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P-231 The quality improvement methodology used to create Daffodil Standards- to improve end-of-life care
  1. Catherine Millington-Sanders1,
  2. Eve Barnes2 and
  3. Julie Pearce3
  1. 1Royal College of General Practitioners, London, UK
  2. 2Great Western Hospitals NHS Foundation Trust, Swindon, UK
  3. 3Marie Curie, London, UK


Background Most palliative care is provided by GPs and wider palliative care and community services (Mitchell, Loew, Millington-Sanders, et al., 2016). The Daffodil Standards (DS) were created in order to provide a free, accessible, evidence-based support around end-of-life care (see: This work presents the quality improvement (QI) methodology used to establish an ongoing, national level process that helps engage practices in working to improve end-of-life care through QI and reflective practices.


  • Supporting GP practices and Primary Care Networks, to provide high quality end-of-life care across their populations.

  • Offering a structured approach - minimising variation in end-of-life care experienced.

  • Supporting GP teams - learning and development.

  • Improving equity.

  • Connecting GP care within compassionate community development (see:

Methods The QI methodology of Diagnose, Plan and Test, Implement and Embed, Sustain and Spread (NHS England, 2019) has been employed to evidence, establish and continually improve the Daffodil Standards.

Results The process:


  • Review of learning from policy and research for gaps.

  • Review of GP QI programmes/curriculum for scale service improvements to support general practice.

  • Triangulation matrix between end-of-life care ‘Ambitions’, I-statements, GP qualitative research and feedback.

Plan and Test

  • Development of draft DS headings.

  • Consultation with end-of-life care partners.

  • Reviewed from 9 to 8 core DS based on feedback.

  • Organisational sign-off.

Implement and Embed

  • Launch February 2019.

  • Connected with England end-of-life care QOF 19/20.

Sustain and Spread (including developments)

  • COVID-19 learning.

  • Development of Older People’s Care Home Standard.

  • End-of-life care GP lead review from each nation to make more devolved nation accessible.

  • Refresh of the Daffodil Standards.

  • RCGP end-of-life care suite of webinars 2021.

  • Planned evaluation 2021/22.

Conclusions This review of processes demonstrates how QI methodologies can be used on a national level to support clinical care and deliver improved end-of-life care in the community.

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