Background It is known that shared advance care plans (ACPs) increase preferred place of care achievement and reduce emergency hospital attendances (The Gold Standards Framework. Attainments of the first 10 GSF accredited GP practices). There is little information regarding the quality of ACPs (including Treatment Escalation Plans, TEPs) and their effect on patient outcomes. This was confirmed by a literature search. There are known barriers in creating them (Jones, Dale, MacArtney. BJGP Open. 2023 Jun 27;7(2):BJGPO.2022.0159; Roberts, Joyce, Greig, et al.Healthc Q. 2023;26(3):43–52).

Aim To audit the quality of ReSPECT forms and compare outcomes for the patient and their family.

Method Practices in two Primary Care Networks in Mid-Nottinghamshire were invited to allow access to records of patients who died within six months. Their SystmOne records were audited remotely, using a template spreadsheet to record GSF coding, EPaCCS use, support offered and outcomes. A locally developed scoring system assessed ReSPECT quality. Families were invited to consent to debrief-type telephone interview. An anonymised report was shared in a practice team debrief.

Results 50% of practices engaged (6/12). 60 records were audited. Lack of capacity/head space were reasons for declining. Ten family members opted in to interviews. Training practices were more likely to offer ACP and registrars to follow up patients. Higher GP:patient ratio and continuity of care resulted in better support and ACP quality. Community nurses achieved the highest quality ACP, followed by GP registrars. The highest quality TEPs were generated by registrars and specialist palliative care nurses. Hospital forms were either not accessible or of low quality. Clinicians indicated increased motivation to engage with ReSPECT if it improved outcomes for patients. Families wanted active inclusion to encourage their loved one to express their wishes.

Conclusions There was a clear relationship between people having a ReSPECT form, achieving their preferences and reporting positively about their support. This increased further with high quality forms, particularly the TEP. Findings will be used in future training and strategy.