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Improving Palliative Care within Primary Care using the Gold Standards Framework - a Quality Improvement Project

Background and Objectives

An ageing worldwide population means there are increasing numbers of people with chronic illness in need of palliative care. Improvement and equity of palliative care provision is a national priority in the UK.  Evidence of inadequacies in palliative care provision within Your Health Partnership primary care network led to the development of this quality improvement project (QIP).

 

The overall aim of the QIP was to improve palliative care for patients in the last year of life utilising the Gold Standards Framework by increasing identification of patients, education of staff, improving proactive monitoring and improved communication with community teams.

Method

The Model for Improvement was chosen as the QI methodology. Fishbone and driver diagrams were used to identify the problems and establish ideas for change. PDSA cycles were carried to achieve three main outcomes: Increasing identification of patients, improvements in proactive care, improvement in communication.

Results

Identification of patients improved with the size of the register almost doubling and evidence of this being sustained change. There was improved multidisciplinary working and communication but there was less evidence of improvement in proactive care. Some changes, such as increased numbers of expected deaths, may not yet be evident because of the limited timeframe of the project.

Conclusion

The GSF contributes to supporting GPS in improving palliative care provision however further research is needed to support identification of patients with non-malignant disease. Effective proactive care of patients in modern general practice is likely to require integrated and collaborative working with the wider MDT and non-nhs agencies.

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