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1Z01. Terminal illness - late stage
2JE.. Last days of life
8BA2. Terminal care
8BAP. Specialist palliative care
8BAS. Specialist palliative care treatment - daycare
8BAT. Specialist palliative care treatment - outpatient
8BAe. Anticipatory palliative care
8BJ1. Palliative treatment
8CM1. On gold standards palliative care framework
8CM10 GSF supportive care stage 1 - advancing disease
8CM11 GSF supportive care stage 2 - increasing decline
8CM12 GSF supportv care stge 3 - last days: cat C - wks prognosis
8CM13 GSF supportv care stge 3 - last days: cat D - days prognosis
8CM14 Gold standards framework supportive care stage 3 - last days: category B - months prognosis
8CM16 GSF prognostic indicator stage B (green) - months prognosis
8CM17 GSF prognostic indicator stage C (yellow) - weeks prognosis
8CM18 GSF prognostic indicator stage D (red) - days prognosis
8CM4. Liverpool care pathway for the dying
8CME : Has end of life advanced care plan
8H6A. Refer to terminal care consult
8H7L. Refer for terminal care
8H7g. Referral to palliative care service
8HH7. Referred to community specialist palliative care team
8IEE. Referral to community palliative care team declined
9EB5. DS 1500 Disability living allowance (terminal care) completed
9Ng7 : On end of life care register
ZV57C [V]Palliative care
8CMQ. On Liverpool care pathway for the dying
9NgD. Under care of palliative care service
9G8.. Ambulance service notified of patient on EoL care register
9c0P. Current palliative oncology treatment
9c0N. Current supportive care for terminal illness
8CMW3 End of life care pathway
9K9.. Palliative care handover form completed
9367. Patient held palliative care record
9c0L0 Planned palliative oncology treatment
9c0M. Planned supportive care for terminal illness
9NNd. Under care of palliative care specialist nurse
8CMb. Integrated care priorities for end of life
8B2a. Prescription of palliative care anticipatory medication
9NNf0 Under care of palliative care physician
38QH. Palliative Care Outcomes Collaboration Assessment Toolkit
38QK. Palliative Care Problem Severity Score
8CMg. End of life advance care plan (v30)
Palliative care is the active total care of patients with life-limiting disease and their families by a multi-professional team. The first National End of Life Care (EOLC) Strategy was published in July 2008. It builds on work such as the NHS cancer plan 2000, NICE guidance 2004, NHS EOLC programme 2005.
The way primary care teams provide palliative care in the last months of life has changed and developed extensively in recent years with:
The National EoLC Strategy suggests that all contractors adopt a systematic approach to EoLC and work to develop measures and markers of good care. They recommend the Gold Standards Framework (GSF) and the associated After Death Analysis (ADA) as examples of good practice. Evidence suggests that over 60 per cent of practices across the UK now use GSF to some degree to improve provision of palliative care by their primary care team.
The introduction of Gold Standard Framework (GSF) to primary care and its associated audit tool, the ADA are associated with a considerable degree of research and evaluation. GSF provides ideas and tools that help practices to focus on implementing high quality patient centred care.
About 1% of the population in the UK die each year (over half a million), an average of 20 deaths per GP per year. A quarter of all deaths are due to cancer, a third from organ failure, a third from frailty or dementia, and only one twelfth of patients have a sudden death. It should be possible therefore to predict the majority of deaths, however, this is difficult, with errors occurring, 30 per cent of the time. Two thirds of errors are based on over optimism and one third on over pessimism. However the considerable benefits of identifying these patients include providing the best health and social care to both patients and families and avoiding crises, by prioritising them and anticipating need.
Identifying patients in need of palliative care, assessing their needs and preferences and proactively planning their care, are the key steps in the provision of high quality care at the end of life in general practice. Therefore this QOF indicator set is focused on the maintenance of a register, (identifying the patients) and on regular multidisciplinary meetings where the team can ensure that all aspects of a patient’s care have been assessed and future care can be co-ordinated and planned proactively.
A patient is included on the register if any of the following apply:
1. Their death in the next 12 months can be reasonably predicted (rather than trying to predict, clinicians often find it easier to ask themselves ‘the surprise question’ – ‘Would I be surprised if this patient were still alive in 12 months?’).
2. They have advanced or irreversible disease and clinical indicators of progressive deterioration and thereby a need for palliative care e.g. they have 1 core and 1 disease specific indicator in accordance with the GSF Prognostic Indicators Guidance (see QOF section of GSF website. www.goldstandardsframework.nhs.uk)
3. They are entitled to a DS 1500 form. (The DS 1500 form is designed to speed up the payment of financial benefits and can be issued when a patient is considered to be approaching the terminal stage of their illness. For these purposes, a patient is considered as terminally ill if they are suffering from a progressive disease and are not expected to live longer than six months.)
The register applies to all patients fulfilling the criteria regardless of age or diagnosis. The creation of a register will not in itself improve care but it enables the wider practice team to provide more appropriate and patient focussed care.
See indicator wording for requirement criteria.
In the rare case of a nil register at year end, if a contractor can demonstrate that it established and maintained a register in the financial year then they will be eligible for payment.
Prepared By Jean Keenan