How ADA Relates To National End Of Life Targets

Quality targets and goals

How GSF & ADA can help PCTs achieve targets

1. Department of Health End of Life Care Strategy

The DH has specified that PCTs, working with local authorities, will wish to “ensure that general practices have systems in place to identify, assess and plan for the care of people approaching the end of life. The GSF is an example of such a system.” (4.25)

Also, “PCTs, working with local authorities, will wish to give high priority to development of the local workforce through initiatives such as GSF, PPC and LCP and ensure that differing funding processes are not a barrier to integrated workforce developments.”(6.56)

• The GSF Primary Care programme will support you with a systematic approach to the care for people nearing the end of life in the commmunity.
• Principles of GSF are used in all settings as suggested in the EOLC Strategy. The specific GSF Care Homes Training programme now in its fifth year, enables best implementation of GSF in care homes, plus accreditation.
• ADA helps to assess the effectiveness of primary care systems in your PCT, and will enable you to adopt the best approach in future to secure the most significant improvements in care. The ADA analysis benchmarks against national figures, will indicate areas for improvement and make constructive suggestions, acting as an improvement tool. ADA is the only such national audit tool of its kind. We are committed to further developing ADA and will continue to make it accessible and easier for busy clinicians and administrators to use.

Evidence for progress against many can be attained using GSF and its tools including the ADA audit tool ie

Part 1. PCTS, 1.8-1.16

Part 2. Primary care 2.1-2.11 - all can be attained through GSF and mentioned as best practice in many

Part 5. Care Homes - 5.1-5.12 all can be attained using GSF Care Homes#

Part 8. Community nursing 8.4-8.6,

Part 10. Out of Hours 10.2 and 10.5

plus involvement in other areas

• GSF Primary Care and ADA are recommended best practice examples that support several markers
• By doing the GSF Care Homes Programme all care homes markers are attained 5.1-5.12
• ADA is the only recommended audit tool fit for purpose to monitor effectiveness and progress in primary care and care homes for your PCT. ADA indicates areas for improvement and makes suggestions for improvement.
• Other tools include Prognostic Indicator Guidance (PIG) to support identification, Advance Care Planning.
• Community nurses are key to spread of GSF in primary care and new targets for them will be easily achieveable by those using GSF.
• Working with Out of hours is integral to GSF Prim care

Palliative care prevelance (measure 53) and percentage home deaths (measure 54)

• ADA and PIG can help you lnow how many appropriate patients are identified, and ADA can provide data on the percentage of home deaths, at individual patient level . ADA examines preferred place of care and actual place of death, and reasons for admission to hospital to identify opportunities for improvement.
• Implementing anticipatory care suggestions through the effective introduction of elements of GSF in primary care and the GSF Care Home Training Programme will contribute to increasing the percentageof patients dying in their place of choice.

4. Addressing Practice Based Commissioning concerns

Unscheduled care and avoidable admissions for potential cost savings

• A key feature of GSF is pre-planning of care, and reducing avoidable admissions in the final months of life. ADA can provide information on these issues and explore measures to improve cost effectiveness.
• This helps PBC groups to consider the most appropriate local courses of action.
• Use of GSF Care Homes programme reduces crisis admissions and hospital deaths by about half and a third respectively. (see Clifford 2007, Hockley 2008)

Patient choice, quality of care, care homes, locality registers and so on, according to your own Baseline Review

• Accordiing to your local areas eg GSF Prognostic Indicators Guide for early identification, advanced care planning, the GSF Care Homes Training Programme etc