Background The Local Enhanced Service agreement (LES) for End Of Life (EOL) care was started by Worcestershire Primary Care Trust in 2009, and is now in its 3rd year, with the aim of developing good practice and improving EOL care in Worcestershire. GPs have been asked to sign up to and fully adopt the Gold Standards Framework (GSF), including collating a palliative care register, use anticipatory prescribing, use the Liverpool Care Pathway for all dying patients, apply the GSF surprise question to all care home residents. All GPs in participating practices were expected to complete 2 h-long learning modules, and each practice had to nominate a lead GP to attend a 1 day study day each year.

Outcomes IT software from MSDi installed on all GP surgeries to collect data. Practices were offered 50 pence per patient on the practice list. 60 out of 68 GP practices signed up for the first 2 years, and 339 GPs completed education modules. The number of people on the palliative care register increased from 500 in 2006/7 to 1983 in 2010/11. The proportion of deaths in acute hospital has reduced from 45.4% in 2007/8 to 42.0% in 2010/11. 27% of patients on the palliative care register who died at home or in a community hospital were placed on the LCP.

Conclusion Already data shows that a patient on a palliative care register is more likely to die at home than someone not on such a register, and we have achieved a 3.4% reduction in the proportion of deaths happening in the acute trust since 2007/08, which equates to a 5% reduction in the numbers of people dying in the acute.