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20  Protocol to evaluate the implementation of the royal college of general practitioners and Marie Curie daffodil standards in UK general practice
  1. Stephanie Sivell1,
  2. Delyth Price2,
  3. Mirella Longo1,
  4. Andrew Holness3,
  5. Sarah Holmes4,
  6. Catherine Millington-Sanders5,
  7. Giles Skerry4 and
  8. Andrew Carson-Stevens2
  1. 1Marie Curie Palliative Care Research Centre, Division of Population Medicine, Cardiff University School of Medicine
  2. 2PRIME Centre Wales, Cardiff University
  3. 3Patient and People’s Voice Partner (Somerset, Wiltshire, Avon and Gloucestershire Cancer Alliance); Lived Experience Member (Brain Tumour and Palliative and End of Life Care), NHS England Personalised Care Strategic Co-Production Group
  4. 4Marie Curie
  5. 5Royal College of General Practitioners


Introduction General Practitioners (GPs) provide a key role to facilitate end-of-life care. However, variable provision of palliative care in primary care settings may lead to both inequitable or suboptimal care. The Royal College of General Practitioners and Marie Curie launched the ‘GP Daffodil Standards for Advanced Serious Illness and End of Life Care’ in 2019 to improve and sustain practices delivering high-quality palliative and end-of-life care; we were commissioned to undertake an independent evaluation of the Standards.

Aims To evaluate the implementation of the Daffodil Standards in general practice, and how they sustained or improved end-of-life care activities;

To identify factors and processes which could lead to wider implementation of the Daffodil Standards.

Methods A multi-method study comprising three phases, underpinned by the Normalisation Process Theory:

Phase 1: online survey for UK GP practices (n=200 sample) to map end-of-life activities and levels of implementation of the Standards.

Phase 2: semi-structured interviews with a sub-sample of survey respondents (n=20–26) to refine and provide further information from the survey.

Phase 3: case studies (n=6–8), informed by Phases 1 and 2, to capture learning and identify exemplars of best practice to inform wider implementation of the Standards.

Results The study has commenced, running from 2022 to 2024. We will share lessons learnt from implementing our protocol, and reflect on any required adaptations, within a community context. We will actively involve and engage with our research partner and Service Users for Primary and Emergency care Research (SUPER) group (PRIME Centre Wales).

Conclusions We anticipate the learning will contribute a greater understanding of key enablers and barriers to implementing the Standards, capture lessons learnt, and build an evidence-base to encourage wider implementation across the UK.

Impact To improve care for those affected by serious illness and end-of-life care with realistic and practical support for primary care teams.


  1. Royal College of General Practitioners (2021). The Daffodil Standards. 10th October 2022.

  2. Marie Curie (2022). Daffodil Standards for GPs. 10th October 2022.

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