Background It can often be difficult for audit to make a sustained difference to clinical practice across and between organisations. The Merseyside and Cheshire Palliative Care Network Group was initially formed in 1995 and consists of individuals involved in specialist palliative care across the network who are based in community, hospice and hospital settings. The strength of the group lies in the multi disciplinary representation and the on-going enthusiasm of the various teams to participate in the projects. Method There are bi-monthly audit meetings with five audits and one planning session each year. The audits are a combination of new audits, regional audits (which look at previously audited topics) and non symptom control subjects. Results Each meeting attracts approximately 60 healthcare professionals plus an external expert. The presentation includes a literature review, audit results and a discussion around standards and guidelines. Regional audits complete the cycle by assessing group performance against previously developed standards. Dissemination is achieved at national and international level. Every 3 years, the guidelines are collated into a book which is part of the core formulary for the Network. It is now in the 4th edition and contains 43 different topics. Each chapter is referenced with levels of evidence and grades of recommendation. Conclusion The book acts as a resource for professionals and is applicable to those caring for cancer patients and other forms of advanced disease. It encourages the setting and monitoring of standards in palliative care and through the audit programme promotes clinical excellence in end of life care.