Implementation and impact of the Gold Standards Framework in community palliative care: a qualitative study of three primary care trusts

Abstract

The Gold Standards Framework (GSF) has been widely adopted within UK general practices, yet there is little understanding of its impact on the provision of community palliative care services. This study presents data on the anticipation and adoption of the GSF within three Primary Care Trusts in North West England. Forty-seven interviews were conducted with generalist and specialist palliative and primary care professionals. Important aspects of the GSF identified were the patient register, communication and out-of-hours protocols. Positive benefits to professionals included improved communication between professionals and appropriate anticipatory prescribing. Negative aspects included increased nursing workload and the possibility of fewer or later visits for patients. Many respondents believed that the GSF needed local champions to be sustainable. Slow or incomplete adoption was reported. The GSF was recognised as important because it facilitated changes to previously difficult aspects of work between professionals, but few respondents reported direct benefits to patient care.

Identifying patients with chronic conditions in need of palliative care in the general population: development of the NECPAL tool and preliminary prevalence rates in Catalonia

“…The qualitative study showed that the use of the NECPAL tool has a considerable impact on the perceptions, and eventually in clinical practice, of primary care professionals, as has been observed in other experiences 31. The identification of patients, and their high prevalence in the community, produces a ‘sharp awareness’ in primary care professionals, and leads to identifying an unexpected level of needs even in the absence of demands (the ‘surprised team’).…”

Systematic review of the effectiveness, barriers and facilitators to general practitioner engagement with specialist secondary services in integrated palliative care

“…Communication is required,26 28 providing an equitable status, or an equal respect and authority between all participants. Communication builds partnerships.…”

‘Best practice’ in developing and evaluating palliative and end-of-life care services: A meta-synthesis of research methods for the MORECare project

“…Services are delivered in primary, secondary and tertiary health-care and social care settings, 4 by both specialists in PC (for whom this forms the majority of their work) and generalists (where this is part of their work). 4,13,14 There is a long and growing commentary on the requirement for evidence and the difficulties in attaining. 9,[15][16][17][18][19][20] Trials of models of service provision in particular are few in number and often beset by specific challenges, 4,19 notably accrual, attrition, contamination of exposure and selection of adequate outcome measures.…”