Primary Care Training Programme

“This Going for Gold programme had a transformational effect on the practice, including for non-clinical staff”
-Practice Manager, after GSF going for Gold 

1. First Stage GSF in Primary Care

Since 2004, GSF principles at Awareness or Foundation Level have been mainstreamed into general practice in the UK supported by the NHS End of life Care Programme through the QOF processes, with 95% GP practices now having a palliative care/GSF register and regular meetings to discuss these patients. We are the only country in the world to do this, it has helped many thousands of patients receive better care and it is a great start……….but there’s more to do.

“I’ve been here for 15 years, and seen a number of my patients through to the end of their life. It is a humbling and incredibly rewarding experience and is also one of the most important aspects of care that we provide as GPs. We are passionate about providing the best care we can for our patients, particularly in the final months of their life. Ensuring our patients have a ‘good’ death is really important to their families.GSF has really helped us to have a good structure in place and given everyone in the practice the confidence to initiate what can be difficult conversations with people about where and how they want to be cared for and that means everyone feels more in control.”

-Dr Sally Giovanelli, Macklin Street Surgery

2. Next Stage GSF in Primary Care - 'Going for Gold'

Over a decade on from this, now is the time to build on this good practice in the UK to consider all people in the practice population in the final years of life (about 1%) and further integrating other improvements in end of life care into mainstream practice as part of the Going for Gold GSF programme. This includes earlier identification of people with non-cancer conditions and from care homes (use of early alerting, coding, E-PIG, etc), better sharing of information (through locality registers), better communication with patients and families (through advance care planning discussions), better cross-boundary care to reduce excessive time in hospital and help people live well and die well where they choose.

“GSF has become part of the fabric of improving end of life care in this country and has made a real difference for thousands of patients and their families. But there is still a way to go, and I welcome this new drive towards greater and deeper use of GSF, and renewed efforts towards excellence in the Going for Gold programme”

- Prof Sir Mike Richards DH National Director End of Life Care 2009

**The GSF Centre has been working with national policy leads & CQC to help improve end of life care delivered by GP practices. Now GSF can help you develop and provide evidence of good practice in End of Life Care to support you in your CQC practice Inspections **

Please see -  GSF & CQC Information sheet

The new Next Stage GSF Quality Improvement Training Programme is called Going for Gold and  builds on QOF Foundation Level GSF to support the NHS End of Life Care Strategy (2008).

Why do it?

GSF is the leading quality improvement programme for GP practices, building on GSF at QOF level, leading to next stage Going for Gold programme. This leads to significant improvements and coordination of care. Practices who attain enhanced level then progress to GSGF Accreditation and the Quality Hallmark Award for end of life care -endorsed by the Royal College of GPs.

"We have reduced by 50% hospital admissions for this patient group, and with the help of GSF are providing better, cheaper care for our patients and their carers. As a family doctor whose job it is to see people through to the end and it is much more satisfying to care for your patients in a calm, planned way.”

-Dr Helena Rolfe, Ilkley Moor Medical Practice

How to do it? 

Practice based learning programmes – 6 one-hour modules over 6 months, plus the popular ‘GSF-in-a-day’ workshops. Individual practice or in groups.  Full resources with everything you need to do this plus evaluation and support.

What GSF improves? 

Earlier recognition of patients, better coordinated care in line with patients’ wishes, reduced  hospitalisation, more living and dying where they choose.

"We only have one chance to get it right. With an ageing population, this is becoming an increasingly important part of our work as GPs and so we have to ensure consistency and equality.The GSF programme has helped us change the culture of the practice. Now, with better planning, communication and coordination, we have increased the number of people dying in their preferred place and significantly improved the support we provide their carers.”

 - Dr Ian Livingstone, Saltaire Medical Practice

Examples of best practice - what can be achieved by practices

GP practices undertaking Going for Gold showed ...

  • Trebling of numbers of patients on Palliative Care Register (range 32-69%)
  • Trebling of non-cancer patients on Palliative Care Register (13-44%)
  • 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 (3-60%, 9-68%)

For more details see our Accredited GP Practices flyer

Poster summary of programme - click to access PDF

“(Doing Going for Gold) has been very worthwhile, it’s been a cultural shift for us, we are much more proactive. It would be hard to go back now – we’ve changed the culture of how we practice and I think ……. when we look back on the way we practiced before, it seems very old fashioned and unsatisfactory”

- Dr Karen Chumley GSF Accredited practice Essex 2012 – now recruiting 42 further Essex practices.

Next Steps

“GSF presents the vision but also the practical tools and resources to make it happen. Doing ‘GSF Going for Gold’ with our practices has been transformational - it really works.  It's like the difference between the Premier League and League Division Three”

Dr Peter Nightingale, GP Facilitator and RCGP End of Life Care Lead 


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