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P-38 ‘Going for gold’ – achieving top quality end of life care in GP practices and mainstreaming advance care planning (ACP) discussions – findings from the first GP practices to be GSF accredited
  1. Keri Thomas and
  2. Wilson J Armstrong
  1. National GSF Centre for End of Life Care, West Midlands, UK


Background Patients prefer Advance Care Planning discussions with their GPs above other health-workers. Most UK GP practices use Foundation Level GSF i.e., have a Palliative Care Register and meetings, but only 25% were included on the register and formalised ACP uptake use was low (NPCA 2010). Recent English government policy of the Avoiding Unplanned Admissions DES and systematic ‘Care Planning’ was commendable in intention, but results were variable/poor.

Aim To discuss recent policy changes (DES AUA) and CQC regulation compared with experiences from GSF Accredited practices, seeking guidance as to successful implementation of best practice.

Methods Mixed method evaluations include Key Outcomes Ratios, After Death Analysis audits, etc., and accreditation portfolios. Comparative benchmarked analysis with annual follow up to assess sustainability. This is compared with feedback from non-GSF practices.

Results Significant improvements were made by the first 10 GSF accredited practices (see data and graphs) in earlier recognition of patients for the register, non-cancer and care home patients, prediction of the 2% patients for the DES Register, increase in uptake of ACP and DNAR discussions, development of practice protocol for sustainability and other benefits following the GSF Going for Gold training and accreditation.

Discussion By earlier identification, use of registers and routinely offering ACP discussions, more patients were enabled to communicate their views and preferences and reduce hospitalisation.

Conclusion The systemisation of end-of-life care through GSF accreditation helped successful policy implementation in accredited practices. Lessons learnt for further successful policy implementation and CQC regulation are discussed.

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