
| 1. GSF Primary Care - see GSF Primary Care Briefing Paper |
| Currently 90% of practices nationally claim the Quality and Outcomes Framework (QOF) palliative care points in the GP Contract (equates to 90% adoption of GSF Level 1). Two other independent surveys indicate that over 60% of practices in the UK are using GSF more fully, and 10-15% have fully embedded it - see Evidence Base In 2009 the RCGP approved the College End of life Care Strategy, supporting further progress with GSF. In June 2009, the fully refreshed and revised GSF Primary care Next Stage Programme ‘Going for Gold’ was launched with new training programme, support and resources to support practice teams to move on to the next stage with use of GSF in their teams - see GSF Next Stage |
| 2. GSF Care Homes - see GSFCH Briefing Paper 2 Jun 09 |
| In 2004 GSF was adapted and piloted for use in care homes, and a new GSF in Care Homes Training Programme was developed, with a more structured curriculum, training programme and formalised accreditation process. A national phased programme with up to 10 project bases a year has now involved almost 1000 care homes (nursing and residential homes) in the UK, with about 3-400 a year currently in training and 100 a year being accredited. Evaluations have shown improved quality of care provided, improved staff confidence, improved processes/documentation, plus a significant decrease in crisis hospital admissions (about a third) and decrease in hospital deaths (almost half). |
| 3. Other End of Life Care Areas and Tools |
| The principles of GSF have been adapted for various settings but retain common features, to ease cross-boundary communication, as patients move from one setting to another. Since 2006 there have been adaptations for children, new programmes in Acute Hospitals, with further programmes for Prisons, Community Hospitals and other areas in development. The ‘toolkit’ of resources and tools has also developed to, plan ahead, audit provision etc. There are now specific training programmes include means to better identify patients nearing the end of life, assess their needs for GSF Care Homes and GSF Primary Care, with GSF in Acute Hospitals and Prisons in development. |
GSF is endorsed or recommended as best practice by: - The Department of Health End of Life Care Strategy (July 08)
- The Department of Health End of Life Care Quality Markers (July 09)
- The NHS End of Life Care Programme (since 05)
- The Royal College of General Practitioners (since 07)
- The White Paper ‘Our Health our Care Our Say’ (Jan 07)
- NICE Guidance for Supportive and Palliative Care (2004 )
- The House of Commons Health Select Committee Report (July 04)
- The Labour & Conservative Party Manifestos (April 05)
- Macmillan Cancer Support (2002-4)
- The National Council for Palliative Care (since 2003)
- Mentioned in many National Service Frameworks – eg for CHD and Renal
