Abstract

The end of life strategy (2008) has set key recommendations as to what constitutes high quality care at end of life. In light of this ground-breaking document, and following on from the Keep Improving the Experience (KITE, 2006–2009 used as an alternative to Gold Standards Framework) project across SoTW, a new set of eight standards for supportive and palliative care were developed locally. An initial qualitative baseline pilot was carried out across SOTW examining the workability of these standards, followed by a project with a single practice based commissioning group to further test their feasibility and to demonstrate the value of the standards in primary care. Initial phase workshops were followed by in-depth, practice-based sessions which afforded individualised and focused support for participating practices. Key areas of improvement were:

• Identifying patients in the last 6 to 12 months of life

• Managing palliative care registers

• Managing multidisciplinary team meetings

• Proactively planning palliative care

• Communication and co-ordination of care.

Practices worked to uplift from their baseline assessment by demonstrating progression with supporting evidence to achieve accredited status. The results have been encouraging although it is not possible to fully evaluate the impact of the Standards in terms of clinical outcomes as this data is not yet available (eg, quality outcomes framework). However, qualitative feedback from practices who achieved accreditation is overwhelmingly positive. In particular the one-to-one support was highly valued and the standards themselves have attracted positive feedback, in both this project and the pilot. The authors believe that it is this combined approach which is of most benefit in primary care. The evidence suggests that it is a workable model for other clinical commissioning groups to adopt. Furthermore, practices previously KITE-accredited have consistently demonstrated continued improvement over several years, indicating that the model is also sustainable.