Background The key challenge for most developed countries is meeting the needs of our ageing population, in particular, those nearing the end of their lives – population-based end-of-life care. Building on a public health approach to meet needs of an area-wide population, and a practical approach of enabling generalist frontline staff care for all people in a variety of settings using the GSF Quality Improvement Programmes, we describe progress in a few GSF Cross-Boundary Care Foundation Sites taking a population-based view to meet the challenges of the ageing population.

Aims Taking a whole-system view, we explore ways to ensure all people receive quality care towards the final stages of life in line with their needs and wishes in a way that is cost-effective, responsive and compassionate. Expanding concepts of palliative/end-of-life care to include care for people with long-term conditions, dementia, and frailty.

Methods We describe practical progress in a number of GSF XBC Sites, enabling generalist frontline staff including:

• Identifying and prioritising people earlier

• Reducing ‘diagnostic apartheid’

• Enabling more to live well and die well in the place and manner of their choosing

• Encouraging integrated person-centred care, reducing inappropriate over-Hospitalisation and prevention of over – medicalising.

Results Use of GSF in various settings to enable generalist frontline staff is described, with key outcome measures and evaluations in the UK, and internationally.

Conclusion As the population ages, population-based end of life care will be one of the most significant developments to meet the challenges for a fit-for-purpose health service of the future.