Spread and Sustainability

The Gold Standards Framework is now extensively used across the UK, embedded as mainstream within primary care and endorsed by all major policy groups, including The National Institute of Clinical Excellence, the Royal College of General Practitioners and Royal College of Nursing. The Department of Health’s End of Life Care Strategy recommends GSF as the key tool to improve coordination within primary care. We have come a long way since GSF started from within general practice in England in 2000 - many thousands of patients and their carers have benefited from receiving more coordinated care enabling them to die at home if preferred. But even greater challenges await us as we move on to the GSF Next Stage.

Spread

Independent surveys of GP practices in England now show:

• over 90% have a palliative care register and a planning meeting (Foundation Level GSF)
• over 60% have adopted deeper levels of GSF
• 10-15% have fully integrated GSF into standard practice

The central GSF team is working on spread of GSF in acute hospitals, community hospitals and prisons and promoting better cross boundary working. We are keen to work with commissioners and facilitators to further spread good practice across primary care and care homes. Use of GSF is also spreading internationally.

To enable effective spread and implementation of the framework, a GSF support programme has been running since 2001. This has moved onto the next level with the launch of Next Stage GSF - Going for Gold June 2009. Support available from the National GSF Centre includes:

• Updated website and quarterly newsletters
• GSF Helpdesk for all enquiries
• Facilitator training workshops, support and mentoring
• New Toolkits, factsheets and resources available on this website
• Sharing of good practice, new ideas and development
• Commissioners full Quality Improvement Support Package
• Training programmes for primary care and care homes

The central GSF team is a small group of highly committed clinicians who are happy to discuss your local challenges and share good practice. Do not hesitate to contact us for a discussion.

The GSF Programme has largely functioned on a 'cascade' principle of enabling and supporting local people to facilitate GSF in their own area, giving it local flavour, relevance and ownership. GSF has been adopted and adapted in very rural and very urban areas alike, with varying circumstances and degrees of specialist palliative care provision. The National GSF team works mainly with the PCT, PBC group, commissioners or local GSF Facilitators.

GSF sustainability is ensured by the fact that it is now embedded at many levels:

Nationally

• DH End of Life Care Strategy (2008) and its associated Quality Markers and Measures (June 2009)
• Quality Outcome Framework (further developments expected with move to NICE)

Strategic Health Authority / Network initiatives

• Monitoring End of Life Care Plans includes GSF implementation across PCTs

Local Initiatives

• Many Locally Enhanced Services include GSF or its principles. See examples in commissioning and strategy section.
• Many facilitators are reporting on local GSF implementation and continued progress to the PCT Professional Executive Committee
• PCT Clinical Governance teams have developed local audits in relation to the implementation of GSF

Audit

• The GSF 'After Death Analysis' (ADA) tool supports organisations with ongoing audit to benchmark care and monitor progress in relation to GSF and quality markers of end of life care. This ADA tool is currently being used both in care homes and in general practices. If you are interested in using the ADA tool locally or participating in a pilot in a new setting please contact the National GSF Centre. (15 PCTs have used ADA during 2009 in their practices, over 600 care homes have used ADA to date).