GSF Primary Care 'Going for Gold' Training Programme

Description & background - Next Stage GSF Primary Care Going for Gold’

The new GSF Quality Improvement Training Programme, building on QOF Foundation Level GSF to support the NHS End of Life Care Strategy and ‘Find the 1% campaign’

The Gold Standards Framework (GSF) for Primary Care is a well-used evidence based systematic approach to improving the quality and organisation of care for all people nearing the end of life. 

Although over 95% of UK GP practices adopt the basic principles of GSF at Foundation Level to meet their QOF targets, there is evidence that most are not using it to its full potential to help deliver best possible care for all appropriate patients in the final year of life. With the developments in  policy in End of Life Care, growing use of GSF in care homes and other settings, more Locality Registers and the QIPP ‘Find the 1% campaign’, there is a need to build on the good work of many practices even further; not just Foundation Level GSF, but to ‘go for gold’. As we face increasing numbers of deaths from 2012, more with long-term conditions and radical demographic changes, there has never been a more important time to improve the primary care provision of end of life care for all patients.

Programme - The GSF ‘Going for Gold’ Primary Care Training Programme

GSF aims to help you improve the:

  • Quality of care provided in alignment with preferences
  • Coordination of care and collaboration within and between teams
  • Cost effectiveness by reducing hospitalisation

It helps you do this by improving earlier identification of people nearing the end of life, having and recording those crucial conversations or ‘Advance Care Planning discussions’, and enabling better coordination and team working; leading to top quality care in alignment with the wishes of patients and their families.

The ‘Going for Gold’ GSF Training Programme is designed to give a new impetus to delivering high quality end of life care in primary care. It helps attain local and national policy targets, including NICE Standards, encourages cross-boundary working, and helps reduce avoidable hospitalisation leading to cost savings. There are four one-hour lunchtime sessions required as a team, with introduction and follow up, plus homework in between.

There are 3 learning outcomes for each session, linked to the NICE/Quality Markers, with practical illustrations and exercises to help self-reflection and action planning. This is via DVD Distance Leaning or on the GSF Virtual Learning Zone.

    

Meeting targets & Quality Markers

The programme helps you meet your DH Quality Markers, QIPP targets, EOLC NICE standards, and many local CQUIN targets and other local targets.

How and where training is delivered

The training is delivered within the practice using the resources either in hard copy, DVD or on the GSF Virtual Learning Zone. The filmed sessions include activities for the team to stop and interact, planning their own development at their own pace.

There is an option of GSF in a day launch workshop. This is a good way to launch GSF and is a very popular full or half day crash workshop, led by the GSF Central Team, covering the key elements of the programme. This is an enjoyable interactive way to convey the key messages and enables teams to return to their practices informed and ready to get going.

Programme length

The comprehensive programme includes everything required to run the training in your practice covering 6 sessions over about 6 months.

Benefits and outcomes

  • Improved delivery of high quality patient care aligned to patient choices
  • More dying in preferred place - more home deaths, fewer in hospital
  • Improved cost effectiveness by reducing hospital admissions and bed days
  • Improved identification, co-ordination and earlier planning of care
  • More patients with advance care planning discussions
  • Workload- practice teams working ‘smarter’, life easier and more satisfying
  • Increased staff confidence and team-working with evidence of progress proved delivery of high quality
  • CME points applied for through RCGP

Examples of best practice - what can be achieved by Practices

1. Ten GP practices undertaking Going for Gold and GSF Accreditation have shown:

  • Trebling of numbers of patients on Palliative Care / GSF Register (range 32%-69%)
  • Trebling of non-cancer and care homes patients on Palliative Care Register (13%-44%, 15%-44% resp.)
  • Quadrupling numbers  with recorded ACP, DNAR  etc. (15-62%,14-60%)
  • Increasing numbers dying in usual place of residence (38-50%)
  • Carers assessment and bereavement protocols increased  several fold (3%-60%,  23%-82% resp.)
  • Development of practice protocols to enable sustained long term  quality improvement  in all

               2. Thirteen Lancaster GP practices undertaking Going for Gold showed a:

  • Doubling of patients on Palliative Care Register
  • Trebling of non-cancer patients on Palliative Care Register
  • Doubling those with recorded preferred place of care and other benefits

Support provided

When a group of practices is commissioned full support from the GSF Central Team is provided to the local facilitator with:

  • Optional conference calls
  • DVD and workbook or Virtual Learning Zone package
  • GSF IT to help identify the 1% of the practice population
  • GSF Resources including proactive identification guidance (PIG), needs support matrices (NSM) and other clinical assessment tools are all included in the various programmes

Resources included in the standard package are...

  • DVD with workshop sessions
  • Good Practice Guide
  • Personalised Workbook with action plans
  • Palliative Care Guidance Book

Evaluation

Baseline and follow up Key Ratios, ADA Audits and Staff Confidence Surveys to demonstrate change.

The GSF Quality Recognition and Accreditation process assesses the impact of this training on practice activity and outputs with a well-established quality assurance process. 

Accreditation

The successful practices have:

Undertaken the full GSFPC ‘Going for Gold’ Training programme as a team over 6-12 months. Progressed to accreditation; which includes summary of key ratios, portfolio with inclusion of a practice protocol for sustainability, 10 further ADA audits and assessment by conference call or visit. Results are collated and are presented to a panel consisting of GPs and nurses.

The practices receive a full report following Accreditation, with cumulated ratios, and noting areas of excellence and areas requiring further improvement. They are presented with the GSF Quality Hallmark Award, endorsed by RCGP, which lasts for 3 years with annual appraisals of the key ratios.

The results have demonstrated really significant changes with earlier identification of patients, improved teamwork and collaboration with care home, and development of an effective, equitable means to identify, assess and plan coordinated care for patients in the final year of life and their carers.

 

Updated:  6/2/17